Flexible surgical screwdriver and methods of arthroscopic ligament reconstruction

• US 5,797,918 A
• Filed: 11/06/1995
• Issued: 08/25/1998
• Est. Priority Date: 12/13/1991
• Status: Expired due to Fees

• Current Assignee: David A. Mcguire
• Original Assignee: David A. Mcguire
• Inventors: Lefler, Jeffery W., Garman, Gary T., McGuire, David A.
• Primary Examiner(s): Tucker, Guy V.
• Application Number:
  US08/554,601
• Time in Patent Office: 1,023 Days
• Field of Search: 606/80, 606/104, 606/79, 606/73, 606/72, 81/442, 81/450, 81/64, 81/65.2
• US Class Current: 606/104
• CPC Class Codes: A61B 17/15 Guides therefor arrangements for guiding straight saw blades in general B23D51/025
• CPC Class Codes: A61B 17/1714 for applying tendons or ligaments implements for applying tendons or ligaments A61F2/0805
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 17/1796 for holes for sutures or flexible wires
• CPC Class Codes: A61B 17/8875 Screwdrivers, spanners or wrenches
• CPC Class Codes: A61B 2090/033 Abutting means, stops, e.g. abutting on tissue or skin
• CPC Class Codes: A61F 2/0805 Implements for inserting tendons or ligaments
• CPC Class Codes: B25B 13/481 for operating in areas having limited access
• CPC Class Codes: B25B 23/0021 Prolongations interposed between handle and tool
• CPC Class Codes: B25G 1/043 for screwdrivers, wrenches or spanners
• CPC Class Codes: B25G 3/26 comprising nails, screws, bolts, or pins traversing or entering the socket

Abstract

A surgical screwdriver for inserting bone screws in bone tunnels in ligament reconstruction has, in a preferred embodiment, a cannulated flexible shaft portion. The flexible shaft portion is formed by a plurality of linkage members disposed in series. Each linkage member is joined to an adjacent linkage member so as to permit adjacent linkage members to be pivotally movable with respect to one another about a pivot axis. The screwdriver is used in methods of arthroscopic cruciate ligament reconstruction including the steps of introducing the screwdriver along a guide wire through a portal that is offset from the longitudinal axis of a bone tunnel and driving an interference screw mounted on the driver in the bone tunnel to fixate a bone block in the bone tunnel.

Claims

1. A screwdriver comprising:

(a) a rotatable handle having a distal portion, and a central longitudinal axis;

(b) a flexible shaft portion coupled to the distal portion of the handle, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough;

(c) a plurality of links, each link joining a linkage member to an adjacent linkage member by a means for preventing adjacent linkage members from substantially rotating about the longitudinal axis relative to one another, so as to permit torque to be transmitted along the linkage members while permitting adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis; and

(d) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for driving a cannulated screw with rotation transmitted from the flexible shaft portion.

2. A screwdriver as set forth in claim 1, wherein the flexible shaft portion and the cannulated driving tip are aligned such that a guide wire may be inserted into the cannulated drive tip and through the longitudinal bore of each linkage member in the flexible shaft portion.

3. A screwdriver as set forth in claim 1, wherein each linkage member includes a male end and a female end, the female end being adapted to engage a male end of an adjacent linkage member.

4. A screwdriver as set forth in claim 3 wherein the male end includes a tongue lying generally in a first plane parallel to the longitudinal bore, and the female end includes a channel adapted to receive the tongue of an adjacent linkage member, the channel defining a second plane parallel to the longitudinal bore, wherein the first and second planes are less than perpendicular to one another.

5. A screwdriver as set forth in claim 3, wherein the distal portion of the handle terminates in one of a male end and a female end for engaging the other of a male end and a female end of a linkage member.

6. A screwdriver as set forth in claim 5, wherein the flexible shaft portion terminates in one of a male end and a female end for engaging the other of a male end and a female end of the drive tip.

7. A screwdriver as set forth in claim 3, wherein the linkage member is generally cylindrical in shape.

8. A screwdriver as set forth in claim 3, further including a flexible sheath disposed about the entire series of linkage members of the flexible shaft portion.

9. A screwdriver as set forth in claim 1, further comprising a stiff shaft portion disposed between the distal portion of the handle and the flexible shaft portion and having a passageway therethrough, the passageway being in axial alignment with the central longitudinal axis.

10. A screwdriver comprising:

(a) a rotable handle having a distal portion, and a central longitudinal axis;

(b) a flexible shaft portion coupled to the distal portion of the handle, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough and being joined to an adjacent linkage member via link, so as to permit adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis, so that the flexible shaft portion may transmit rotation from the handle while conforming generally to a curvature along the longitudinal axis; and

(c) a cannulated drive tip attached to terminal linkage member of the flexible shaft portion for driving a cannulated screw with rotation transmitted from the flexible shaft portion;

wherein each linkage member includes a male end and a female end, the female end being adapted to engage a male end of an adjacent linkage member, and

wherein the male end includes a tongue lying generally in a first plane parallel to the longitudinal bore, and the female end includes a channel adapted to receive the tongue of an adjacent linkage member, the channel defining a second plane parallel to the longitudinal bore, wherein the first and second planes are perpendicular to one another.

11. A screwdriver comprising:

(a) a rotable handle having a distal portion, and a central longitudinal axis;

(b) a flexible shaft portion coupled to the distal portion of the handle, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough and being joined to an adjacent linkage member via link, so as to permit adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis, so that the flexible shaft portion may transmit rotation from the handle while conforming generally to a curvature along the longitudinal axis; and

(c) a cannulated drive tip attached to terminal linkage member of the flexible shaft portion for driving a cannulated screw with rotation transmitted from the flexible shaft portion;

wherein each linkage member, being generally cylindrical in shape, includes a male end and a female end, the female end being adapted to engage a male end of an adjacent linkage member, and

wherein each linkage member further includes a ring positioned circumferentially about the female end therof for securing the engagement between the female end and the male end of an adjacent linkage member.

12. A screwdriver comprising:

(a) a rotable handle having a distal portion, and a central longitudinal axis;

(b) a flexible shaft portion coupled to the distal portion of the handle, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough and being joined to an adjacent linkage member via link, so as to permit adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis, so that the flexible shaft portion may transmit rotation from the handle while conforming generally to a curvature along the longitudinal axis; and

(c) a cannulated drive tip attached to terminal linkage member of the flexible shaft portion for driving a cannulated screw with rotation transmitted from the flexible shaft portion

wherein the handle includes a tunnel along the longitudinal axis so that the entire screwdriver possesses an axially disposed cannula.

13. A surgical screwdriver for rotationally advancing a screw into a bone, the screwdriver comprising:

(a) a rotatable rigid shaft portion having a distal end, a proximal end, and a passageway extending from the distal end to the proximal end along a longitudinal axis;

(b) a flexible shaft portion coupled to the distal end of the rotatable rigid shaft portion, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough;

(c) a plurality of links, each link joining a linkage member to an adjacent linkage member by a means for preventing adjacent linkage members from substantially rotating about the longitudinal axis relative to one another, so as to permit torque to be transmitted along the linkage members while permitting adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis;

(d) a handle fixed to the proximal end of the rigid shaft portion for rotating the stiff shaft portion; and

(e) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for advancing, upon rotation of the handle, a cannulated screw situated on a guide wire.

14. A surgical screwdriver as set forth in claim 13, wherein the cannulated drive tip is elongated so that when the tip engages the cannulated screw at its proximal end, a portion of the tip protrudes beyond the proximal end of the screw by a distance so as to allow the screw to be driven into the bone until its proximal end lies beneath the bone surface by such a distance.

15. A surgical screwdriver as set forth in claim 14, wherein such distance is approximately 5 mm.

16. A surgical screwdriver as set forth in claim 13, wherein each linkage member includes a male end and a female end, the female end being adapted for engaging a male end of an adjacent linkage member.

17. A surgical screwdriver as set forth in claim 16, wherein the male end includes a tongue lying generally in a first plane parallel to the longitudinal bore, and the female end includes a channel adapted to receive the tongue of an adjacent member, the channel defining a second plane parallel to the longitudinal bore, wherein the first and second planes are less than perpendicular to one another.

18. A surgical screwdriver as set forth in claim 16, wherein the proximal end of the rigid shaft handle terminates in one of a male end and a female end for engaging the other of a male end and a female end of a linkage member.

19. A surgical screwdriver as set forth in claim 18, wherein the flexible shaft portion terminates in one of a male end and a female end for engaging the other of a male end and a female end of the drive tip.

20. A surgical screwdriver as set forth in claim 16 wherein the linkage member is generally cylindrical in shape.

21. A surgical screwdriver as set forth in claim 16 further including a flexible sheath disposed about the entire series of linkage members of the flexible shaft portion.

22. A surgical screwdriver as set forth in claim 21, wherein the flexible sheath is also disposed about the rigid shaft portion.

23. A surgical screwdriver for rotationally advancing a screw into a bone, the screwdriver comprising:

(a) a rotatable rigid shaft portion having a distal end, a proximal end, and a passageway extending from the distal end to the proximal end along a longitudinal axis;

(b) a flexible shaft portion coupled to the distal end of the stiff shaft portion for being rotated upon rotation of the stiff shaft portion, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough and being joined to an adjacent linkage member via a link so as to permit adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis;

(c) a handle fixed to the proximal end of the rigid shaft portion for rotating the stiff shaft portion; and

(d) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for advancing, upon rotation of the handle, a cannulated screw situated on a guide wire;

wherein the handle is cannulated and the passageway aligned so that the guide wire may extend up through the drive tip, through the flexible and rigid shaft portions, and out through the handle.

24. A surgical screwdriver for rotationally advancing a screw into a bone, the screwdriver comprising:

(a) a rotatable rigid shaft portion having a distal end, a proximal end, and a passageway extending from the distal end to the proximal end along a longitudinal axis;

(b) a flexible shaft portion coupled to the distal end of the stiff shaft portion for being rotated upon rotation of the stiff shaft portion, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough and being joined to an adjacent linkage member via a link so as to permit adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis;

(c) a handle fixed to the proximal end of the rigid shaft portion for rotating the stiff shaft portion; and

(d) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for advancing, upon rotation of the handle, a cannulated screw situated on a guide wire;

wherein each linkage member includes a male end and a female end, the female end being adapted for engaging a male end of an adjacent linkage member, and

wherein the male end includes a tongue lying generally in a first plane parallel to the longitudinal bore, and the female end includes a channel adapted to receive the tongue of an adjacent linkage member, the channel defining a second plane parallel to the longitudinal bore, wherein the first and second planes are perpendicular to one another.

25. A surgical screwdriver for rotationally advancing a screw into a bone, the screwdriver comprising:

(a) a rotatable rigid shaft portion having a distal end, a proximal end, and a passageway extending from the distal end to the proximal end along a longitudinal axis;

(b) a flexible shaft portion coupled to the distal end of the rotatable rigid shaft portion, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough;

(c) a plurality of links, each link joining a linkage member to an adjacent linkage member to permit torque to be transmitted along the linkage members while permitting adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis;

(d) a handle fixed to the proximal end of the rigid shaft portion for rotating the stiff shaft portion; and

(e) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for advancing, upon rotation of the handle, a cannulated screw situated on a guide wire;

wherein each linkage member, being generally cylindrical in shape, includes a male end and a female end, the female end being adapted to engage a male end of an adjacent linkage member; and

wherein each linkage member further includes a ring positioned circumferentially about the female end thereof for securing the engagement between the female end and the male end of the adjacent linkage members.

26. A surgical screwdriver for rotationally advancing a screw into a bone, the screwdriver comprising:

(a) a rotatable rigid shaft portion having a distal end, a proximal end, and a passageway extending from the distal end to the proximal end along a longitudinal axis;

(b) a flexible shaft portion coupled to the distal end of the stiff shaft portion for being rotated upon rotation of the stiff shaft portion, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough and being joined to an adjacent linkage member via a link so as to permit adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis;

(c) a handle fixed to the proximal end of the rigid shaft portion for rotating the stiff shaft portion; and

(d) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for advancing, upon rotation of the handle, a cannulated screw situated on a guide wire;

wherein the handle includes a longitudinal tunnel so that the screwdriver possesses an axially disposed cannula.

27. A screwdriver comprising:

(a) a rotatable handle having a distal portion, and a central longitudinal axis;

(b) a flexible shaft portion coupled to the distal portion of the handle, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough;

(c) a plurality of links, each link joining a linkage member to an adjacent linkage member, so as to permit torque to be transmitted along the linkage members while permitting adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis to conform generally to a curvature along the longitudinal axis; and

(d) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for driving a cannulated screw with rotation transmitted from the flexible shaft portion;

wherein each linkage member includes a male end and a female end, the female end being adapted to engage a male end of an adjacent linkage member, and

wherein the male end includes a tongue lying generally in a first plane parallel to the longitudinal bore, and the female end includes a channel adapted to receive the tongue of an adjacent linkage member, the channel defining a second plane parallel to the longitudinal bore, wherein the first and second planes are perpendicular to one another.

28. A screwdriver comprising:

(a) a rotatable handle having a distal portion, and a central longitudinal axis;

(b) a flexible shaft portion coupled to the distal portion of the handle, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough;

(c) a plurality of links, each link joining a linkage member to an adjacent linkage member, so as to permit torque to be transmitted along the linkage members while permitting adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis to conform generally to a curvature along the longitudinal axis; and

(d) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for driving a cannulated screw with rotation transmitted from the flexible shaft portion;

wherein each linkage member, being generally cylindrical in shape, includes a male end and a female end, the female end being adapted to engage a male end of an adjacent linkage member, and

wherein each linkage member further includes a ring positioned circumferentially about the female end thereof for securing the engagement between the female end and the male end of an adjacent linkage member.

29. A screwdriver comprising:

(a) a rotatable handle having a distal portion, and a central longitudinal axis;

(b) a flexible shaft portion coupled to the distal portion of the handle, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough;

(c) a plurality of links, each link joining a linkage member to an adjacent linkage member, so as to permit torque to be transmitted along the linkage members while permitting adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis to conform generally to a curvature along the longitudinal axis; and

(d) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for driving a cannulated screw with rotation transmitted from the flexible shaft portion;

wherein the handle includes a tunnel along the longitudinal axis so that the entire screwdriver possesses an axially disposed cannula.

30. A surgical screwdriver for rotationally advancing a screw into a bone, the screwdriver comprising:

(a) a rotatable rigid shaft portion having a distal end, a proximal end, and a passageway extending from the distal end to the proximal end along a longitudinal axis;

(b) a flexible shaft portion coupled to the distal end of the rotatable rigid shaft portion, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough;

(c) a plurality of links, each link joining a linkage member to an adjacent linkage member to permit torque to be transmitted along the linkage members while permitting adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis;

(d) a handle fixed to the proximal end of the rigid shaft portion for rotating the stiff shaft portion; and

(e) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for advancing, upon rotation of the handle, a cannulated screw situated on a guide wire;

wherein the handle is cannulated and the passageway aligned so that the guide wire may extend up through the drive tip, through the flexible and rigid shaft portions, and out through the handle.

31. A surgical screwdriver for rotationally advancing a screw into a bone, the screwdriver comprising:

(a) a rotatable rigid shaft portion having a distal end, a proximal end, and a passageway extending from the distal end to the proximal end along a longitudinal axis;

a flexible shaft portion coupled to the distal end of the rotatable rigid shaft portion, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough;

(c) a plurality of links, each link joining a linkage member to an adjacent linkage member to permit torque to be transmitted along the linkage members while permitting adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis;

(d) a handle fixed to the proximal end of the rigid shaft portion for rotating the stiff shaft portion; and

(e) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for advancing, upon rotation of the handle, a cannulated screw situated on a guide wire;

wherein each linkage member includes a male end and a female end, the female end being adapted for engaging a male end of an adjacent linkage member, and

wherein the male end includes a tongue lying generally in a first plane parallel to the longitudinal bore, and the female end includes a channel adapted to receive the tongue of an adjacent linkage member, the channel defining a second plane parallel to the longitudinal bore, wherein the first and second planes are perpendicular to one another.

32. A surgical screwdriver for rotationally advancing a screw into a bone, the screwdriver comprising:

(a) a rotatable rigid shaft portion having a distal end, a proximal end, and a passageway extending from the distal end to the proximal end along a longitudinal axis;

(b) a flexible shaft portion coupled to the distal end of the rotatable rigid shaft portion, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough;

(c) a plurality of links, each link joining a linkage member to an adjacent linkage member to permit torque to be transmitted along the linkage members while permitting adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis;

(d) a handle fixed to the proximal end of the rigid shaft portion for rotating the stiff shaft portion; and

(e) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for advancing, upon rotation of the handle, a cannulated screw situated on a guide wire;

wherein each linkage member, being generally cylindrical in shape, includes a male end and a female end, the female end being adapted to engage a male end of an adjacent linkage member; and

wherein each linkage member further includes a ring positioned circumferentially about the female end thereof for securing the engagement between the female end and the male end of the adjacent linkage members.

33. A surgical screwdriver for rotationally advancing a screw into a bone, the screwdriver comprising:

(a) a rotatable handle having a distal portion, and a central longitudinal axis;

(b) a flexible shaft portion coupled to the distal portion of the handle, the flexible shaft portion having a plurality of linkage members disposed in series, each linkage member having a bore extending longitudinally therethrough;

(c) a plurality of links, each link joining a linkage member to an adjacent linkage member, so as to permit torque to be transmitted along the linkage members while permitting adjacent linkage members to be pivotally movable with respect to one another about a pivot axis that is transverse to the longitudinal axis to conform generally to a curvature along the longitudinal axis; and

(d) a cannulated drive tip attached to a terminal linkage member of the flexible shaft portion for driving a cannulated screw with rotation transmitted from the flexible shaft portion;

wherein the handle includes a longitudinal tunnel so that the screwdriver possesses an axially disposed cannula.