Coordinate instrument set

Abstract

Surgical instruments for use in mapping tissue defects include telescoping rulers and tubes. One of the instruments has a pointed anchoring tip for piercing tissue near the site of the defect. Another instrument has a hook for catching an anatomical landmark. Measuring portions of the rulers of both instruments include distance indicia so that a coordinate system can be established for mapping the location of the defect or of an implant at the defect site. The coordinate system can be re-established at a later time using the same fixation point for the anchoring tip and the same landmark for the hook to evaluate the clinical effects of the treatment selected. The method of using the instrument set is also described.

1 . A surgical instrument having a proximal end and a distal end, the surgical instrument comprising a tube and a ruler, 
 the tube having a proximal end, a distal end, and an elongate channel;    the ruler having a proximal end, a distal end, a straight portion received within the channel of the tube, a measurement portion between the straight portion and the distal end, and an anchoring tip at the distal end, the measurement portion of the ruler including distance indicia and the anchoring tip having a pointed end;    wherein the measurement portion of the ruler lies in a plane;    wherein the pointed end of the anchoring tip is spaced from the plane of the measurement portion of the ruler; and    wherein the ruler is reciprocable in a proximal-distal direction with respect to the tube between a retracted position and an extended position.    
     
     
         2 . The surgical instrument of  claim 1  wherein in the retracted position at least part of the measurement portion of the ruler is received within the channel of the tube and in the extended position at least part of the measurement portion of the ruler is exposed outside of the channel of the tube.  
     
     
         3 . The surgical instrument of  claim 1  wherein the anchoring tip of the ruler comprises a segment of the ruler having a longitudinal axis that intersects the plane of the measurement portion of the ruler.  
     
     
         4 . The surgical instrument of  claim 3  wherein the longitudinal axis of the anchoring tip is perpendicular to the plane of the measurement portion of the ruler.  
     
     
         5 . The surgical instrument of  claim 1  wherein at least part of the measurement portion of the ruler is curved when the ruler is in the extended position.  
     
     
         6 . The surgical instrument of  claim 1  wherein at least part of the ruler comprises a shape-memory material.  
     
     
         7 . The surgical instrument of  claim 6  wherein at least part of the ruler comprises nitinol.  
     
     
         8 . The surgical instrument of  claim 1  wherein at least part of the ruler comprises a super-elastic material.  
     
     
         9 . The surgical instrument of  claim 8  wherein the super-elastic material comprises nitinol.  
     
     
         10 . The surgical instrument of  claim 1  further comprising a handle having a proximal end and a distal end, the distal end of the handle being connected to the proximal end of the tube, the handle further having a channel aligned with the channel of the tube.  
     
     
         11 . The surgical instrument of  claim 10  further comprising an actuator shaft having a proximal end and a distal end, the distal end of the actuator shaft being connected to the proximal end of the ruler, at least part of the actuator shaft being received in the channel of the handle, the actuator shaft being reciprocable in a proximal-distal direction with respect to the channel of the handle.  
     
     
         12 . The surgical instrument of  claim 11  wherein the proximal end of the actuator shaft is exposed beyond the proximal end of the handle when the ruler is in the retracted position and when the ruler is in the extended position.  
     
     
         13 . The surgical instrument of  claim 12  wherein a portion of the actuator shaft includes distance indicia that are exposed beyond the proximal end of the handle when the ruler is in the retracted position and when the ruler is in the extended position.  
     
     
         14 . The surgical instrument of  claim 1  wherein the distal end of the tube has a maximum cross-sectional outer dimension of 12 mm or less.  
     
     
         15 . The surgical instrument of  claim 1  wherein the tube has a proximal portion having a longitudinal axis and a distal portion having a longitudinal axis intersecting the longitudinal axis of the proximal portion.  
     
     
         16 . A surgical instrument having a proximal end and a distal end, the surgical instrument comprising a tube and a ruler, 
 the tube having a proximal end, a distal end, and an elongate channel;    the ruler having a proximal end, a distal end, a straight portion received within the channel of the tube, a measurement portion between the straight portion and the distal end and a hook at the distal end, the measurement portion of the ruler including distance indicia;    wherein the ruler is reciprocable in a proximal-distal direction with respect to the tube between a retracted position and an extended position.    
     
     
         17 . The surgical instrument of  claim 16  wherein in the retracted position at least part of the measurement portion of the ruler is received within the channel of the tube and in the extended position at least part of the measurement portion of the ruler is exposed outside of the channel of the tube.  
     
     
         18 . The surgical instrument of  claim 16  wherein at least part of the ruler comprises a shape-memory material.  
     
     
         19 . The surgical instrument of  claim 18  wherein at least part of the ruler comprises nitinol.  
     
     
         20 . The surgical instrument of  claim 16  wherein at least part of the ruler comprises a super-elastic material.  
     
     
         21 . The surgical instrument of  claim 20  wherein the super-elastic material comprises nitinol.  
     
     
         22 . The surgical instrument of  claim 16  further comprising a handle having a proximal end and a distal end, the distal end of the handle being connected to the proximal end of the tube, the handle further having a channel aligned with the channel of the tube.  
     
     
         23 . The surgical instrument of  claim 22  further comprising an actuator shaft having a proximal end and a distal end, the distal end of the actuator shaft being connected to the proximal end of the ruler, at least part of the actuator shaft being received in the channel of the handle, the actuator shaft being reciprocable in a proximal-distal direction with respect to the channel of the handle.  
     
     
         24 . The surgical instrument of  claim 23  wherein the proximal end of the actuator shaft is exposed beyond the proximal end of the handle when the ruler is in the retracted position and when the ruler is in the extended position.  
     
     
         25 . The surgical instrument of  claim 24  wherein a portion of the actuator shaft includes distance indicia that are exposed beyond the proximal end of the handle when the ruler is in the retracted position and when the ruler is in the extended position.  
     
     
         26 . The surgical instrument of  claim 16  wherein the distal end of the tube has a maximum cross-sectional outer dimension of 12 mm or less.  
     
     
         27 . The surgical instrument of  claim 16  wherein the tube has a proximal portion having a longitudinal axis and a distal portion having a longitudinal axis intersecting the longitudinal axis of the proximal portion.  
     
     
         28 . The surgical instrument of  claim 16  wherein the ruler is straight between the hook and the proximal end of the ruler and the tube is straight along its length.  
     
     
         29 . The surgical instrument of  claim 16  wherein the tube includes an angled distal portion and a straight portion.  
     
     
         30 . The surgical instrument of  claim 16  wherein the tube includes a curved portion and a straight portion.  
     
     
         31 . A surgical instrument set comprising first and second surgical instruments, each surgical instrument having a proximal end and a distal end, and each surgical instrument comprising a tube and a ruler, 
 the tube of each surgical instrument having a proximal end, a distal end and a channel extending from the proximal to the distal end;    the ruler of each surgical instrument having a proximal end, a distal end, a measurement portion between the proximal end and the distal end and a straight portion between the measurement portion and the proximal end, the measurement portion including distance indicia;    wherein the straight portion of the ruler of each surgical instrument has a longitudinal axis;    wherein the ruler of each surgical instrument is reciprocable in a proximal-distal direction with respect to the tube between a retracted position and an extended position; and    wherein the distal end of the ruler of the first surgical instrument comprises an anchoring tip having a pointed end and the distal end of the ruler of the second surgical instrument comprises a hook.    
     
     
         32 . The surgical instrument set of  claim 31  wherein in the retracted position at least part of the measurement portion of the ruler of each instrument is received within the channel of the tube and in the extended position at least part of the measurement portion of the ruler of each instrument is exposed outside of the channel of the tube.  
     
     
         33 . The surgical instrument set of  claim 31  wherein the measurement portion of the ruler of each instrument lies in a plane and wherein the pointed end of the anchoring tip of the first instrument is spaced from the plane of the measurement portion of the ruler of that instrument.  
     
     
         34 . The surgical instrument set of  claim 33  wherein the anchoring tip comprises a segment of the ruler having a longitudinal axis that intersects the plane of the measurement portion of the ruler of the first surgical instrument.  
     
     
         35 . The surgical instrument set of  claim 34  wherein the longitudinal axis of the anchoring tip is perpendicular to the plane of the measurement portion of the ruler of the first surgical instrument.  
     
     
         36 . The surgical instrument set of  claim 31  wherein at least part of the measurement portion of the ruler of the second surgical instrument is angled in one direction with respect to the longitudinal axis of the straight portion of the ruler of the second surgical instrument when the ruler of the second instrument is in the extended position.  
     
     
         37 . The surgical instrument set of  claim 36  wherein at least part of the measurement portion of the ruler of the second surgical instrument is perpendicular to the longitudinal axis of the straight portion of the ruler of that instrument when the ruler is in the extended position.  
     
     
         38 . The surgical instrument set of  claim 36  wherein a least part of the measurement portion of the ruler of the second surgical instrument defines an acute angle with the longitudinal axis of the straight portion of the ruler of the second surgical instrument when the ruler of the second surgical instrument is in the extended position.  
     
     
         39 . The surgical instrument set of  claim 31  wherein at least part of the measurement portion of the ruler of the first surgical instrument is curved.  
     
     
         40 . The surgical instrument set of  claim 31  wherein at least part of the ruler of each surgical instrument comprises a shape-memory material.  
     
     
         41 . The surgical instrument set of  claim 40  wherein at least part of the ruler of each surgical instrument comprises nitinol.  
     
     
         42 . The surgical instrument set of  claim 31  wherein at least part of the ruler of each surgical instrument comprises a super-elastic material.  
     
     
         43 . The surgical instrument set of  claim 42  wherein the super-elastic material of each surgical instrument comprises nitinol.  
     
     
         44 . The surgical instrument set of  claim 31  wherein each surgical instrument includes a handle having a proximal end and a distal end, the distal end of the handle being connected to the proximal end of the tube of that instrument, the handle further having a channel aligned with the channel of the tube of that instrument.  
     
     
         45 . The surgical instrument set of  claim 44  wherein each instrument includes an actuator shaft having a proximal end and a distal end, the distal end of the actuator shaft being connected to the proximal end of the ruler of that instrument, at least part of the actuator shaft being received in the channel of the handle of that instrument, the actuator shaft being reciprocable in a proximal-distal direction in the channel of the handle of that instrument.  
     
     
         46 . The surgical instrument set of  claim 45  wherein the proximal end of the actuator shaft of each instrument is exposed beyond the proximal end of the handle of that instrument when the ruler of that instrument is in the retracted position and when the ruler of that instrument is in the extended position.  
     
     
         47 . The surgical instrument set of  claim 46  wherein a portion of the actuator shaft of each instrument includes distance indicia that are exposed beyond the proximal end of the handle of that instrument when the ruler of that instrument is in the retracted position and when the ruler of that instrument is in the extended position.  
     
     
         48 . The surgical instrument set of  claim 31  wherein the distal end of the tube of each instrument has a maximum cross-sectional outer dimension of 12 mm or less.  
     
     
         49 . The surgical instrument set of  claim 31  wherein the tube of the second surgical instrument is straight along its entire length.  
     
     
         50 . The surgical instrument set of  claim 31  wherein the tube of the second surgical instrument has a proximal portion having a longitudinal axis and a distal portion having a longitudinal axis intersecting the longitudinal axis of the proximal portion.  
     
     
         51 . The surgical instrument set of  claim 31  wherein the measurement portion of the ruler of the first surgical instrument has one shape when the ruler of that instrument is in the extended position and the measurement portion of the ruler of the second surgical instrument has a different shape when the ruler of that instrument is in the extended position.  
     
     
         52 . The surgical instrument set of  claim 31  wherein in the retracted position at least part of the measurement portion of the ruler of each instrument is received within the channel of the tube and in the extended position at least part of the measurement portion of the ruler of each instrument is exposed outside of the channel of the tube.  
     
     
         53 . A surgical instrument set comprising a plurality of surgical instruments, each surgical instrument having a proximal end and a distal end, and each surgical instrument comprising a tube and a ruler, 
 the tube of each surgical instrument having a proximal end, a distal end and a channel extending from the proximal to the distal end;    the ruler of each surgical instrument having a proximal end, a distal end, a measurement portion between the proximal end and the distal end and a straight portion between the measurement portion and the proximal end, the measurement portion including distance indicia;    wherein the straight portion of the ruler of each surgical instrument has a longitudinal axis;    wherein the ruler of each surgical instrument is reciprocable in a proximal-distal direction with respect to the tube between a retracted position and an extended position; and    wherein the measurement portion of the ruler of each surgical instrument extends in a different direction from the longitudinal axis of the straight portion when the ruler is in the extended position.    
     
     
         54 . The surgical instrument set of  claim 53  wherein in the retracted position at least part of the measurement portion of the ruler of each instrument is received within the channel of the tube and in the extended position at least part of the measurement portion of the ruler of each instrument is exposed outside of the channel of the tube.  
     
     
         55 . The surgical instrument set of  claim 53  wherein the distal end of the ruler of one instrument includes an anchoring tip having a pointed end.  
     
     
         56 . The surgical instrument set of  claim 53  wherein the measurement portion of the ruler of each instrument lies in a plane and wherein the pointed end of the anchoring tip is spaced from the plane of the measurement portion of the ruler of that instrument.  
     
     
         57 . The surgical instrument set of  claim 56  wherein the anchoring tip comprises a segment of the ruler having a longitudinal axis that intersects the plane of the measurement portion of that ruler.  
     
     
         58 . The surgical instrument set of  claim 57  wherein the longitudinal axis of the anchoring tip is perpendicular to the plane of the measurement portion of the ruler.  
     
     
         59 . The surgical instrument set of  claim 53  wherein at least part of the measurement portion of the ruler of one instrument is angled in one direction with respect to the longitudinal axis of the straight portion of the ruler of that instrument and at least part of the measurement portion of the ruler of another instrument is angled in another direction with respect to the straight portion of the ruler of that instrument when the rulers are in the extended position.  
     
     
         60 . The surgical instrument set of  claim 59  wherein at least part of the measurement portion of the ruler of at least one instrument is perpendicular to the longitudinal axis of the straight portion of the ruler of that instrument when the ruler is in the extended position.  
     
     
         61 . The surgical instrument set of  claim 59  wherein at least part of the measurement portion of the ruler of at least one instrument defines an acute angle with the longitudinal axis of the straight portion of the ruler of that instrument when the ruler is in the extended position.  
     
     
         62 . The surgical instrument set of  claim 53  wherein at least part of the measurement portion of the ruler of one instrument is curved in one direction and at least part of the measurement portion of the ruler of another instrument is curved in an opposite direction.  
     
     
         63 . The surgical instrument set of  claim 53  wherein at least part of the ruler of each instrument comprises a shape-memory material.  
     
     
         64 . The surgical instrument set of  claim 63  wherein at least part of the ruler of each instrument comprises nitinol.  
     
     
         65 . The surgical instrument set of  claim 53  wherein at least part of the ruler of each instrument comprises a super-elastic material.  
     
     
         66 . The surgical instrument set of  claim 65  wherein the super-elastic material of each instrument comprises nitinol.  
     
     
         67 . The surgical instrument set of  claim 53  wherein each instrument includes a handle having a proximal end and a distal end, the distal end of the handle being connected to the proximal end of the tube of that instrument, the handle further having a channel aligned with the channel of the tube of that instrument.  
     
     
         68 . The surgical instrument set of  claim 67  wherein each instrument includes an actuator shaft having a proximal end and a distal end, the distal end of the actuator shaft being connected to the proximal end of the ruler of that instrument, at least part of the actuator shaft being received in the channel of the handle of that instrument, the actuator shaft being reciprocable in a proximal-distal direction in the channel of the handle of that instrument.  
     
     
         69 . The surgical instrument set of  claim 68  wherein the proximal end of the actuator shaft of each instrument is exposed beyond the proximal end of the handle of that instrument when the ruler of that instrument is in the retracted position and when the ruler of that instrument is in the extended position.  
     
     
         70 . The surgical instrument set of  claim 69  wherein a portion of the actuator shaft of each instrument includes distance indicia that are exposed beyond the proximal end of the handle of that instrument when the ruler of that instrument is in the retracted position and when the ruler of that instrument is in the extended position.  
     
     
         71 . The surgical instrument set of  claim 53  wherein the distal end of the tube of each instrument has a maximum cross-sectional outer dimension of 12 mm or less.  
     
     
         72 . The surgical instrument set of  claim 53  wherein the tube of at least one instrument is straight along its entire length.  
     
     
         73 . The surgical instrument set of  claim 53  wherein a portion of the tube of one instrument is curved in one direction and a portion of the tube of another instrument is curved in an opposite direction.  
     
     
         74 . The surgical instrument set of  claim 53  wherein the tube of at least one instrument has a proximal portion having a longitudinal axis and a distal portion having a longitudinal axis intersecting the longitudinal axis of the proximal portion.  
     
     
         75 . The surgical instrument set of  claim 53  wherein the measurement portion of the ruler of one instrument has one shape when the ruler of that instrument is in the extended position and the measurement portion of the ruler of another instrument has a different shape when the ruler of that instrument is in the extended position.  
     
     
         76 . A method of mapping a feature of a tissue site of a patient with a surgical instrument, the surgical instrument including a tube and a ruler reciprocable with respect to the tube between a retracted position and an extended position, the ruler including a distal end and distance indicia, the method comprising: 
 moving a portion of the tube to the tissue site with at least part of the ruler retracted;    piercing the tissue with a portion of the ruler at a selected fixation point to temporarily anchor the distal end of the ruler to the tissue at the fixation point;    moving the tube with respect to the ruler so that the ruler is in the extended position;    determining a distance based on the position of the tissue feature with respect to the fixation site; and    moving the tube with respect to the ruler so that the ruler is in the retracted position and removing the tube and ruler from the tissue site.    
     
     
         77 . The method of  claim 76  wherein distance is determined by viewing distance indicia outside of the arthroscopic portal.  
     
     
         78 . The method of  claim 76  further comprising the steps of: 
 providing a second surgical instrument including a tube and a ruler reciprocable with respect to the tube between a retracted position and an extended position, the ruler including a distal end and distance indicia;    moving a portion of the tube of the second instrument to the tissue site with at least part of the ruler retracted;    fixing an end of the ruler to the tissue at a second location spaced from the fixation point;    moving the tube of the second instrument with respect to the ruler so that the ruler is in the extended position and wherein a portion of the ruler of the second instrument crosses a portion of the ruler of the first instrument;    determining a distance based on the position of the ruler of the second instrument with respect to the ruler of the first instrument; and    moving the tube with respect to the ruler so that the ruler is in the retracted position and removing the tube and ruler from the tissue site.    
     
     
         79 . The method of  claim 76  further comprising moving a portion of the tube to the same tissue site in the same patient at a later time, guiding the tube to the same tissue site with at least part of the ruler in the retracted position, moving the ruler to the extended position, piercing the tissue at a selected location to temporarily anchor the distal end of the ruler to the fixation point; determining a location based on the position of part of the ruler with respect to the fixation point and moving the ruler to the retracted position and removing the tube and ruler from the tissue site.  
     
     
         80 . The method of  claim 79  wherein the fixation point is substantially the same in both procedures.  
     
     
         81 . The method of  claim 76  wherein the tissue site is the meniscus.  
     
     
         82 . A method of measuring a feature of a tissue site within the body of a patient with a surgical instrument, 
 the surgical instrument including a tube having a proximal end and a distal end, an elongated member reciprocable with respect to the tube between a distally retracted position and a distally extended position, the elongated member having a proximal end and a distal end, and distance indicia at the proximal end of the elongated member, the method comprising:    moving the distal end of the tube to the tissue site within the body of the patient;    positioning the distal end of the elongated member at a first desired location;    moving the tube with respect to the elongated member so that the distal end of the tube is at a second desired location while the position of the distal end of the elongated member is maintained at the first desired location;    determining the distance between the first desired location and the second desired location by observing the distance indicia at the proximal end of the elongated member.    
     
     
         83 . The method of  claim 82  wherein the elongated member comprises an assembly of a ruler at the distal end and a shaft at the proximal end.  
     
     
         84 . The method of  claim 82  wherein the proximal end of the elongated member is maintained outside of the patient's body throughout the procedure.  
     
     
         85 . The method of  claim 82  wherein the tissue site is the meniscus of the knee.  
     
     
         86 . A method of mapping a feature of a tissue site of a patient with a surgical coordinate instrument and a surgical measuring instrument, the surgical coordinate instrument including a tube and a coordinate ruler reciprocable with respect to the tube between a retracted position and an extended position, the coordinate ruler including a distal end and distance indicia, the surgical measuring instrument including a tube and a ruler reciprocable with respect to the tube between a retracted position and an extended position, the ruler including a distal end and distance indicia, the method comprising: 
 moving a portion of the tube of the coordinate instrument to the tissue site with at least part of the coordinate ruler retracted, piercing the tissue with a portion of the coordinate ruler at a selected fixation point to temporarily anchor the distal end of the coordinate ruler to the tissue at the fixation point, moving the tube with respect to the coordinate ruler so that the coordinate ruler is in the extended position;    moving a portion of the tube of the measuring instrument to the tissue site with at least part of the ruler retracted, placing the distal end of the ruler at a desired location related to the feature to be mapped, moving the tube with respect to the ruler until a portion of the measuring instrument crosses the coordinate ruler;    determining the distance between a portion of the surgical measuring instrument and the coordinate ruler.    
     
     
         87 . The method of  claim 86  wherein the step of determining the distance between a portion of the surgical measuring instrument and the coordinate ruler comprises determining the distance between the hook and a location on the coordinate ruler.  
     
     
         88 . The method of  claim 86  wherein the feature to be mapped comprises a defect and wherein the desired location for placement of the distal end of the ruler of the measuring instrument comprises a portion of the defect.  
     
     
         89 . A surgical instrument having a proximal end and a distal end, the instrument comprising: 
 a handle at the proximal end;    a tube extending distally from the handle, the tube defining a channel;    a first gear rotatably mounted to the handle, the first gear having a plurality of grooved teeth;    a second gear rotatably mounted to the handle, the second gear having a plurality of grooved teeth intermeshed with the grooved teeth of the first gear, the grooves of the intermeshed teeth of the first gear and second gear defining a passageway aligned with the channel of the tube; and    an elongated member extending through the passageway and into the channel of the tube, the elongated member being movable in a proximal direction by rotating the first gear in one direction and being movable in the distal direction by rotating the first gear in the opposite direction;    wherein the elongated member has a distal end and includes distance indicia at the distal end.    
     
     
         90 . The surgical instrument of  claim 89  wherein the elongated member has a proximal end and includes distance indicia at the proximal end.  
     
     
         91 . The surgical instrument of  claim 90  wherein the proximal end of the elongated member extends out the proximal end of the handle.  
     
     
         92 . The surgical instrument of  claim 91  wherein the elongated member comprises an assembly of a ruler and a shaft.