A system including a bone punch tool and a needle guide. The bone punch tool can include a support arm having a support arm proximal portion and a support arm distal portion, a pivot arm having a pivot arm proximal portion and a pivot arm distal portion, and an arcuate punch configured to punch through bone. The pivot arm distal portion can be pivotably coupled to the support arm distal portion, such that the pivot arm proximal portion is configured to be moved away from the support arm proximal portion to extend the arcuate punch into a punch position to punch an arcuate hole through bone. The needle guide can be configured to guide a needle through the arcuate hole.

An articulating surgical implement (1) comprising: an elongate body (2) having a proximal end (4) and a distal end (5) and a longitudinal axis (6); a grip (7) on the proximal end for holding the surgical implement; a surgical implement head (8) formed on the distal end of the elongate body, and having surgical implement jaws (10, 11), the surgical implement head having a first joint (13) It that allows the surgical implement jaws to move relative to each other to open and close for gripping or cutting; a second joint (12) on the distal end of the elongate body for changing the angle of the surgical implement head relative to the longitudinal axis of the elongate body; a mechanism comprising a control lever (35), a control rod (39) and a linkage arm (40) for changing the angle of the surgical implement head relative to the longitudinal axis of the elongate body through an angular range of movement by pivoting about an axis of rotation of the second joint; and a mechanism comprising a pulley wheel (50) and a push/pull wire (51) for opening and closing the surgical implement jaws. The surgical implement head may be a rongeur and is operable at 90 degrees to the elongate body in either an upbite or downbite position. It has an angular range of movement of 180 degrees. A desired angle of the surgical implement head is selected by a user, for example for tissue removal from a target site.

A surgical instrument (1) comprises at least three individual components (2,3,4,5,6) arranged movably relative to one another. Each of the individual components (2,3,4,5,6) is directly and movably connected to at least one further one of the individual components (2,3,4,5,6). All of the constituent parts of the surgical instrument (1) are made of a metallic or metal-containing material. Each individual component (2,3,4,5,6) has at least one friction surface region (9,10) which forms a pair of friction surfaces with at least one friction surface region (9,10) of another individual component (2,3,4,5,6). At least one of the two friction surface regions (9,10) of each pair of friction surfaces has a hard-material surface layer (16).

An arthroscopic cutting probe includes an elongated shaft assembly having a distal end, a proximal end, and a longitudinal axis therebetween. A working end at the distal end of the elongated shaft assembly includes a first active electrode and a second active electrode The shaft assembly is rotates the first electrode relative to the second electrode about the longitudinal axis, and a return electrode is carried on the shaft assembly proximal of the working end. The first and second active electrodes are electrically coupled to each other and electrically isolated from the return electrode.

A system including a bone punch tool and a needle guide. The bone punch tool can include a support arm having a support arm proximal portion and a support arm distal portion, a pivot arm having a pivot arm proximal portion and a pivot arm distal portion, and an arcuate punch configured to punch through bone. The pivot arm distal portion can be pivotably coupled to the support arm distal portion, such that the pivot arm proximal portion is configured to be moved away from the support arm proximal portion to extend the arcuate punch into a punch position to punch an arcuate hole through bone. The needle guide can be configured to guide a needle through the arcuate hole.

An instrumentation set for preparing a proximal tibia during a bi-cruciate retaining procedure can include a tibial resection block and a stylus. The tibial resection block can be configured to be fixed to an anterior portion of the proximal tibia. The tibial resection block can define a slot that extends in a medial-lateral direction when the tibial resection block is fixed to the proximal tibia. The stylus can have a first block attachment feature and a second block attachment feature. The first block attachment feature can be offset from the stylus a first distance. The second block attachment feature can be offset from the stylus a second distance. The first and second block attachment features of the stylus can be selectively and alternatively received by the slot of the tibial resection block to position the stylus at distinct offset locations relative to the slot.

Improved spinal instruments are provided. In particular, the present application relates to an improved rongeur that allows for multiple bites of bone to be performed in a patient before removing the rongeur from the patient. The rongeur includes a lower shaft and an upper shaft slidable relative to the lower shaft. The lower shaft and upper shaft form a jaw mechanism that can take multiple bites of bone, which can be deposited in a storage cavity formed in the upper shaft. To assist in removing the bone from within the storage cavity, an internal plunger mechanism can be provided that is actuated by a finger hold. In addition, at least portions of the upper shaft are detachable from the lower shaft such that the upper shaft can be thoroughly cleaned and re-used if desired.

Methods and devices are disclosed for inhibiting proximal junctional failure in a patient having posterior spinal instrumentation. One or more tension bands can be threaded through transverse bores in a spinous process of a vertebral body of a spine, superior and adjacent an uppermost instrumented vertebral body. Tension is applied to bias the spinous processes together and also in an inferior direction. The tension band is locked with respect to the spine, to maintain tension.

A system including a bone punch tool and a needle guide. The bone punch tool can include a support arm having a support arm proximal portion and a support arm distal portion, a pivot arm having a pivot arm proximal portion and a pivot arm distal portion, and an arcuate punch configured to punch through bone. The pivot arm distal portion can be pivotably coupled to the support arm distal portion, such that the pivot arm proximal portion is configured to be moved away from the support arm proximal portion to extend the arcuate punch into a punch position to punch an arcuate hole through bone. The needle guide can be configured to guide a needle through the arcuate hole.

An ultrasonic surgical system is disclosed comprising a surgical instrument and a wrench assembly. The surgical instrument comprises a handle assembly and a body member pivotably coupled to the handle assembly. The handle assembly comprises a first finger grip, an ultrasonic blade, and a waveguide extending proximally from the ultrasonic blade. The body member comprises a second finger grip, a clamp arm movable relative to the ultrasonic blade to capture tissue therebetween, a first body surface defined on a first side of the body member, and a second body surface defined on a second side of the body member. The wrench assembly comprises a wrench and an adapter operably coupled to the wrench. The adapter comprises a first wrench surface configured to engage the first body surface and a second wrench surface configured to engage the second body surface.