Mechanically expandable arthroscopic retractors

• US 5,454,365 A
• Filed: 08/27/1993
• Issued: 10/03/1995
• Est. Priority Date: 11/05/1990
• Status: Expired due to Term

• Current Assignee: Apogee Medical Products, Inc., digEcor Incorporated (Burrana, Inc.), The Bonutti 2003 Trust A
• Original Assignee: Apogee Medical Products, Inc.
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Thaler, Michael H.
• Application Number:
  US08/112,884
• Time in Patent Office: 767 Days
• Field of Search: 606/198, 606/192, 606/63, 606/90, 606/200, 604/105-109, 128/20
• US Class Current: 600/204
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/320036 adapted for use within the carpal tunnel
• CPC Class Codes: A61B 17/320725 with radially expandable cutting or abrading elements A61B17/32075 takes precedence
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 2017/00535 pneumatically or hydraulically operated A61B2017/22051, A61B2090/401 take precedence
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/00986 Malecots, e.g. slotted tubes, of which the distal end is pulled to deflect side struts
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/320048 Balloon dissectors
• CPC Class Codes: A61B 2017/3484 Anchoring means, e.g. spreading-out umbrella-like structure
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61M 2025/006 having a special surface topography or special surface properties, e.g. roughened or knurled surface
• CPC Class Codes: A61M 25/1002 characterised by balloon shape A61M25/1006, A61M25/1009 take precedence

Abstract

A mechanically expandable retractor for use in arthroscopic surgery. The retractor has an expanding portion at its distal end for expanding against sub-surface tissues when the retractor is in use. The expanding portion includes a plurality of radially expanding The radially outermost surface of each arm when expanded is longitudinally disposed approximately at the distal end of the retractor. The expanding arms can be disposed irregularly circumferentially around the retractor to expand the tissues to provide a working space between adjacent arms. The retractor is inserted through a small percutaneous opening, expanded in sub-surface tissues without significantly damaging the tissue, then collapsed after use for removal. The retractor has a projecting portion at a proximal end of the retractor for manipulating the retractor, to allow the surgeon to push or pull or lever on tissue.

The retractor can be hollow like a cannula to permit the passage of surgical instruments through the retractor, with a side portal into the passage. Alternatively, the retractor can be solid or needle-like. The retractor can include an expandable bladder which can circumscribe the expandable portion of the retractor or be placed elsewhere.

Claims

1. A retractor for forming a space at a location in body tissue which is free of naturally occurring space to facilitate arthroscopic surgery, said retractor comprising a body portion having a distal end portion, a proximal end portion, and an intermediate portion disposed between said proximal and distal end portions, and a tubular sleeve at least partially enclosing said body portion, said sleeve having a distal end portion adjacent to said distal end portion of said body portion, said sleeve having a proximal end portion disposed adjacent to said proximal end portion of said body portion, said sleeve having an intermediate portion disposed between said distal and proximal end portions of said sleeve, said distal end portion of said sleeve including a plurality of arms, each of said arms including a distal portion which is connected with the distal end portion of said sleeve and a proximal portion which is connected with the intermediate portion of said sleeve, said distal and proximal portions of said arms being interconnected by connector portions of said arms, said connector portions of said arms having a first edge portion and a second edge portion which is opposite from said first edge portion, said arms being movable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion and deflection of said arms at said connector portions of said arms to form open space which is asymmetrical relative to a central axis of said body portion at the location in the body tissue which is free of naturally occurring space, said connector portion of a first one of said arms being spaced from a connector portion of a second one of said arms by a first distance when said arms are in the extended condition, said second one of said arms being the arm which is next adjacent to the first edge portion of said connector portion of said first one of said arms, said connector portion of said first one of said arms being spaced from a connector portion of a third one of said arms by a second distance which is greater than said first distance when said arms are in the extended condition, said third one of said arms being the arm which is next adjacent to the second edge portion of said connector portion of said first one of said arms, said arms having means for forming the space which is asymmetrical relative to the central axis of said body portion by moving body tissue further away from the central axis of said body portion at a location between said first one of said arms and said second one of said arms than at a location between said first one of said arms and said third one of said arms upon movement of said arms from the retracted condition to the extended condition.

2. A retractor as set forth in claim 1 further including barrier means for blocking space at a location between at least some of said plurality of arms when said plurality of arms are in the extended condition, said barrier means being ineffective to block space between said first one of said arms and said third one of said arms.

3. A retractor as set forth in claim 1 wherein said sleeve includes a second plurality of arms disposed between said intermediate portion of said sleeve and said proximal end portion of said sleeve, said second plurality of arms being spaced apart in an axial direction along said body portion from said first plurality of arms, said second plurality of arms being deflectable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion.

4. A retractor as set forth in claim 3 further including an elongated side opening formed in said sleeve and extending between said plurality of arms in said distal end portion of said sleeve and said second plurality of arms, said body portion including surface means for defining a passage which extends from said proximal end portion to said distal end portion of said body portion and which is adapted to receive an instrument during arthroscopic surgery, said body portion having an elongated side opening connecting said side opening in said sleeve with said passage in said body portion.

5. A retractor as set forth in claim 1 further including a side opening formed in said sleeve between said first one of said arms and said third one of said arms, said body portion including surface means for defining a passage which extends from said proximal end portion to said distal end portion of said body portion and which is adapted to receive an instrument during arthroscopic surgery, said body portion having a side opening connecting said side opening in said sleeve with said passage in said body portion.

6. A retractor as set forth in claim 1 wherein at least said connector portions of said arms are spaced apart from each other and from said body portion when said arms are in the extended condition, said retractor further including barrier means for blocking movement of tissue into space between at least some of said arms and said body portion when said arms are in the extended condition.

7. A retractor as set forth in claim 1 wherein said arms are formed of biodegradable material which degrades after prolonged exposure to tissue.

8. A retractor as set forth in claim 1 wherein said arms are formed of transparent material to facilitate viewing of tissue.

9. A retractor as set forth in claim 1 wherein said body portion and said sleeve are formed of transparent material to facilitate viewing of tissue.

10. A retractor as set forth in claim 1 wherein said retractor further includes barrier means formed of transparent material for blocking movement of tissue into space at a location between said connector portions of at least some of said arms and body portion when said arms are in the extended condition and for facilitating viewing of tissue.

11. A retractor as set forth in claim 10 wherein said arms are formed of transparent material to further facilitate viewing of tissue.

12. A retractor as set forth in claim 1 wherein said distal portions of said arms and said proximal portions of said arms form a construct having the same general configuration as a portion of a cone when said arms are in the extended condition, said distal portions of said arms forming the base of the cone, said proximal portions of said arms forming sloping side surface areas of the cone.

13. A retractor as set forth in claim 1 where the distal end of said sleeve has a circular configuration, said distal portions of said arms extending radially outwardly from said distal end of said sleeve when said arms are in the extended condition.

14. A cannula for forming a space in body tissue to facilitate arthroscopic surgery, said cannula comprising a body portion having a distal end portion, a proximal end portion, and an intermediate portion disposed between said proximal and distal end portions, said body portion including surface means for defining a passage which extends from said proximal end portion to said distal end portion of said body portion and which is adapted to receive an instrument during arthroscopic surgery, said passage in said body portion including surface means for defining a first elongated opening which extends axially along said body portion from the distal end portion of said body portion into the intermediate portion of said body portion and through which the instrument can move to engage body tissue during the performance of arthroscopic surgery, and a tubular sleeve at least partially enclosing said body portion, said sleeve having a distal end portion connected with said distal end portion of said body portion, said sleeve having a proximal end portion disposed adjacent to said proximal end portion of said body portion, said sleeve having an intermediate portion disposed between said distal and proximal end portions of said sleeve, said distal end portion of said sleeve including a first plurality of arms, each of said arms of said first plurality of arms including a distal portion which is connected with a distal end of said sleeve and a proximal portion which is connected with the intermediate portion of said sleeve, said arms of said first plurality of arms being movable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion and deflection of said arms of said first plurality of arms at locations between said distal portions of said arms of said first plurality of arms and said proximal portions of said arms of said first plurality of arms to at least partially form in the body tissue an open space into which the instrument can move from the first elongated opening during the performance of arthroscopic surgery, said intermediate portion of said sleeve including a second plurality of arms which are axially spaced along said sleeve from said first plurality of arms, each of said arms of said second plurality of arms including a distal portion which is connected with said intermediate portion of said sleeve at a location which is axially spaced from locations where said proximal portions of said first plurality of arms are connected with said intermediate portion of said sleeve, each of said arms of said second plurality of arms including a proximal portion which is connected with said proximal portion of said sleeve, said arms of said second plurality of arms being movable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion and deflection of said arms of said second plurality of arms at locations between said distal portions of said arms of said second plurality of arms and said proximal portions of said arms of said second plurality of arms to at least partially form in the body tissue open space into which the instrument can move from the first elongated opening during the performance of arthroscopic surgery, said sleeve having an axially extending portion which is disposed between the proximal portions of the arms of said first plurality of arms and said distal portions of said arms of said second plurality of arms, said axially extending portion of said sleeve being disposed in engagement with said body portion when said arms of said first plurality of arms and said arms of said second plurality of arms are in their extended conditions, said first elongated opening in said body portion facing outward of said body portion in a direction transverse to a longitudinal central axis of said body portion, said first elongated opening in said body portion extending axially along said body portion from a location adjacent to a distal end of said body portion and the distal portions of said arms of said first plurality of arms at least to a location adjacent to ends of the proximal portions of said arms of said second plurality of arms where the proximal portions of said arms of said second plurality of arms are connected with said proximal portion of said sleeve when said arms of said first plurality of arms and said arms of said second plurality of arms are in their extended conditions, said sleeve including surface means for defining a second elongated opening which extends along said sleeve from a location adjacent to the distal end of said body portion and the distal portions of said arms of said first plurality of arms through said axially extending portion of said sleeve disposed between said first plurality of arms and said second plurality of arms to at least a location adjacent to the proximal portions of said arms of said second plurality of arms where the proximal portions of said arms of said second plurality of arms are connected with said proximal portion of said sleeve, said second elongated opening in said sleeve being aligned with said first elongated opening in said body portion and opening outward of said body portion in the direction transverse to the longitudinal central axis of said body portion when said arms of said first plurality of arms and said arms of said second plurality of arms are in their extended conditions to enable the instrument to move from the passage through the first elongated opening and into open space at least partially disposed between said body portion and portions of said first and second pluralities of arms when said first and second pluralities of arms are in their extended conditions.

15. A cannula as set forth in claim 14 wherein said distal portions of said arms of said first plurality of arms have a first length, said proximal portions of said arms of said first plurality of arms have a second length which is greater than said first length, said distal portions of said arms of said first plurality of arms extending generally perpendicular to the longitudinal central axis of said body portion at a first angle when said first plurality of arms are in the extended condition, said proximal portions of said arms of said first plurality of arms being skewed relative to the longitudinal central axis of said body portion at a second angle which is substantially smaller than said first angle when said first plurality of arms are in the extended condition.

16. A cannula as set forth in claim 14 wherein said second elongated opening in said sleeve is at least partially formed between a first one of said arms of said first plurality of arms and a second one of said arms of said first plurality of arms and is at least partially formed between a first one of said arms of said second plurality of arms and a second one of said arms of said second plurality of arms, said cannula further including barrier means which extends between at least some of said arms of said first plurality of arms and at least some of said arms of said second plurality of arms to block space at a location between arms of said first plurality of arms and at a location between arms of said second plurality of arms, said barrier means being ineffective to block the second elongated opening in said sleeve between the first one of said arms of said first plurality of arms and the second one of said arms of said first plurality of arms and between the first one of said arms of said second plurality of arms and the second one of said arms of said second plurality of arms to enable the instrument to move through the second elongated opening between the first one of said arms of said first plurality of arms and the second one of said arms of said first plurality of arms and to enable the instrument to move through the second elongated opening between the first one of said arms of said second plurality of arms and the second one of said arms of the second plurality of arms.

17. A cannula as set forth in claim 14 wherein said distal portions of said arms of said first plurality of arms have a first length, said proximal portions of said arms of said first plurality of arms have a second length which is greater than said first length, said distal portions of said arms of said first plurality of arms extending at a first angle to the longitudinal central axis of said body portion when said first plurality of arms are in the extended condition, said proximal portions of said arms of said first plurality of arms extending at a second angle to the longitudinal central axis of said body portion when said first plurality of arms are in the extended condition, said first angle being larger than said second angle, said distal portions of said arms of said second plurality of arms having a third length, said proximal portions of said arms of said second plurality of arms having a fourth length which is greater than said third length, said distal portions of said arms of said second plurality of arms extending at a third angle to the longitudinal central axis of said body portion when said second plurality of arms are in the extended condition, said proximal portions of said arms of said second plurality of arms extending at a fourth angle to the longitudinal central axis of said body portion when said second plurality of arms are in the extended condition, said third angle being larger than said fourth angle.

18. A cannula as set forth in claim 14 wherein said second elongated opening in said sleeve is at least partially formed between a first one of said arms of said first plurality of arms and a second one of said arms of said first plurality of arms, said cannula further including barrier means which extends between at least some of said arms of said first plurality of arms to block space between arms of said first plurality of arms, said barrier means being ineffective to block the second elongated opening in said sleeve at a location between the first one of said arms of said first plurality of arms and the second one of said arms of the first plurality of arms.

19. A cannula as set forth in claim 14 wherein said distal and proximal portions of said arms of said first plurality of arms are interconnected by connector portions of said arms of said first plurality of arms, said distal and proximal portions of said arms of said second plurality of arms being interconnected by connector portions of said arms of said second plurality of arms, said connector portion of a first one of said arms of said first plurality of arms being spaced from a connector portion of a second one of said arms of said first plurality of arms by a first distance when said arms of said first plurality of arms are in the extended condition, said second one of said arms of said first plurality of arms being the arm of said first plurality of arms which is next adjacent to a first edge portion of said first one of said arms of said first plurality of arms, said connector portion of said first one of said arms of said first plurality of arms being spaced from a connector portion of a third one of said arms of said first plurality of arms by a second distance which is greater than said first distance, said third one of said arms of said first plurality of arms being the arm of said first plurality of arms which is next adjacent to a second edge portion of said first one of said arms of said first plurality of arms, said second elongated opening being at least partially disposed between the second edge portion of said first one of said arms of said first plurality of arms and a first edge portion of said third one of said arms of said first plurality of arms, said connector portion of a first one of said arms of said second plurality of arms being spaced from a connector portion of a second one of said arms of said second plurality of arms by a third distance when said arms of said second plurality of arms are in the extended condition, said second one of said arms of said second plurality of arms being the arm of said second plurality of arms which is next adjacent to a first edge portion of said first one of said arms of said second plurality of arms, said connector portion of said first one of said arms of said second plurality of arms being spaced from a connector portion of a third one of said arms of said second plurality of arms by a fourth distance which is greater than said third distance, said third one of said arms of said second plurality of arms being the arm of said second plurality of arms which is next adjacent to a second edge portion of said first one of said arms of said second plurality of arms, said second elongated opening being at least partially disposed between the second edge portion of said first one of said arms of said second plurality of arms and a first edge portion of a third one of said arms of said second plurality of arms.

20. A cannula for forming a space at a location in body tissue which is free of naturally occurring space to facilitate arthroscopic surgery, said cannula comprising a body portion having a distal end portion, a proximal end portion, and an intermediate portion disposed between said proximal and distal end portions, said body portion including surface means for defining a passage which extends from said proximal end portion to said distal end portion of said body portion and which is adapted to receive an instrument during arthroscopic surgery, said passage in said body portion including surface means for defining an opening in the distal end portion of said body portion and through which the instrument can move to engage body tissue at the location in the body tissue which is free of naturally occurring space during the performance of arthroscopic surgery, and a tubular sleeve at least partially enclosing said body portion, said sleeve having a distal end portion connected with said distal end portion of said body portion, said sleeve having a proximal end portion disposed adjacent to said proximal end portion of said body portion, said sleeve having an intermediate portion disposed between said distal and proximal end portions of said sleeve, said distal end portion of said sleeve including a plurality of arms, each of said arms including a distal portion which is connected with a distal end of said sleeve and a proximal portion which is connected with the intermediate portion of said sleeve, said distal portions of said arms having a first length, said proximal portions of said arms having a second length which is greater than said first length, said arms being movable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion and deflection of said arms at locations between said distal portions of said arms and said proximal portions of said arms to said form space at the location in the body tissue which is free of naturally occurring space and into which the instrument can move from the passage opening during the performance of arthroscopic surgery, said distal portions of said arms extending transversely to a longitudinal central axis of said sleeve at a first angle when said arms are in the extended condition, said proximal portions of said arms extending relative to the central axis of said sleeve at a second angle which is substantially smaller than said first angle when said arms are in the extended condition, said proximal portions of said arms having means for forming an open space in the body tissue by moving body tissue away from said distal portions of said arms and away from a distal end of said body portion upon movement of said arms from the retracted condition to the extended condition to form an open space in the body tissue adjacent to the distal end of said body portion to facilitate the performance of arthroscopic surgery on the body tissue at the location which is free of naturally occurring space, said passage opening being in communication with the open space formed in the body tissue by movement of body tissue by said outer proximal portions of said arms during movement of said arms from the retracted condition to the extended condition to enable the instrument to move through said passage opening into the open space at the location in the body tissue which is free of naturally occurring space, said distal and proximal portions of said arms being interconnected by connector portions of said arms, said connector portion of a first one of said arms being spaced from said connector portion of a second one of said arms by a first distance when said arms are in the extended condition, said second one of said arms being the arm which is next adjacent to a first edge portion of said first one of said arms, said connector portion of said first one of said arms being spaced from said connector portion of a third one of said arms by a second distance which is greater than said first distance when said arms are in the extended condition, said third one of said arms being the arm which is next adjacent to a second edge portion of said first one of said arms.

21. A cannula as set forth in claim 20 wherein said connector portion of a fourth one of said arms is spaced from said connector portion of said third one of said arms by said first distance when said arms are in the extended condition, said fourth one of said arms being the arm which is next adjacent to a first edge portion of said third one of said arms.

22. A cannula as set forth in claim 20 further including barrier means for blocking space between said first edge portion of said first one of said arms and said second arm and for blocking space between said second and third arms when said arms are in the extended condition, said barrier means being ineffective to block space at a location between said second edge portion of said first one of said arms and said third arm when said arms are in the extended condition.

23. A cannula as set forth in claim 20 wherein said surface for defining an elongated opening in said body portion and which faces outward of said body portion in a direction transverse to a longitudinal central axis of said body portion and toward a location between said second edge portion of said first one of said arms and said third one of said arms and which extends axially along said body portion from a location adjacent to the distal end of said body portion and the distal portions of said arms at least to a location adjacent to ends of the proximal portions of said first one of said arms and said third one of said arms where the proximal portions of said first one of said arms and said third one of said arms are connected with said intermediate portion of said sleeve when said arms are in the extended condition to enable the instrument to move from the passage through the elongated opening in said body portion.

24. A cannula for forming a space at a location in body tissue which is free of naturally occurring space to facilitate arthroscopic surgery, said cannula comprising a body portion having a distal end portion, a proximal end portion, and an intermediate portion disposed between said proximal and distal end portions, said body portion including surface means for defining a passage which extends from said proximal end portion to said distal end portion of said body portion and which is adapted to receive an instrument during arthroscopic surgery, said passage in said body portion including surface means for defining an opening in the distal end portion of said body portion and through which the instrument can move to engage body tissue at the location in the body tissue which is free of naturally occurring space during the performance of arthroscopic surgery, and a tubular sleeve at least partially enclosing said body portion, said sleeve having a distal end portion connected with said distal end portion of said body portion, said sleeve having a proximal end portion disposed adjacent to said proximal end portion of said body portion, said sleeve having an intermediate portion disposed between said distal and proximal end portions of said sleeve, said distal end portion of said sleeve including a plurality of arms, each of said arms including a distal portion which is connected with a distal end of said sleeve and a proximal portion which is connected with the intermediate portion of said sleeve, said distal portions of said arms having a first length, said proximal portions of said arms having a second length which is greater than said first length, said arms being movable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion and deflection of said arms at locations between said distal portions of said arms and said proximal portions of said arms to form space at the location in the body tissue which is free of naturally occurring space and into which the instrument can move from the passage opening during the performance of arthroscopic surgery, said distal portions of said arms extending generally perpendicular to a longitudinal central axis of said sleeve at a first angle when said arms are in the extended condition, said proximal portions of said arms being skewed relative to the central axis of said sleeve at a second angle which is substantially smaller than said first angle when said arms are in the extended condition, said proximal portions of said arms having means for forming an open space in the body tissue at the location which is free of naturally occurring space by moving body tissue away from said distal portions of said arms and away from a distal end of said body portion upon movement of said arms from the retracted condition to the extended condition to form an open space in the body tissue adjacent to the distal end of said body portion to facilitate the performance of arthroscopic surgery on the body tissue at the location which is free of naturally occurring space, said passage opening being in communication with the open space formed in the body tissue by movement of body tissue by said proximal portions of said arms during movement of said arms from the retracted condition to the expanded condition to enable the instrument to move through said passage opening into the open space at the location in the body tissue which is free of naturally occurring space, said body portion and said sleeve have a cylindrical configuration when said arms are in the retracted condition, said passage opening extends axially along said body portion from a location adjacent to the distal end of said body portion and the distal portions of said arms at least to a location adjacent to the proximal portions of said arms to enable the instrument to move from the passage through the opening, said opening facing radially outward of said body portion, said sleeve including surface means for at least partially defining a slot which extends axially along said sleeve from a location adjacent to the distal end of said body portion and the distal portions of said arms at least to a location adjacent to the proximal portions of said arms, said slot in said sleeve being radially aligned with said opening in said body portion to enable the instrument to move from the passage through the opening in said body portion and into space at least partially disposed between said body portion and said proximal portions of said arms and formed in the body tissue at the location which is free of naturally occurring space by movement of body tissue by said proximal portions of said arms upon movement of said arms from the retracted condition to the extended condition, said distal and proximal portions of said arms being interconnected by connector portions of said arms, said connector portions of said arms having a first edge portion and a second edge portion which is opposite from said first edge portion, said connector portion of a first one of said arms being spaced from a connector portion of a second one of said arms by a first distance when said arms are in the extended condition, said second one of said arms being the arm which is next adjacent to the first edge portion of said connector portion of said first one of said arms, said connector portion of said first one of said arms being spaced from a connector portion of a third one of said arms by a second distance which is greater than said first distance when said arms are in the extended condition, said third one of said arms being the arm which is next adjacent to the second edge portion of said connector portion of said first one of said arms, said opening in said body portion and said slot in said sleeve opening radially outward toward space between proximal portions of said first one of said arms and said third one of said arms when said arms are in the extended condition.

25. A cannula as set forth in claim 24 further including barrier means for blocking space between at least some of the arms of said plurality of arms when said plurality of arms are in the extended condition, said barrier means being ineffective to block space at a location between said first one of said arms and said third one of said arms to enable the instrument to move between said first one of said arms and said third one of said arms, said barrier means being effective to block movement of the instrument between arms other than said first one of said arms and said third one of said arms.

26. A cannula as set forth in claim 24 wherein said distal portions of said arms and said proximal portions of said arms form a construct having the same general configuration as a portion of a cone when said arms are in the extended condition, said distal portions of said arms forming the base of the cone, said outer side surface means of said proximal portions of said arms forming sloping side surface areas of the cone, said sloping side surface areas of the cone being effective to apply force against the body tissue to maintain the open space in the body tissue at the location which is free of naturally occurring space during the performance of arthroscopic surgery.

27. A cannula as set forth in claim 26 further including first areas of reduced thickness connecting ends of said proximal portions of said arms with said intermediate portion of said sleeve, second areas of reduced thickness connecting ends of said distal portions of said arms with the distal end of said sleeve, and third areas of reduced thickness connecting said distal portions of said arms with said proximal portions of said arms.

28. A cannula as set forth in claim 26 where a distal end of said sleeve has a circular configuration, said distal portions of said arms extending radially outwardly from said distal end of said sleeve when said arms are in the extended condition.

35. A cannula as set forth in claim 25 wherein said sleeve includes a second plurality of arms disposed between said intermediate portion of said sleeve and said proximal end portion of said sleeve, said second plurality of arms being deflectable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion to form space which extends between said second plurality of arms and the distal end portion of said sleeve at the location in the body tissue which is free of naturally occurring space.

29. A cannula for forming a space at a location in body tissue which is free of naturally occurring space to facilitate arthroscopic surgery, said cannula comprising a body portion having a distal end portion, a proximal end portion, and an intermediate portion disposed between said proximal and distal end portions, said body portion including surface means for defining a passage which extends from said proximal end portion to said distal end portion of said body portion and which is adapted to receive an instrument during arthroscopic surgery, said passage in said body portion including surface means for defining an opening in the distal end portion of said body portion and through which the instrument can move to engage body tissue at the location in the body tissue which is free of naturally occurring space during the performance of arthroscopic surgery, and a tubular sleeve at least partially enclosing said body portion, said sleeve having a distal end portion connected with said distal end portion of said body portion, said sleeve having a proximal end portion disposed adjacent to said proximal end portion of said body portion, said sleeve having an intermediate portion disposed between said distal and proximal end portions of said sleeve, said distal end portion of said sleeve including a plurality of arms, each of said arms including a distal portion which is connected with a distal end of said sleeve and a proximal portion which is connected with the intermediate portion of said sleeve, said distal portions of said arms having a first length, said proximal portions of said arms having a second length which is greater than said first length, said arms being movable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion and deflection of said arms at locations between said distal portions of said arms and said proximal portions of said arms to form space at the location in the body tissue which is free of naturally occurring space and into which the instrument can move from the passage opening during the performance of arthroscopic surgery, said distal portions of said arms extending generally perpendicular to a longitudinal central axis of said sleeve at a first angle when said arms are in the extended condition, said proximal portions of said arms being skewed relative to the central axis of said sleeve at a second angle which is substantially smaller than said first angle when said arms are in the extended condition, said proximal portions of said arms having means for forming an open space in the body tissue at the location which is free of naturally occurring space by moving body tissue away from said distal portions of said arms and away from a distal end of said body portion upon movement of said arms from the retracted condition to the extended condition to form an open space in the body tissue adjacent to the distal end of said body portion to facilitate the performance of arthroscopic surgery on the body tissue at the location which is free of naturally occurring space, said passage opening being in communication with the open space formed in the body tissue by movement of body tissue by said proximal portions of said arms during movement of said arms from the retracted condition to the expanded condition to enable the instrument to move through said passage opening into the open space at the location in the body tissue which is free of naturally occurring space, said distal portions of said arms being spaced apart and disposed in a circular array with different spacings between adjacent distal portions of at least some of said arms when said arms are in the extended condition.

30. A cannula as set forth in claim 29 further including a side opening formed in said distal end portion of said sleeve between said plurality of arms in said distal end portion of said sleeve, said opening in the distal end portion of said body portion connecting said side opening in said sleeve in communication with said passage in said body portion.

31. A cannula as set forth in claim 29 further including barrier means for blocking movement of tissue into space between said arms and said body portion when said arms are in the extended condition.

32. A cannula as set forth in claim 29 further including barrier means formed of transparent material for blocking movement of tissue into space at a location between said arms and body portion when said arms are in the extended condition and for facilitating viewing of tissue.

33. A cannula as set forth in claim 32 wherein said arms are formed of transparent material to further facilitate viewing of tissue.

34. A cannula as set forth in claim 29 wherein said body portion and said sleeve have a cylindrical configuration when said arms are in the retracted condition, said passage opening extends axially along said body portion from a location adjacent to the distal end of said body portion and the distal portions of said arms at least to a location adjacent to the proximal portions of said arms to enable the instrument to move from the passage through the groove, said opening facing radially outward of said body portion, said sleeve including surface means for at least partially defining a slot which extends axially along said sleeve from a location adjacent to the distal end of said body portion and the distal portions of said arms at least to a location adjacent to the proximal portions of said arms, said slot in said sleeve being radially aligned with said opening in said body portion to enable the instrument to move from the passage through the opening in said body portion and into space at least partially disposed between said body portion and said proximal portions of said arms and formed in the body tissue at the location which is free of naturally occurring space by movement of body tissue by said proximal portions of said arms upon movement of said arms from the retracted condition to the extended condition.

36. A cannula as set forth in claim 29 wherein said arms are formed of biodegradable material which degrades after prolonged exposure to tissue.

37. A cannula as set forth in claim 29 wherein said arms are formed of transparent material to facilitate viewing of tissue.

38. A cannula as set forth in claim 29 wherein said body portion and said sleeve are formed of transparent material to facilitate viewing of tissue.

39. A cannula for forming a space at a location in body tissue which is free of naturally occurring space to facilitate arthroscopic surgery, said cannula comprising a body portion having a distal end portion, a proximal end portion, and an intermediate portion disposed between said proximal and distal end portions, said body portion including surface means for defining a passage which extends from said proximal end portion to said distal end portion of said body portion and which is adapted to receive an instrument during arthroscopic surgery, said passage in said body portion including surface means for defining an opening in the distal end portion of said body portion and through which the instrument can move to engage body tissue at the location in the body tissue which is free of naturally occurring space during the performance of arthroscopic surgery, and a tubular sleeve at least partially enclosing said body portion, said sleeve having a distal end portion connected with said distal end portion of said body portion, said sleeve having a proximal end portion disposed adjacent to said proximal end portion of said body portion, said sleeve having an intermediate portion disposed between said distal and proximal end portions of said sleeve, said distal end portion of said sleeve including a plurality of arms, each of said arms including a distal portion which is connected with a distal end of said sleeve and a proximal portion which is connected with the intermediate portion of said sleeve, said distal portions of said arms having a first length, said proximal portions of said arms having a second length which is greater than said first length, said arms being movable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion and deflection of said arms at locations between said distal portions of said arms and said proximal portions of said arms to form space at the location in the body tissue which is free of naturally occurring space and into which the instrument can move from the passage opening during the performance of arthroscopic surgery, said distal portions of said arms extending generally perpendicular to a longitudinal central axis of said sleeve at a first angle when said arms are in the extended condition, said proximal portions of said arms being skewed relative to the central axis of said sleeve at a second angle which is substantially smaller than said first angle when said arms are in the extended condition, said proximal portions of said arms having means for forming an open space in the body tissue at the location which is free of naturally occurring space by moving body tissue away from said distal portions of said arms and away from a distal end of said body portion upon movement of said arms from the retracted condition to the extended condition to form an open space in the body tissue adjacent to the distal end of said body portion to facilitate the performance of arthroscopic surgery on the body tissue at the location which is free of naturally occurring space, said passage opening being in communication with the open space formed in the body tissue by movement of body tissue by said proximal portions of said arms during movement of said arms from the retracted condition to the expanded condition to enable the instrument to move through said passage opening into the open space at the location in the body tissue which is free of naturally occurring space, said distal and proximal portions of said arms being interconnected by connector portions of said arms, said connector portion of a first one of said arms being spaced from a connector portion of a second one of said arms by a first distance when said arms are in the extended condition, said second one of said arms being the arm which is next adjacent to a first edge portion of said first one of said arms, said connector portion of said first one of said arms being spaced from a connector portion of a third one of said arms by a second distance which is greater than said first distance when said arms are in the extended condition, said third one of said arms being the arm which is next adjacent to a second edge portion of said first one of said arms.

40. A cannula as set forth in claim 39 wherein said body portion and said sleeve have a cylindrical configuration when said arms are in the retracted condition, said passage opening extends axially along said body portion from a location adjacent to the distal end of said body portion and the distal portions of said arms at least to a location adjacent to the proximal portions of said arms to enable the instrument to move from the passage through the groove, said opening facing radially outward of said body portion, said sleeve including surface means for at least partially defining a slot which extends axially along said sleeve from a location adjacent to the distal end of said body portion and the distal portions of said arms at least to a location adjacent to the proximal portions of said arms, said slot in said sleeve being radially aligned with said opening in said body portion to enable the instrument to move from the passage through the opening in said body portion and into space at least partially disposed between said body portion and said proximal portions of said arms and formed in the body tissue at the location which is free of naturally occurring space by movement of body tissue by said proximal portions of said arms upon movement of said arms from the retracted condition to the extended condition.

41. A cannula as set forth in claim 39 further including barrier means for blocking space between at least some of the arms of said plurality of arms when said plurality of arms are in the extended condition, said barrier means being ineffective to block space at a location between said first one of said arms and said third one of said arms to enable the instrument to move between said first one of said arms and said third one of said arms, said barrier means being effective to block movement of the instrument between arms other than said first one of said arms and said third one of said arms.

42. A cannula as set forth in claim 39 wherein said sleeve includes a second plurality of arms disposed between said intermediate portion of said sleeve and said proximal end portion of said sleeve, said second plurality of arms being deflectable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion to form space which extends between said second plurality of arms and the distal end portion of said sleeve at the location in the body tissue which is free of naturally occurring space.

43. A cannula as set forth in claim 42 further including surface means for defining a side opening in said intermediate portion of said sleeve between said plurality of arms in said distal end portion of said sleeve and said second plurality of arms, said opening in the distal end portion of said body portion connecting said side opening in said sleeve with said passage in said body portion.

44. A cannula as set forth in claim 39 further including a side opening formed in said distal end portion of said sleeve between said plurality of arms-in said distal end portion of said sleeve, said opening in the distal end portion of said body portion connecting said side opening in said sleeve in communication with said passage in said body portion.

45. A cannula as set forth in claim 39 further including barrier means for blocking movement of tissue into space between said arms and said body portion when said arms are in the extended condition.

46. A cannula as set forth in claim 39 wherein said arms are formed of biodegradable material which degrades after prolonged exposure to tissue.

47. A cannula as set forth in claim 39 wherein said arms are formed of transparent material to facilitate viewing of tissue.

48. A cannula as set forth in claim 39 wherein said body portion and said sleeve are formed of transparent material to facilitate viewing of tissue.

49. A cannula as set forth in claim 39 further including barrier means formed of transparent material for blocking movement of tissue into space at a location between said arms and body portion when said arms are in the extended condition and for facilitating viewing of tissue.

50. A cannula as set forth in claim 49 wherein said arms are formed of transparent material to further facilitate viewing of tissue.

51. A cannula for forming a space at a location in body tissue which is free of naturally occurring space to facilitate arthroscopic surgery, said cannula comprising a body portion having a distal end portion, a proximal end portion, and an intermediate portion disposed between said proximal and distal end portions, said body portion including surface means for defining a passage which extends from said proximal end portion to said distal end portion of said body portion and which is adapted to receive an instrument during arthroscopic surgery, said passage in said body portion including surface means for defining an opening in the distal end portion of said body portion and through which the instrument can move to engage body tissue at the location in the body tissue which is free of naturally occurring space during the performance of arthroscopic surgery, and a tubular sleeve at least partially enclosing said body portion, said sleeve having a distal end portion connected with said distal end portion of said body portion, said sleeve having a proximal end portion disposed adjacent to said proximal end portion of said body portion, said sleeve having an intermediate portion disposed between said distal and proximal end portions of said sleeve, said distal end portion of said sleeve including a plurality of arms, each of said arms including a distal portion which is connected with a distal end of said sleeve and a proximal portion which is connected with the intermediate portion of said sleeve, said distal portions of said arms having a first length, said proximal portions of said arms having a second length which is greater than said first length, said arms being movable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion and deflection of said arms at locations between said distal portions of said arms and said proximal portions of said arms to form space at the location in the body tissue which is free of naturally occurring space and into which the instrument can move from the passage opening during the performance of arthroscopic surgery, said distal portions of said arms extending generally perpendicular to a longitudinal central axis of said sleeve at a first angle when said arms are in the extended condition, said proximal portions of said arms being skewed relative to the central axis of said sleeve at a second angle which is substantially smaller than said first angle when said arms are in the extended condition, said proximal portions of said arms having means for forming an open space in the body tissue at the location which is free of naturally occurring space by moving body tissue away from said distal portions of said arms and away from a distal end of said body portion upon movement of said arms from the retracted condition to the extended condition to form an open space in the body tissue adjacent to the distal end of said body portion to facilitate the performance of arthroscopic surgery on the body tissue at the location which is free of naturally occurring space, said passage opening being in communication with the open space formed in the body tissue by movement of body tissue by said proximal portions of said arms during movement of said arms from the retracted condition to the expanded condition to enable the instrument to move through said passage opening into the open space at the location in the body tissue which is free of naturally occurring space, said sleeve includes a second plurality of arms disposed between said intermediate portion of said sleeve and said proximal end portion of said sleeve, said second plurality of arms being deflectable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion to form space which extends between said second plurality of arms and the distal end portion of said sleeve at the location in the body tissue which is free of naturally occurring space, surface means for defining a side opening in said intermediate portion of said sleeve between said plurality of arms in said distal end portion of said sleeve and said second plurality of arms, said opening in the distal end portion of said body portion connecting said side opening in said sleeve with said passage in said body portion.

52. A cannula as set forth in claim 517 wherein said arms of said second plurality of arms are spaced apart and disposed in a circular array with different spacings between adjacent portions of at least some of said arms of said second plurality of arms when said arms of said second plurality of arms are in the extended condition.

53. A cannula for forming a space at a location in body tissue which is free of naturally occurring space to facilitate arthroscopic surgery, said cannula comprising a longitudinally extending body portion having a distal end portion, a proximal end portion, and an intermediate portion disposed between said proximal and distal end portions, said body portion including surface means for defining a passage which extends from said proximal end portion to said distal end portion of said body portion and which is adapted to receive an instrument during arthroscopic surgery, and a tubular sleeve at least partially enclosing said body portion, said sleeve having a distal end portion connected with said distal end portion of said body portion, said sleeve having a proximal end portion disposed adjacent to said proximal end portion of said body portion, said sleeve having an intermediate portion disposed between said distal and proximal end portions of said sleeve, said distal end portion of said sleeve including a plurality of arms, each of said arms including a distal portion which is connected with a distal end of said sleeve and a proximal portion which is connected with the intermediate portion of said sleeve, said arms being movable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion and deflection of said arms at locations between said distal portions of said arms and said proximal portions of said arms to form space at the location in the body tissue which is free of naturally occurring space, said arms having means for forming an open space in the body tissue at the location which is free of naturally occurring space by moving body tissue away from said body portion upon movement of said arms from the retracted condition to the extended condition to form an open space in the body tissue to facilitate the performance of arthroscopic surgery on the body tissue at the location which is free of naturally occurring space, said surface means for defining a passage in said body portion including surface means for defining an elongated opening in said body portion and which faces outward of said body portion in a direction transverse to a longitudinal central axis of said body portion and which extends axially along said body portion from a location adjacent to a distal end of said body portion and the distal portions of said arms at least to a location adjacent to ends of the proximal portions of said arms where the proximal portions of said arms are connected with said intermediate portion of said sleeve when said arms are in the extended condition to enable the instrument to move from the passage through the elongated opening in said body portion, said sleeve including surface means for defining an elongated opening which extends axially along said sleeve from a location adjacent to the distal end of said body portion and the distal portions of said arms at least to a location adjacent to the proximal portions of said arms where the proximal portions of said arms are connected with said intermediate portion of said sleeve, said elongated opening in said sleeve being aligned with said elongated opening in said body portion and opens outward of said body portion in the direction transverse to the longitudinal central axis of said body portion when said arms are in the extended condition to enable the instrument to move from the passage through the elongated opening in said body portion and into open space at least partially disposed between said body portion and said proximal portions of said arms and formed in the body tissue at the location which is free of naturally occurring space by movement of body tissue by said arms upon movement of said arms from the retracted condition to the extended condition to enable the instrument to move through the passage and through the elongated opening in said body portion into the open space at the location in the body tissue which is free of naturally occurring space, said distal portions of said arms being spaced apart and disposed in a circular array with different spacings between adjacent distal portions of at least some of said arms when said arms are in the expanded condition.

54. A cannula as set forth in claim 53 wherein said elongated opening in said sleeve being formed between a first one of said arms and a second one of said arms, said cannula further including barrier means which extends between at least some of said arms to block space between said arms, said barrier means being ineffective to block the elongated opening at a location between the first one of said arms and the second one of said arms to enable the instrument to move through the elongated opening between the first one of said arms and the second one of said arms.

55. A cannula as set forth in claim 53 wherein said body portion includes surface means for defining an opening in the distal end of said body portion, said opening in the distal end of said body portion being connected in communication with said passage to enable an instrument to move through said passage to the opening in the distal end of said body portion.

56. A cannula as set forth in claim 53 wherein said elongated opening in said body portion extends past the location where the proximal portions of said arms are connected with said intermediate portion of said sleeve when said arms are in the extended condition.

57. A cannula as set forth in claim 53 wherein said distal portions of said arms have a first length, said proximal portions of said arms having a second length which is greater than said first length, said distal portions of said arms extending at a first angle to the longitudinal central axis of said body portion, said proximal portions of said arms extending at a second angle to the longitudinal central axis of said body portion, said second angle being less than said first angle.

58. A cannula as set forth in claim 53 wherein said distal portions of said arms have a first length and said proximal portions of said arms having a second length which is greater than said first length, said distal portions of said arms extending generally perpendicular to a longitudinal central axis of said sleeve at a first angle when said arms are in the extended condition, said proximal portions of said arms being skewed relative to the central axis of said sleeve at a second angle which is substantially smaller than said first angle when said arms are in the extended condition, said proximal portions of said arms having outer side surface means for transmitting force to move tissue away from said distal portions of said arms and the distal end of said body portion upon movement of said arms from the retracted condition to the extended condition.

59. A cannula as set forth in claim 53 wherein said distal portions of said arms and said proximal portions of said arms form a construct having the same general configuration as a portion of a cone when said arms are in the extended condition, said distal portions of said arms forming the base of the cone, said outer side surface means of said proximal portions of said arms forming sloping side surface areas of the cone.

60. A cannula as set forth in claim 53 further including first areas of reduced thickness connecting ends of said proximal portions of said arms with said intermediate portion of said sleeve, second areas of reduced thickness connecting ends of said distal portions of said arms with the distal end of said sleeve, and third areas of reduced thickness connecting said distal portions of said arms with said proximal portions of said allils.

61. A cannula as set forth in claim 53 wherein the distal end of said sleeve has a circular configuration, said distal portions of said arms extending radially outward from said distal end of said sleeve when said arms are in the extended condition.

62. A cannula as set forth in claim 53 wherein said distal and proximal portions of said arms are interconnected by connector portions of said arms, said connector portion of said first arm being spaced from a connector portion of said second arm by a first distance when said arms are in the extended condition, said connector portion of said first arm being spaced from a connector portion of a third one of said arms by a second distance which is less than said first distance when said arms are in the extended condition, said elongated opening in said sleeve being disposed between said first arm and said second arm.

63. A cannula as set forth in claim 53 wherein said sleeve includes a second plurality of arms disposed between said intermediate portion of said sleeve and said proximal end portion of said sleeve, said second plurality of arms being deflectable from a retracted condition to an extended condition by movement of said sleeve relative to said body portion.

64. A retractor as set forth in claim 63 wherein said elongated opening formed in said sleeve is at least partially disposed between arms of said second plurality of arms.

65. A retractor as set forth in claim 53 wherein at least portions of said arms are spaced apart from each other and from said body portion when said arms are in the extended condition, said retractor further including barrier means for blocking movement of tissue into space at a location between at least some of said arms and said body portion when said arms are in the extended condition.

66. A retractor as set forth in claim 53 wherein said arms are formed of biodegradable material which degrades after prolonged exposure to tissue.

67. A retractor as set forth in claim 53 wherein said arms are formed of transparent material to facilitate viewing of tissue.

68. A retractor as set forth in claim 53 wherein said body portion and said sleeve are formed of transparent material to facilitate viewing of tissue.

69. A retractor as set forth in claim 53 wherein at least portions of some of said arms are spaced apart from each other and from said body portion when said arms are in the extended condition, said retractor further including barrier means formed of transparent material for blocking movement of tissue into space at a location between at least some of said arms and body portion when said arms are in the extended condition and for facilitating viewing of tissue.

70. A retractor as set forth in claim 53 wherein said arms are formed of transparent material to further facilitate viewing of tissue.