SURGICAL INSTRUMENT

Abstract

A surgical instrument for minimally-invasive arthroscopic use in a constrained joint space, including a handle assembly, a shaft assembly including a shaft having a longitudinal shaft axis and a lumen therethrough and connected to handle assembly at proximal end of shaft and an operative portion including a working tip with a tool mounted thereon at distal end of shaft. Operative portion is selectively moveable between a first configuration substantially aligned with longitudinal shaft axis, and a second, deployed, configuration in which at least part of operative portion has a selectable working direction defined by the angle between tool and longitudinal shaft axis and a selectable lateral displacement defined by the linear distance between working tip and longitudinal shaft axis, measured at a central location point at which tool is mounted and perpendicular to longitudinal shaft axis, the working direction and lateral displacement being selectable independently of one another.

Claims

1. A surgical instrument for minimally-invasive arthroscopic use in a constrained joint space, the surgical instrument comprising: a handle assembly; a shaft assembly including: a shaft having a longitudinal shaft axis and a lumen therethrough and being connected to the handle assembly at a proximal end of the shaft; and an operative portion including a working tip with a tool mounted thereon at a distal end of the shaft, wherein, in use, the operative portion is selectively moveable between a first configuration in which the operative portion is substantially aligned with the longitudinal shaft axis, and a second, deployed, configuration in which at least part of the operative portion has: a selectable working direction defined by an angle between the tool and the longitudinal shaft axis; and a selectable lateral displacement defined by a linear distance between the working tip and the longitudinal shaft axis, measured at a central location point at which the tool is mounted thereon and perpendicular to the longitudinal shaft axis, the working direction and lateral displacement being selectable independently of one another.

2. The surgical instrument of claim 1, wherein the operative portion includes an articulation segment which is said working tip or is intermediate said working tip and said shaft, the articulation segment having actuation means capable of moving the operative portion between the first configuration and the deployed configuration.

3. The surgical instrument of claim 2, wherein the actuation means comprises one or more rods, cables, pneumatic or hydraulic means located within the shaft lumen and actuatable via said handle.

4. The surgical instrument of claim 3, wherein the actuation means comprises an actuation rod.

5. The surgical instrument of claim 4, wherein the actuation means includes a rod link at a distal end of and pivotable with respect to said actuation rod.

6. The surgical instrument of claim 5, wherein said actuation rod has a radially extending formation or rod link end at or near a proximal end thereof, the formation being axially fixed with respect to a rod link end housing and axially moveable therewith so as to operate said articulating element.

7. The surgical instrument of claim 6, further comprising a locator tube which is selectively axially translatable along the longitudinal shaft axis, the locator tube being capable of moving the rod link end housing axially.

8. The surgical instrument of claim 7, wherein the locator tube is selectively axially translatable along the longitudinal shaft axis by virtue of a screw thread at one end thereof.

9. The surgical instrument of claim 8, wherein the locator tube screw thread engages a screw thread on a rotatable position selector, wherein rotation of the rotatable position selector causes the axial translation of the locator tube.

10. The surgical instrument of claim 1, further comprising locking means which, in said deployed configuration, lock the operative portion in the deployed configuration with respect to the shaft in order that a working load can be applied in the working direction.

11. The surgical instrument of claim 10, wherein said working load is in the range 3N to 10N.

12. The surgical instrument of claim 2, wherein the lateral displacement is selectable by selecting an angle of articulation of the articulation segment with respect to the longitudinal shaft axis.

13. The surgical instrument of claim 1, wherein the working direction is selectable by selecting the angle at which the tool is mounted on the working tip.

14. The surgical instrument of claim 1, wherein the working direction is selectable by adjusting the angle at which the tool is mounted on the working tip.

15. The surgical instrument of claim 1, wherein the shaft assembly is removable and replaceable via the proximal end of the handle assembly.

16. The surgical instrument of claim 15, further comprising locator means for recording positional information relating to the shaft assembly so that said shaft assembly or another shaft assembly can be replaced in a repeatable position after removal from the handle assembly.

17. The surgical instrument of claim 16, wherein the locator means comprises a locator tube whose axial position remains unchanged while the shaft assembly is being removed and replaced.

18. The surgical instrument of claim 1, wherein the constrained joint space is a hip joint space.

19. The surgical instrument of claim 1, wherein the tool is moveable in a closed loop path with respect to the central location point fixed with respect to the shaft.

20. The surgical instrument of claim 19, wherein said central location point is on an axis aligned with said working direction.

21. The surgical instrument of claim 1, wherein said tool comprises a cutting element capable of producing a cut surface at said target region, the cut surface having one or more selectable characteristics including one or more of size, depth, orientation, shape and surface topography.

22. The surgical instrument of claim 21, wherein the cutting element is a blade, a laser cutter, ultrasonic cutter or a fluid jet cutter.

23. The surgical instrument of claim 21, wherein the cutting element is moveable in a closed loop path with respect to a central location point fixed with respect to the shaft, so as to make a perimeter cut along said closed loop path at said target region.

24. The surgical instrument of claim 23, wherein the cutting element is capable of cutting to remove material from an area within said perimeter cut.

25-51. (canceled)

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0074] Embodiments of the invention are herein, by way of example only, with reference to the accompanying drawings, in which:

[0075] FIG. 1 (PRIOR ART) is a schematic representation of an arthroscopic procedure on a knee joint;

[0076] FIG. 2 is a schematic representation of a hip joint showing a surgical instrument approaching along an access direction;

[0077] FIG. 3 is a schematic representation of a hip joint showing two target regions, each having a working direction;

[0078] FIG. 4A is a schematic representation of a lesion requiring treatment;

[0079] FIG. 4B shows the lesion after preparation of its wall edge;

[0080] FIG. 4C shows the lesion after filling with a regenerative medicine product;

[0081] FIGS. 5 and 6 (PRIOR ART) are reproduced from US2010280526 and have been annotated to illustrate the working direction and lateral displacement of this prior art instrument. Reference numerals in these figures relate to features of US2010280526;

[0082] FIGS. 7A and 7B show the distal end of a surgical instrument in the first and the second, deployed, configurations respectively;

[0083] FIG. 7C is a side view of the surgical instrument of FIG. 7B, partly in section;

[0084] FIG. 8 indicates how the cutting element can make a perimeter cut by moving in a closed loop path indicated by the arrows;

[0085] FIGS. 9A and 9B show the distal end of a surgical instrument in the first and the second, deployed, configurations respectively, having a different working tip to that of FIGS. 7A and 7B;

[0086] FIGS. 10A-10D show the distal end of a surgical instrument in the deployed configuration, having a cutting tool which can be independently articulated;

[0087] FIG. 11 indicates how the cutting element can remove material from an area within the perimeter cut;

[0088] FIG. 12A is a side view of a surgical instrument in the second configuration in which the operative portion is orientated so as to be capable of operating on a target region in a working direction;

[0089] FIG. 12B indicates how the delivery means can deliver implantable material to a target region;

[0090] FIGS. 13A-13H show different embodiments of the surgical instrument, having different tools at the operative portion;

[0091] FIG. 14 is a cross-sectional view of an embodiment of the instrument with the distal end at the left of the Figure, the operative portion being in the first, undeployed position;

[0092] FIG. 15 shows the instrument of FIG. 14 in the second, deployed, position;

[0093] FIG. 16 shows the instrument of FIG. 14 with the shaft assembly temporarily removed;

[0094] FIG. 17 shows the instrument of FIG. 14 with the shaft assembly replaced with one having a different working tip and a different working direction;

[0095] FIG. 18 is a perspective view of another handle assembly;

[0096] FIG. 19A is a perspective view of another handle assembly;

[0097] FIG. 19B is a perspective view of a shaft assembly;

[0098] FIG. 20 is a side view of a handle assembly and shaft assembly assembled together and mounted on a table clamp;

[0099] FIG. 21 shows how the instrument is used to access a lesion site in the hip joint;

[0100] FIG. 22 shows a surgical table arm clamp with adjustable instrument support;

[0101] FIG. 23 shows a reservoir for implantable material, connectable to delivery means;

[0102] FIG. 24 shows a cartridge with end caps in place;

[0103] FIG. 25 shows the cartridge of FIG. 24 with the end caps removed;

[0104] FIG. 26 shows how a cartridge can be loaded into the surgical instrument; and

[0105] FIG. 27 shows how two cartridges can be loaded into the surgical instrument.

DETAILED DESCRIPTION

[0106] In the present disclosure, the following terms may be understood with reference to the following:

[0107] The term target region may refer to a surgical site on which it is desired to operate;

[0108] The term access direction may refer to a direction in which a surgical tool approaches a target region;

[0109] The term working direction may refer to a direction in which a surgical tool operates on a target region, for example by applying a working load in the working direction. The working direction may be the angular deviation of the working tip (see below) from the access direction or from the longitudinal axis of the shaft;

[0110] The term constrained joint space may refer to a joint space in which the axes of the access direction and the working direction are not always collinear for every given target region;

[0111] The term proximal end may refer to the end of the instrument furthest from the target region, in use;

[0112] The term distal end may refer to the end of the instrument nearest to the target region, in use;

[0113] The term working tip may refer to a tool, end effector or other component at the distal end of the instrument, the working tip being used to operate on the target region. A non-exhaustive list of example working tips includes: perimeter cutters having a single blade, perimeter cutters having a circular blade, scrapers, burr removers, ablation tools including RF or acoustics (e.g. ultrasound), water jets, lasers, any combination of the above;

[0114] The term operative portion may refer to a distal portion of the instrument including at least one articulating portion and the working tip;

[0115] The term lateral displacement of the working tip may refer to the linear distance of the working tip from the access direction or from the longitudinal axis of the shaft, measured at a central location point at which the tool is mounted thereon and perpendicular to the longitudinal shaft axis;

[0116] The term central location point may refer to the point at which the tool is mounted on the working tip. The central location point may be located on the distal end of the working tip (in the case of an end-mounted tool an example of which is in FIG. 13A) or on a side surface near the distal end of the working tip (in the case of a side-mounted tool an example of which is in FIG. 13B).

[0117] As described above, arthroscopic procedures for constrained joint spaces, such as the hip, are difficult using known techniques because of the difficulty in accessing the lesion to be treated.

[0118] FIG. 2 shows a hip joint including an acetabulum 25 and femoral head 26. A surgical instrument 30 approaches the joint along an access direction AD. Lesions 27 to be treated are shown in FIG. 3. Each lesion 27 needs to be treated along a working direction WD. It can be seen that neither of the working directions WD indicated in FIG. 3 are collinear with the access direction of FIG. 2, there being no line of sight between the possible access directions and the required working directions. This is a problem addressed by embodiments of the claimed invention, as will be described in further detail below.

[0119] The aim of the arthroscopic procedure is illustrated in general terms in FIGS. 4A-4C. FIG. 4A shows a typical cartilage lesion whose edges 28 are frayed and uneven in terms of profile, mechanical and surface quality. The cartilage in the region of the lesion edge 28 will be degenerate and represents an unsuitable region around which to base a repair. This degenerate region may extend some distance (typically mm) away from the lesion edge 28, thus, if the repair is to be based around entirely undamaged tissue then the damaged region needs to be removed, despite the likelihood that it may appear healthy.

[0120] FIG. 4B shows the lesion 27 after the lesion edge or wall 28 has been prepared. Degenerate cartilage has been removed to leave a prepared wall 28 whose surface quality and geometry should optimise integration with a Regenerative Medicine Product (RMP). FIG. 4C shows the lesion 27 after delivery of the RMP 29.

[0121] The claimed invention can equally be used to treat lesions on the acetabulum, the femoral head or in any other constrained joint spaces such as the shoulder or ankle. In a constrained joint space, it is highly unlikely that the working direction will be collinear with the access direction. The claimed invention can also be used to treat lesions where there is a direct line of sight between access direction and target region such that the working direction is collinear with the access direction (for example in a knee joint).

[0122] FIGS. 5 and 6 (PRIOR ART) are reproduced from US2010280526. The working direction is the angular deviation of the working tip from the longitudinal axis of the shaft, this being selectable by the surgeon. Two different working directions are indicated in FIGS. 5 and 6, indicated as angles and respectively.

[0123] The lateral displacement of the working tip is the linear displacement of the working tip from the longitudinal axis of the shaft, this being dependent upon the selected working direction. The lateral displacement is indicated in FIGS. 5 and 6 by letters y and x respectively.

[0124] In the prior art, the working direction and lateral displacement are dependent upon one another. Therefore, for a working direction of , the only possible lateral displacement is x. Similarly, for a lateral displacement of y, the only possible working direction is .

[0125] The claimed invention improves the functionality of the instrument by permitting the working direction and lateral displacement to be selectable independently of one another, thus allowing the surgeon much greater freedom to select the optimum lateral displacement for any given working direction and vice versa.

[0126] The surgical instrument 30 according to an embodiment of the invention comprises two assemblies: a handle assembly and a shaft assembly. FIGS. 7A and 7B show the distal end of the shaft assembly which includes a shaft 31 having a longitudinal shaft axis L and an operative portion 32. The shaft axis L is alignable with an access direction AD along which a target region of a joint (not illustrated) can be accessed, in use. In use, the shaft assembly is inserted into the handle assembly in a manner that will be described in more detail later.

[0127] At the distal end of the shaft is the operative portion 32 which, as shown in FIG. 87, is aligned with the longitudinal axis L of the instrument (and hence with the access direction AD).

[0128] The operative portion 32 includes at least one articulation segment 33 and a working tip 34. In some embodiments, the working tip and articulation segment are separate segments which articulate with respect to one another. However, it is possible for the articulation segment and the working tip to be fixed with respect to one another (e.g. as a unitary segment), so long as the operative portion as a whole can articulate with respect to the shaft. In the embodiment shown in FIG. 7A, the working tip includes a tool in the form of a cutting element 35 for preparing (by cutting) the target region. Other working tips and tools will be described below which have different functions, for example the delivery of RMP to the target region.

[0129] The operative portion 32 is selectively moveable between a first configuration shown in FIG. 7A and a second, deployed, configuration shown in FIG. 7B. Movement between the two configurations is by means of the articulation segment 33. More than one articulation segment may be present. The articulation segment 33 is caused to pivot with respect to the distal end of the shaft by means of, for example, a rod contained within the lumen of the shaft which is moveable axially by an actuator located at the proximal end of the shaft. In the aligned configuration, shown generally in FIG. 7A, it is preferable that none of the surgical instrument 30 is outside the maximum cross section of the shaft 31. That is, the operative portion 32, including the at least one articulation segment 33, the working tip 34 and the cutting element 35 (or indeed any other tool) do not extend beyond the widest point of the shaft 31.

[0130] In the deployed configuration shown in FIG. 7B, the operative portion 32 is no longer aligned with the longitudinal axis L of the instrument. A working direction WD has a direct line of sight to the target region and is the direction in which the tool acts upon the target region. The working direction is defined by the angle of articulation .sub.1 with respect to the access direction and the longitudinal axis L which could, potentially, be zero (if both access and working directions are aligned). The lateral displacement z of the working tip is the linear displacement of the working tip 34 from the longitudinal axis L of the shaft. The working direction and the lateral displacement are independently selectable by the surgeon.

[0131] Locking means (not shown in FIG. 7B) may be used to lock the operative portion 32 in the deployed configuration with respect to the shaft 31 sufficiently firmly to handle a typical working load applied in the working direction when cutting at the target region. Alternatively, no locking means may be required, as is the case in one of the embodiments described in further detail below.

[0132] The cutting element 35 is moveable in a closed loop path centred on the central location point 36 so as to describe a circle around the location point 36. Example drive means 80 are indicated in FIG. 7C. As shown schematically in FIG. 8, the cutting element 35 is used to make a perimeter cut at the target region (in this case on the femoral head).

[0133] One way in which the working direction may be selectable independent of the lateral displacement is by removing the shaft assembly from the handle assembly and replacing with another shaft assembly that has a different working tip. This requires the presence of locator means for recording positional information relating to the shaft assembly so that said shaft assembly can be replaced in a repeatable position after removal from the handle assembly (for example using the embodiment illustrated in FIGS. 14-17). FIGS. 9A and 9B show a shaft 31 having a working tip 34 which the cutting element 35 mounted on a differently-angled face (as compared with that of FIGS. 7A and 7B. This results in a different working direction, defined by angle 2, for the same lateral displacement z.

[0134] Another way in which the working direction may be selectable independent of the lateral displacement is shown in FIGS. 10A-10D in which, for a given lateral displacement z, the working direction can be varied by independently articulating the working tip 34 and/or the cutting element 35 mounted thereon. In this way, a range of working directions WD.sub.1, WD.sub.2, WD.sub.3 are available.

[0135] The cutting element 35 at the working tip is replaceable with other tools according to need. The diameter of the circle and hence the size of the perimeter cut is determined by the size of the cutting element 35 and is selected to cut well outside the lesion edges. A range of sizes of cutting element 35 would be available to the surgeon. The peripheral cutting element 35 can be replaced by an alternative type of cutting element 38 which has an abrading function shown in FIG. 11. This cutting element 38 is used to remove material from the area within the perimeter cut.

[0136] The cutting element described above is a blade, but other types of cutting element e.g. laser cutters or fluid jet cutters could equally be used. After the cutting is complete, the lesion wall has been prepared as previously shown in FIG. 4B.

[0137] FIGS. 12A and 12B show a surgical instrument 30 in which the working tip comprises a nozzle 40 for the delivery of implantable material, such as RMP, to the target region. As before, the operative portion of the instrument is selectively moveable between a first configuration wherein the operative portion is aligned with the longitudinal shaft axis and a second, deployed, configuration (FIG. 12A). FIG. 12B shows the nozzle delivering RMP to a prepared target region on the femoral head 26.

[0138] The implantable material may be, but is not limited to being regenerative medicine product (RMP). The implantable material may be a powder, an injectable liquid, a morcellated solid, a gel, or any combination thereof, for example.

[0139] FIGS. 13A-13H show a selection of exemplary working tips that can be used in the claimed invention. These are:

[0140] FIG. 13A: a tripod for locating the centrepoint of the target region, mounted on the end of the working tip;

[0141] FIG. 13B: a tripod for locating the centrepoint of the target region, mounted on the side of the working tip;

[0142] FIG. 13C: cutting element for making a perimeter cut, mounted on the end of the working tip;

[0143] FIG. 13D: cutting element for making a perimeter cut, mounted on the side of the working tip;

[0144] FIG. 13E: cutting element for removing material from within the perimeter cut, mounted on the end of the working tip;

[0145] FIG. 13F: cutting element for removing material from within the perimeter cut, mounted on the side of the working tip;

[0146] FIG. 13G: delivery means for delivering implantable material to the target region, mounted on the end of the working tip; and

[0147] FIG. 13H: delivery means for delivering implantable material to the target region, mounted on the side of the working tip.

[0148] An embodiment of the instrument 30 will now be described in more detail in relation to FIGS. 14-17. FIGS. 14-17 show the instrument with its distal end at the left of the Figures and its proximal end at the right of the Figures.

[0149] FIG. 14 shows the instrument 30 in its first, non-deployed, position. The instrument comprises a housing assembly 50 and a shaft assembly including an elongate shaft 31 having a longitudinal axis and lumen 37 therethrough. An elongate actuation rod 59 is located in the lumen 37, the rod 59 serving as actuation means for the working tip 34. A pivotable distal rod link 39 connects the distal end of the rod 59 to the working tip 34. In this embodiment, there is only one articulating segment, this being the working tip 34 itself. A cutting element 35 is mounted on the working tip 34.

[0150] At or near the proximal end of the rod 59 is a rod link end 59a comprising a lug, boss, pin, or other formation extending radially from the rod 59. The rod link end 59a is captured within and is axially fixed with respect to a generally cylindrical rod link end housing 52. The rod link end housing 52 is located within a loading funnel 55 and is able to move axially with respect to the funnel 55. The funnel is provided with two orthogonally placed lugs 55a or other formations which engage with an interior surface of the housing 51 in order to lock the funnel 55 axially in the housing 51.

[0151] The rod link end housing 52 is moveable axially because of its engagement with an axially moveable locator tube 58. The engagement may be by virtue of a screw-thread (not illustrated), or other engagement means. The locator tube 58 is axially translatable along the longitudinal axis of the shaft. In the illustrated embodiment, the axial translation is possible because the locator tube 58 has an internal screw thread 58a at the distal end thereof. The internal screw thread 58a engages with an external screw thread 57a on the proximal end of a working tip position selector 57.

[0152] The working tip position selector 57 is rotatable about the longitudinal axis by the surgeon when the instrument is in use. Referring now to FIG. 15, rotation of the position selector 57, which is axially locked with respect to the housing 51, causes the locator tube 58 to travel axially in a proximal direction as indicated by the arrow in FIG. 15. The locator tube is rotationally locked with respect to the housing 51 by radial lugs or other formations 58b. These lugs 58b also serve as an axial endstop for the locator tube 58 as it reaches the distal end of the loading funnel 55, as shown in FIG. 15.

[0153] As the locator rod 58 moves axially, it brings with it the rod link end housing 52 and therefore the rod link end 59a and rod 59. Axial movement of the rod 59 in the proximal direction pulls the distal rod link 39 in order to effect articulation of the working tip 34 to a deployed position shown in FIG. 15 having a desired lateral displacement z and working direction WD.

[0154] Rotation of the position selector 57 in the opposite direction causes the locator tube 58 to travel in a distal direction, moving the rod 59 in a distal direction back towards the position shown in FIG. 14. Further rotation of the position selector 57 causes the rod link 39 to pivot downwardly (not illustrated) offering further range of movement of the working tip to select a desired lateral displacement. The position selector 57 itself may serve as an endstop for axial movement of the locator tube 58 in the distal direction, when it reaches the distal end of screw thread 57a.

[0155] When the desired lateral displacement and working direction are obtained, the cutting element 35 can be actuated by the surgeon operating a working tip actuator dial 81 at the proximal end of the instrument. The actuator dial 81 operates drive means 80 (not shown) which are in communication with the cutting element via the lumen 37 of the shaft 31. Additional locking means (not shown) could be provided to hold the selected lateral displacement and working direction against the working load, although additional locking means are generally not necessary as the pitch of the screw threads 57a, 58a is narrow enough to prevent undesired relative movement thereof.

[0156] When it is desired to provide a different working tip, in order to provide a different tool or a different working direction, the working tip actuator dial 81 can be removed so that the entire shaft assembly can be removed via the proximal end of the handle assembly 50. This condition is illustrated in FIG. 16. Whilst the shaft assembly is removed, the relative axial positions of the position selector 57, locator tube 58 and loading funnel 55 are retained and unchanged. Therefore, when the same or another shaft assembly is loaded into the handle assembly, as in FIG. 17, the rod link end housing 52 thereof abuts the unmoved locator tube 58, allowing the previous positioning of the shaft assembly to be restored. FIG. 17 shows the condition in which the working direction WD is different compared with FIG. 15 because of the differently-angled working tip 34 that has been selected. The lateral displacement z may also be different compared with FIG. 15.

[0157] Alternative embodiments of the housing are shown in FIGS. 18-22. In FIGS. 18 and 19, the handle assembly 50 comprises a housing 51 having a pistol-type grip 56 and a trigger-type actuator 82. An axially-extending shaft locator 53 is a cylindrical tube of greater diameter than the shaft 31 and through which the shaft can be inserted via a loading funnel 55 located at the rear of the housing 51. A portal bridge 54 is provided which, in use, mates with an arthroscopy portal. This ensures that the instrument 30 is firmly seated against the portal and provides further stability during operation. The housing assembly can be clamped to an operating table clamp 60 or the like.

[0158] The shaft 31 and its associated operative portion 32 (in the first, undeployed, configuration) is insertable into the housing assembly via loading funnel 55. A drive dial (working tip position selector) 57 locates against the proximal end of the housing when the shaft assembly is fully inserted. Typically the first-selected operative portion is a tripod of the type shown in FIG. 13A or 13B which can be used to pinpoint the centre of the target region.

[0159] The shaft assembly advances towards the target region along an access direction. As the operative portion approaches the target region, the surgeon actuates the instrument to move the operative portion into the deployed position so that the operative portion is now aligned with a suitable working direction for the target region concerned. As shown in FIG. 20, the surgeon can adjust the position of the whole surgical instrument by moving the adjustable arm clamp 61 and/or table clamp 60 until the desired position of the operative portion at the target region (which may not have a direct line of sight with the access direction) is reached. Then the clamps are tightened so that the position of the handle assembly is fixed with respect to the operating table and the patient.

[0160] Once the handle assembly position is fixed, the whole shaft assembly including the operative portion can be removed from the target region by withdrawing it through the handle assembly, exiting through the loading funnel 55.

[0161] The first shaft assembly can then be switched for a second shaft assembly having a cutting element at its working tip. Other than the different working tip, the dimensions of the second shaft assembly are the same as those of the first shaft assembly, in particular the length of the shaft assembly along its longitudinal axis is the same. Therefore, when the second shaft assembly is inserted into the housing assembly, the operative portion of the second shaft assembly will arrive at the same, defined, position at the target region that is desired. The interaction between the drive dial 57 and the loading funnel 55 and the interaction between the shaft locator 53 and the shaft 31 serve as locator means for recording positional information relating to the shaft assembly so that it can be repeatably removed and replaced in the housing assembly.

[0162] The second shaft assembly includes cutting element of the type shown in FIG. 13C or 13F which can make a perimeter cut at the target region.

[0163] Next, with the handle assembly still clamped in place, the second shaft assembly can be removed and replaced with a third shaft assembly, this time having a cutting element of the type shown in FIG. 13E or FIG. 13F which can remove material from an area within the perimeter cut. The target region is now prepared to receive implantable material such as RMP.

[0164] Next, with the handle assembly still clamped in place, the third shaft assembly can be removed and replaced with a fourth shaft assembly, this time having delivery means of the type shown in FIG. 13G or 13H. This shaft assembly can deliver RMP to the target region. Still further shaft assemblies may be used after, for example having a wiper tool which can wipe excess RMP from the target region and/or to compress the RMP within the target region. A separate compressor tool may be used before or after the wiper tool to compress the RMP within the target region. A curing tool which can cure implantable material delivered to the target region may be used after delivery of the RMP to the target region. In every case, the positioning of the operative portion of the shaft assembly is accurately repeatable in view of the positional information recorded by the locator means components.

[0165] In a further embodiment illustrated in FIG. 22, the positional information could be recorded by an adjustable instrument support 62 attached to an adjustable arm clamp 61. The position of the instrument support 62 can be set up by adjusting in any of the directions indicated by arrows in FIG. 22 and then locked in place with respect to the arm clamp 61. The handle assembly can optionally be clamped to the instrument support 62. Then the shaft assembly and/or entire surgical instrument 30 (i.e. handle assembly and shaft assembly) can be removed and repeatably replaced.

[0166] Exemplary details of the delivery of RMP to the target region will now be described with reference to FIGS. 12A-12B and 23-27.

[0167] The nozzle 40 of the delivery means is connected to a reservoir 70 containing implantable material, e.g. RMP by means of a tube 71 which passes through the lumen of the shaft 31. The reservoir 70 is typically located within the handle assembly but could possibly be located within the lumen of the shaft 31 itself or located near the distal end of the shaft.

[0168] The reservoir 70 is similar to the barrel of a typical syringe and includes a plunger 72 which, when moved axially into the chamber of the reservoir, causes a piston 73 to expel RMP from the reservoir through an outlet 74. The chamber may have more than one compartment, separated by a frangible membrane so that different components of medicament can be stored separately and then mixed shortly before, or upon delivery.

[0169] The reservoir 70 may form part of a medicament cartridge (illustrated in FIGS. 24 and 5) which is supplied as shown in FIG. 24, having end caps 75, 76 to seal the RMP within the reservoir. The cartridge may be single-use or refillable and one or more cartridges can be loaded into the handle assembly via the loading funnel 55 as shown in FIGS. 26 and 27.

[0170] Throughout the description and claims of this specification, the words comprise and contain and variations of them mean including but not limited to, and they are not intended to (and do not) exclude other moieties, additives, components, integers or steps. Throughout the description and claims of this specification, the singular encompasses the plural unless the context otherwise requires. In particular, where the indefinite article is used, the specification is to be understood as contemplating plurality as well as singularity, unless the context requires otherwise.

[0171] Features, integers, characteristics, compounds, chemical moieties or groups described in conjunction with a particular aspect, embodiment or example of the invention are to be understood to be applicable to any other aspect, embodiment or example described herein unless incompatible therewith. All of the features disclosed in this specification (including any accompanying claims, abstract and drawings), and/or all of the steps of any method or process so disclosed, may be combined in any combination, except combinations where at least some of such features and/or steps are mutually exclusive. The invention is not restricted to the details of any foregoing embodiments. The invention extends to any novel one, or any novel combination, of the features disclosed in this specification (including any accompanying claims, abstract and drawings), or to any novel one, or any novel combination, of the steps of any method or process so disclosed.

[0172] The reader's attention is directed to all papers and documents which are filed concurrently with or previous to this specification in connection with this application and which are open to public inspection with this specification, and the contents of all such papers and documents are incorporated herein by reference.

REFERENCE NUMERALS

Prior Art

[0173] 2 arthroscope [0174] 4 skin [0175] 6 ligaments [0176] 8 patella [0177] 100 knee [0178] 10 target region [0179] 12 femoral condyles [0180] 14 femur [0181] 16 axis of access direction [0182] 18 tibia [0183] 20 fibula [0184] 22 tibial plateau [0185] working direction in prior art [0186] working direction in prior art

Distal End/Working Tip Structure

[0187] 25 acetabulum [0188] 26 femoral head [0189] 27 lesions [0190] 28 edges of lesion [0191] 28 prepared lesion edge or wall [0192] 29 RMP [0193] 30 surgical instrument [0194] 31 shaft [0195] L longitudinal shaft axis [0196] 32 operative portion [0197] 33 articulation segment [0198] 34, 34, 34 working tips [0199] 35 cutting element [0200] 36 central location point [0201] 37 lumen [0202] 38 alternative abrading cutting element [0203] 40 nozzle [0204] AD access direction [0205] WD working direction

Proximal End/Working Tip Positioning

[0206] 50 handle assembly [0207] 51 housing [0208] 52 rod link end housing [0209] 53 shaft locatorfront housing/cannula [0210] 54 portal bridgefront housing/cannula [0211] 55 loading funnel [0212] 55a loading funnel lugs [0213] 56 pistol grip [0214] 57 working tip position selector [0215] 57a position selector screw thread [0216] 58 locator tube [0217] 58a locator tube distal screw thread [0218] 58b locator tube lugs [0219] 59 actuation rod [0220] 59a proximal rod link end [0221] 39 distal rod link [0222] 60 operating table clamp [0223] 61 adjustable arm clamp [0224] 62 instrument support

Working Tip Actuation

[0225] 80 drive means [0226] 81 drive dial/working tip actuator [0227] 82 trigger-type actuator

Delivery of RMP

[0228] 70 reservoir [0229] 72 plunger [0230] 73 piston [0231] 74 outlet [0232] 75,76 end caps