The system includes a retractor 1100 that is self-supporting and may be configured for insertion into a small incision near the knee. Retractor 1100 is preferably placed subcutaneously and along the surface of the Quadriceps Tendon, hereinafter “QT”. The retractor preferably lies on the anterior surface of the QT. The retractor 1100 forms a working cavity for access to and visibility of the QT. Retractor 1100 is configured to provide access for the plurality of instruments of the system to the tendon via the working cavity. Retractor 1100 is configured to hold the working cavity open or tent the skin away from the tendon surface without requiring external forces, and is thereby self-supporting. External forces that are not required include for example a positioning arm or stand, a robot arm, or a second person with a paddle retractor. The retractor 1100 is configured to receive and/or operatively engage and guide the plurality of instruments, such as dissector 1200, harvester 1300 and proximal cutter 1400, while forming the strip of tendon tissue.

The blunt dissector 1200 may perform a plurality of functions, both independent of other portions of the system 1000, and while assembled thereto. For example, the blunt dissector 1200 may dissect the tissue before the retractor 1100 is inserted. Blunt dissector 1200 may also operatively couple to the retractor 1100 to provide a handle for retractor insertion and manipulation. Blunt dissector 1200 may also provide a trajectory guide to limit the trajectory of the harvester 1300. In some system embodiments, a separate tool may dissect the tissue first. The harvester 1300 may be configured to form two lateral sides of the tendon strip simultaneously, using portions of the retractor 1100 and blunt dissector 1200 as a guide to control the cut trajectory. The proximal cutter 1400 may slide along the retractor's working cavity and along a partially dissected tendon strip and disconnect the proximal end of the tendon strip from the native tendon.

Turning now to the details of the individual components of system 1000, and starting with the retractor 1100, a variety of views are illustrated in at least FIG. 2A-2J. Retractor 1100 may be a unibody or single molded element, formed of a flexible material. Retractor is configured to be collapsed, or reduced in profile and then inserted through an incision and under the skin. Once inserted, retractor 1100 is generally self-supporting and configured to hold open the anatomic space it is inserted into for performing minimally invasive surgical procedures. The retractor 1100 defines an elongate body, with proximal and distal ends, and may have a general arch shape or “C” shaped cross-section, defining a passage and longitudinal working cavity therealong. Retractor 1100 preferably includes a rounded, tapered or streamlined shape along its length to facilitate insertion along the dissected space anterior of the tendon, with minimized tissue trauma. Retractor 1100 proximal end 1110 may be enclosed, with a lower profile than distal end 1120. Retractor floor defines a planar lower surface 1118 along its length, to lie relatively flat on an anterior surface of the QT. The QT may not necessarily be perfectly flat, but is considered mostly planar along its length, to engage a substantial portion of the planer lower surface 1118. Retractor 1100 may be formed of a plastic, and may be translucent to facilitate better tissue visualization. In addition to being formed of a flexible material, retractor 1100 also includes a plurality of reliefs to improve elastic deformation of the retractor 1100, for easier insertion through the incision and under the skin. However, the retractor 1100 is sufficiently rigid to return towards its non-deformed shape once under the skin, and push the skin up to form a tent or working cavity. This provides the surgeon with a working cavity on the target tendon, the tendon readily visualized through the incision and open distal end 1120 of retractor 1100. Retractor 1100 may include flanges 1117a, 1117b extending radially from a distal end 1120 of retractor 1100. Flanges 1117a, 1117b may mirror images of each other, either side of the longitudinal axis of the retractor 1100 and may extend orthogonal to the longitudinal axis. Flanges 1117a, 1117b may maintain a location of retractor relative to the skin incision. Flanges 1117a, 1117b may remain external to and directly adjacent the skin incision when retractor 1100 is inserted. Flanges 1117a, 1117b may act as a stop, limiting insertion depth of the retractor 1100 into the anatomical space.

Retractor 1100 defines a proximal end 1110 that is tapered and a distal end 1120 defining an opening for a surgeon to have direct visualization of the target tendon and place instruments therethrough. Retractor 1100 may be of any length that is suitable for harvesting the QT, and may be generally between 3-5 inches long in its entirety, and define a working cavity having a cross sectional dimension “W” between 1-2 inches. Since the skin incision is as small as possible, preferably no wider than an inch, the retractor is configured to collapse and fit through this small incision and then pop open once inserted.

Retractor 1100 may define a shell body. Retractor 1100 may include a plurality of reliefs 1115 and 1116. A proximal relief 1115 may provide additional retractor flexibility while also providing an access window for an optional scope or light source. These optional instruments may extend through the skin directly adjacent relief 1115 and then through relief 1115. Relief 1115 may define a 360 degree (°) bounded hole, the boundary defined entirely by the retractor 1100. Relief 1115 may be oblong in shape having a longer opening dimension across the width of retractor 1100.

Roof relief 1116 may extend from a distal end 1120 of retractor 1100, up to and including the distal most edge. Roof relief 1116 therefore defines a slot that has an open distal end. Roof relief 1116 may define a boundary with elongate ribs 1119 that extend around at least a portion of the boundary of relief 1116. Ribs 1119 may aid in further tenting the skin and may add some resilience to limit the skin from collapsing the retractor 1100 when inserted. Roof relief 1116 defines a medial boundary for bilateral wings 1112a, 1112b either side of the retractor 1100. Wings 1112a, 1112b may be squeezed or pinched together during insertion into the skin incision. As shown in FIG. 3, wings 1112a, 1112b are sufficiently flexible to touch or nearly touch for easy insertion through a relatively small incision. During pinching, the wings 1112a, 1112b move into the roof relief 1116 space.

Retractor has a cross sectional width W (FIG. 2E) that is preferable wider than the QT, to better identify surrounding structures. Retractor 1100 defines an upper curved roof portion 1124, bilateral sidewalls 1125a, 1125b (including the wings 1112a, 1112b), and bilateral stands 1126a, 1126b. The upper curved roof portion 1124 and bilateral sidewalls 1125a, 1125b are configured to lift or tent the skin. The bilateral stands 1126a, 1126b may define planar surfaces of the floor 1118 that may engage both the anterior surface of the QT and tissue lateral to the QT. For access to the anterior QT surface, bilateral stands 1126a and 1126b are laterally disposed and define an elongate medial opening 1130 along the retractor 1100. Bilateral stands 1126a and 1126b may define a smaller width opening (G2) towards the proximal end 1110. Small width opening G2 may be uniform along its entire length and may extend up to the proximal end of retractor 1100. This opening 1130 may limit a trajectory of a cutting tool along the retractor 1100 and thereby along the target tendon. Medial opening 1130 may extend from a distal-most edge of retractor 1100 and extend along a substantial portion of retractor length, best seen in at least FIGS. 2B and 2F. Medial opening 1130 may be bounded by straight edges 1131a, 1131b, that are parallel to retractor longitudinal axis L-L. Medial opening 1130 may by coextensive with relief 1115. Medial opening is configured to provide access for a harvester 1300 to the QT anterior surface.

Seen best in at least both FIGS. 2C, 2G and 2I, proximal end 1110 includes a nose 1132, extending proximally from relief 1115. Nose 1132 includes a pocket 1133 that is continuous with the working cavity. Pocket 1133 is configured to selectively operatively engage with a working end of a guide tool such as dissector 1200. In some embodiments, a guide tool may aid insertion and general handling of the retractor 1100. Guide tool may have a handle end, opposite the working end that extends along the retractor 1100 and out of retractor distal end 1120. Shown in FIGS. 5A and 5B pocket 1133 may operatively engage with a guide tool. Pocket 1133 may also include a means of positively engaging the example tool. Pocket 1133 may be sized to slideably receive guide tool working end, with a little clearance except for at a plurality of discrete locations, where crush ribs 1137 are located. FIG. 2J illustrates example locations of crush ribs 1137, that may extends along the longitudinal axis for a distance. Crush ribs 1137 are sized to locally reduce the pocket size and more positively engage a guides working end.

Pocket 1133 may also include a means of providing positive audible feedback to the user that the guide tool is correctly engaged with pocket 1133. Aperture 1134 for example may click as a corresponding mating tab snaps therein and engages the aperture 1134. Blunt dissector 1200 may include a protruding key or tab, shown in at least FIG. 4A that is received by aperture 1134. Aperture 1134 may define an axis perpendicular to the retractor long axis. Aperture 1134 may, in combination with tab on dissector 1200, increase retention between the retractor 1100 and blunt dissector 1200. Audible feedback, or a clicking feel once correctly inserted may compensate for obscured visibility when engaging the guide tool (dissector 1200) while the retractor 1100 is already inserted. Since the guide tool (dissector 1200) defines a trajectory of a cutting tool into the tendon, the correct insertion of the guide tool is important. Removal of the dissector 1200 from the retractor 1100 may require deformation of the flexible retractor 1100 adjacent the aperture 1134 to remove the mating tab 1226 from the aperture 1134.

Details of the blunt dissector 1200 are illustrated in at least FIGS. 4A-4E. Blunt dissector 1200 generally includes a handle end 1210, working end 1220 and a shaft 1230 extending therebetween. Working end 1220 includes a leading edge 1222 that may be linear across its extent and is generally blunt, configured to separate tissue layers. Blunt dissector 1200 may be inserted through incision near the knee and advanced under the skin, to bluntly separate the skin layers from the anterior QT surface. As such, leading edge or dissecting edge 1222 is preferably not so sharp to cut or pierce tissue. It may however break through connective tissue connecting the QT anterior surface from the skin layers. Blunt dissector 1200 may be configured to clear away the fat pad under the skin. Blunt dissector 1200 may perform this separation before inserting the retractor 1100.

Handle end 1210 may be angularly offset from the working end 1220. Shaft 1230 may include a bend, forming the angular offset. Shaft 1230 defines a distal length portion 1230a, extending directly from handle 1212. Shaft distal length portion 1230a may define a first cross section that is circular. Angular offset may be formed along the distal length portion 1230a. Angular offset may be between 140-160 (°) degrees and is configured to align the shaft proximal portion 1230b along the tendon surface while angling the handle 1212 around a bent knee and out of the way. Shaft proximal length portion 1230b may be non-circular. Proximal length portion 1230b may define a straight linear length, configured to lie on or lie parallel to the relatively flat QT anterior surface. Proximal length portion cross section may include at least one planar surface 1233 that extends along the proximal length portion 1230b, on a top side thereof, seen best in FIG. 4E. In some embodiments, cross section defines an inverted “V” cross section or an inverted cropped “V”. This cross section including the planar surface 1233 is configured to engage and guide a translation of a tendon-cutting tool, such as dual blade scalpel 1300, described in more detail later. Other possible configurations to guide and limit a trajectory of a cutting tool may include elongate slots or elongate rails along the dissector 1200 that operatively engage a mating feature of a cutting tool.

Proximal end of blunt dissector 1200 is shown in more detail in 4D. Shaft proximal length portion 1230b may include length indicators 1232 to indicate a length of QT or depth of insertion of the dissector 1200 along the QT. In some embodiments, working end 1220 may include indicators or markings (not shown) along the leading edge 1222, transverse the longitudinal axis of the shaft 1230 for estimating a width of tissue. Working end 1220 may be wider than shaft 1230, and may be termed a spatula. A tapered edge 1225 may extend between the shaft proximal length portion 1230b and leading edge 1222. Tapered edge 1225 may extend bilaterally from both sides of the shaft 1230 and, in some embodiments, may include a scalloped or cutting edge that may dissect connective tissue while retracting the blunt dissector 1200 (moving it distally). Tapered edge 1225 may also limit a trajectory extent of a cutting tool, as will be described later.

Top side of working end 1220 may include a tab or key 1226 to positively engage a mating feature of retractor 1100. Tab 1226 may be oblong and define a protruding element that inserts into aperture 1134. Tab 1226 may define a major length that is smaller than aperture 1134, allowing some lateral movement between the tab 1226 and aperture 1134, while limiting translation along the retractor longitudinal axis. FIG. 4E shows an example cross section of shaft proximal portion 1230b; including a lower side or surface 1231 that may be flat to engage the anterior surface of the QT. Superior surface 1233 is configured to engage and guide trajectory of a cutting tool, as will be explained hereinafter. Superior surface 1233 may be an inverted “V” or inverted cropped “V” and shaft portion 1230b may defining three surfaces angled relative to each other.

FIGS. 5A-5B illustrate various views of the dissector 1220 assembled with the retractor 1200, the retractor 1100 translucent in FIG. 5B for ease of understanding. Working end 1220 of blunt dissector may be selectively received by pocket 1133 of retractor 1100. Pocket 1133 may frictionally engage working end 1220. Pocket may include a plurality of discrete ribs 1137 to increase grip between the retractor 1100 and dissector 1200. Pocket 1133 may be sized relative to the working end 1220 such that retractor 1100 may deform or flex to receive working end 1220 therein. Pocket 1133 and blunt dissector 1200 may be coupled to aid insertion of retractor 1100 along the QT anterior surface. Alternatively, blunt dissector 1200 may be coupled once the retractor 1100 is inserted. When inserted along the QT anterior surface, lower surface 1231 may engage a portion the QT anterior surface and the shaft portion 1230b may align with longitudinal axis or retractor 1100 and preferably along a target cutting trajectory of the tendon. Blunt dissector 1200 may help in moving the retractor around while identifying the target cutting trajectory.

FIG. 6A-6D illustrates various views of a dual blade harvester 1300, configured to form two lateral sides of a resulting tendon strip 50′ simultaneously, hereafter termed “Harvester”. Relative to the patient, harvester 1300 forms two elongate cuts along the tendon 50, including a lateral and medial cut. Harvester 1300 includes a handle 1310 and working end 1320, with an elongate shaft 1330 therebetween. Shaft 1330 and handle 1310 may both extend along the same longitudinal axis. In other words, handle 1310 and shaft 1330 may not include any bend or angular offset, similar to the blunt dissector 1200. Handle 1310 and shaft 1330 may include reusable or multi use components, with a detachable working end 1320. In some embodiments, the working end 1320 is coupled to shaft 1330 via a release sleeve (not shown). In other embodiments, working end 1320 may define a housing 1322 fixedly coupled to shaft 1330 and include engagement means 1325 to selectively attach to blades 1340, illustrated in FIG. 6D. Engagement means 1325 may include elongate tabs, one each on lateral external surfaces of housing 1322. Engagement means may be oriented at an angle that defines a location of a leading cutting edge of blades 1340 and thereby depth of cut into the tendon. Blades 1340 may be standard scalpel blades. It is preferable that blades 1340 be single use and therefore consistently sharp for each procedure, as sterilization methods for reusable surgical tools tend to dull sharp edges. Harvester 1300 may be provided in varying configurations that may define selectable widths and depths of cut through and along the tendon. The different configurations may have differing widths and/or place the blades 1340 at differing angles to define the widths and depths of cut through and along the tendon. The two blades 1340 may preferably be parallel to each other, and form two equivalent cut depth into and along the QT simultaneously. Example lateral distances between blades 1340, defined by housing 1322 may be between 5-15 mm, and may more preferably be between 8-12 mm

Turning now to FIGS. 6B and 6C, housing 1322 defines a lower surface that may include an elongate channel 1324, the channel having a cross section that receives and operatively slides with guide proximal shaft 1230b therein. Channel 1324 may define a cross section shape that may form a sliding fit with shaft 1230b of guide 1200, as illustrated in FIGS. 7D and 7E. Channel 1324 may mate and slide along mating surface 1233 of blunt dissector. The channel 1324 and blunt dissector shaft 1230b are configured to guide the trajectory and depth of cut of the harvester 1300 and thereby the blades 1340 along the retractor 1100 and into the tendon. The lower surface 1231 of blunt dissector 1200 may engage the tendon anterior surface. In other embodiments, only the retractor lower surface may engage the QT anterior surface. Depth D of cut may therefore be defined and controlled by the configuration of blades 1340, the working end 1320 and shaft 1230b.

FIG. 7A illustrates the retractor 1100 placed on the tendon anterior surface 51, with the dissector 1200 assembled and inserted into retractor pocket 1133 and the harvester 1300 entering the retractor distal end 1110 and cutting into the tendon 50. FIG. 7B illustrates the harvester 1300 after translation along the tendon 50, at a proximal end of the retractor 1100. FIG. 7C illustrates a view of retractor proximal end 1110 with housing 1322 visible through relief 1115. FIG. 7D illustrates the harvester 1300 and dissector 1200 in a position similar to the shown in both FIGS. 7B and 7C, with the retractor 1100 removed for simplicity of understanding. In this location, blunt dissector 1200 may abut a surface of the harvester 1300 to limit the extent of this trajectory, thus proximally limiting the harvester translation. Tapered edge 1225 of dissector 1200 for example may be configured to limit the trajectory of harvester 1300, by abutting a distal surface 1326 and thereby blocking further translation. In other embodiments, a surface of the retractor may limit translation of harvester 1300.

FIG. 7F illustrate a cross section of the harvester 1300 engaging the dissector 1200 in a first position corresponding to FIG. 7A. Harvester 1300 may be at a distal end 1110 of retractor. FIG. 7G illustrate a cross section of the harvester 1300 engaging the dissector 1200 in a second position corresponding to FIG. 7B where the harvester 1300 has translated along the guide 1200 towards the proximal end of retractor 1100. Comparing FIG. 7F with FIG. 7G, it can be seen that the harvester angle α reduces as the harvester 1300 translates further into the retractor's working cavity. Channel 1324 is preferable contoured along its longitudinal axis to at least partially compensate for the changing angles of approach and maintain a substantially contact cut depth. For example, in the first position, the harvester is orientated at a larger angle of approach (angle α) relative to the shaft 1230 and tendon anterior surface 51. A proximal contoured surface portion 1324a of channel 1324 (shown in FIG. 6C) engages the dissector shaft 1230b. Contoured surface portion 1324a may define a convex curved surface, coextensive with blade leading edge 1340a. In the second position, the harvester 1300 is orientated at a shallower angle of approach (angle α) and a distal contoured surface portion 1324b of channel 1324 engages the dissector shaft 1230b. Contoured surface portion 1324b may define a linear surface, axially spaced and distal from blade leading edge 1340a. Contoured surface portions 1324a and 1324b define a cutting depth “D” that is the same, despite the variation in the angle of approach, provided the contoured surface portions engage the surface 1233 of dissector 1200.

The system 1000 may also include a proximal cutter 1400, configured to separate a proximal end of tendon strip from native tendon 50, details of which are shown in at least FIG. 8A-8E. This cutting operation occurs furthest from the skin incision making reliable cuts in the target area more difficult to achieve. Without the proximal cutter 1400, this cut end may be an uneven, jagged end, frustrating later suturing and coupling techniques. Proximal cutter 1400 forms a clean and uniform cut end, which makes later handling of the tendon graft easier. Proximal cutter 1400 includes a replaceable blade 1410 that is selectively operatively coupleable to a distal end of proximal cutter shaft 1440. Having a fresh blade 1410 for each procedure ensures a consistent sharp edge and a more consistent and precise uniform slice through the fibrous tendon tissue. Sterilization methods of reusable instrument may tend to dull sharp edges.

Proximal cutter 1400 includes a handle end 1430 and a guillotine style cutter at a working end 1450 of the cutter 1400. A shaft 1440 extends between the working end 1450 and handle end 1430. Shaft 1440 may include length estimation markers therealong and may include a static outer shaft and axially moveable inner pull rod 1436, which may be coaxially disposed along outer shaft. A blade housing 1452 may extend from shaft 1440. Blade housing 1452 may bilaterally extend from shaft 1440, the shaft longitudinal axis centrally disposed relative to the blade housing 1452. Blade housing 1452 may define a longitudinal axis that is coincident with and parallel to a shaft longitudinal axis. Stated in another way, blade housing 1452 longitudinal axis is preferably not angularly offset from shaft longitudinal axis.

Blade 1410 defines a generally thin planar element with a connecting end 1414 and cutting end 1415 extending therefrom. Cutting end 1415 includes an aperture 1412 configured to receive a strip of tendon therethrough. Aperture 1412 may define a 360 degree (°) bounded opening, with curved edges. Aperture 1412 may be oblong and sized to receive a tendon strip that includes a bone block therethough. Aperture 1412 may therefore define a cross section larger than the target graft strip width or cross section, as the bone block may be slightly larger and more rigid than the graft strip. This is termed a full thickness graft. Aperture 1412 may have an effective diameter configured to receive a graft and bone block up to 12 mm. Aperture boundary may define an arc length 1412a that is sharp. Arc length 1412a may be transition to a less sharp arc length 1412b. Arc lengths 1412a and 1412b may generally face each other, with the sharp arc length 1412a along a furthest edge from handle 1430, defining a proximal side of the aperture 1412. In operation, a tendon strip is slid through aperture 1412 and the working end 1450 is slid along the tendon strip to a prepared tendon strip proximal end. Tension on the tendon strip while positioning the working end 1450 tends to slide the tendon strip along a distal edge or arc length 1412b of aperture 1412. There may be some weaker tissue bridges forming some snagging discrete connections between a posterior surface of the tendon strip and anterior surface of remaining native tendon. Therefore, while arc length 1412b may be preferably less sharp than 1412a to avoid any unintended damage to the graft strip while placing the working end 1450 at a strip proximal end, the distal side of aperture 1412b may be configured to break these snagging tissue bridges is preferable. Arc length 1412b may therefore have some sharpness, sufficient to break these tissue bridges along the tendon while advancing the cutter 1400.

Housing 1452 defines a slot 1454 extending through the housing longitudinal axis, for receiving the blade's connecting end 1414 therethough. Blade connecting end 1414 extends through to a distal or handle side of the housing 1452 to couple to pull rod 1436. Housing 1452 may include a curved leading edge 1456 that may be sharp to cooperate with blade 1410 while transecting the tendon strip. Leading edge 1456 may also aid in breaking snagging tissue bridges while advancing the proximal cutter 1400 along the strip 50′, in combination with aperture arc length 1412b. Housing 1452 includes a lead-in to slot 1454 to receive the blade 1410 therein. Slot leading edge may be asymmetric, seen best in FIG. 8E, having a first distal edge surface 1453 on a first side of the slot that is disposed on a first side of the blade 1410 that is tapered and axially spaced from a second distal edge surface 1455. Second distal edge surface 1455 is disposed on a second opposing side of the blade 1410 and may extend further along blade 1410. This offset in distal edge surfaces (1453, 1455) forms a lead in for the blade 1410.

Housing 1452 includes an arced opening defined at least partially be edge 1456 that may approximately match aperture 1412 in size and shape. In operation, cutter 1400 has two configurations. A first configuration shown in FIG. 8D, defining an open configuration, for receiving the tendon strip through aperture 1412 When in the target location, retraction of the blade 1410 may move the blade distally, towards the handle and into the housing 1452 to transect the tendon strip. In this second or cut configuration the aperture, 1412 is preferably reduced to beyond zero, such that arc length 1412a may be recessed or covered by housing 1452.

Actuation of the handle 1430 retracts blade 1410 to cut the tendon tissue. Handle 1430 may include two levers 1432a, 1432b pivotally coupled to each other and may include at least one biasing member 1434 therebetween. Lever 1432a may be fixed or static. Lever 1432b may be operatively coupled to a first end of pull rod 1436 and activation (motion) of lever 1432b may axially retract pull rod 1436 and thereby retract blade 1410. Handle 1430 may define a pistol grip handle 1430. Lever 1432b may include a slot 1433 that receives a pull rod pin 1427 therethough, such that rotation of lever 1432b towards lever 1432a slides pin 1437 and retracts pull rod 1436. Release of actuation forces on lever 1432b may spring lever 1432b back, to move the blade 1410 to the open configuration, courtesy of biasing member 1434. Other mechanical constructs are contemplated by the inventors, known in the art that may retract a pull rod. In other embodiments, either or both lever arm may move relative to each other. Activation of handle is configured to move the blade 1410 from a position that may receive the tendon therethrough to a position that covers the entire blade aperture 1412 with housing 1452. Therefore, in some example embodiments, housing 1452 may move and the blade 1410 may be stationary. In other embodiments, both the housing 1452 and blade 1410 may move towards each other.

Handle 1430 may include a lock out 1455 configured to hinder inadvertent actuation of handle. Lock out 1455 may be operatively coupled to a torsion spring 1458, configured to maintain lock out 1455 in a position that prevents actuation of handle 1432b. An example mechanism is shown in FIG. 8F illustrating a surface 1457 of lock out 1455 that may engage a surface 1435b of handle 1432b, and thereby limit handle rotation. Rotation of locking out 1455 moves surface 1457 away from handle surface 1435b, allowing actuation thereof, shown in FIG. 8G.

Proximal cutter 1400 defines a longitudinal axis L, and levers 1432a, 14232b extend along a first plane through longitudinal axis L. Housing 1452 defines a maximum width Wm for receiving a corresponding maximum width of blade 1410 therein. This orients aperture 1412 such that a central axis through aperture 1412 is perpendicular to the first plane. In use, this orientation preferably orients levers laterally away from graft strip longitudinal axis. Relative to the patient anatomy, this orients the levers 1432a, 1432b either medially or laterally to the patient anatomy. This lever orientation preferably keeps the levers away from the knee joint and out of the field of view along the tendon 50. In addition, guillotine blade 1410 defines a thin planar element have planar surfaces that define the blade thickness, the planar surface extending along a plane that is parallel to shaft longitudinal axis L. Cutting edge 1412a axially translates during actuation, to move towards the handle end 1430. Cutting edge 1412a moves along a plane that is parallel to the first plane and parallel to the shaft longitudinal axis. Cutting edge 1412a defines a segment (arc length) of a 360° (degree) bounded aperture 1412 through the blade thickness, sized to receive an entire cross section of a tendon strip 50′ therethrough. 360° (degree) bounded aperture 1412 may also include an arc length 1412b that is configured to dissect tissue, but not as sharp as cutting edge. Arc lengths 1412a, 1412b may be opposite each other and may have an extent that is approximately equal in length to each other.

Blade 1410 may operatively couple and detach from pull rod 1436. Connecting portion 1414 may extend along lateral slots of outer shaft 1440 and selectively couple to pull rod 1436. Connecting portion 1414 and pull rod 1436 may include a means to selectively couple and detach from each other. Connecting portion 1414 may include at least one lateral tab 1417 that may aid in detaching the connecting portion 1414 from pull rod 1436. Connecting portion 1414 may include bilateral tabs 1417. Connecting portion 1414 may include aperture 1418 disposed between the tabs 1417 for engaging with a pin or protrusion on pull rod 1436, seen best in cross section image shown in FIG. 8C. Tab(s) 1417 may provide a handle to manipulate the blade 1410, connect, and disconnect it from the pull rod from blade 1410. Tab(s) therefore define a boundary with blunt edges and may be held by the users hand.

In alternative embodiments, housing 1452 and blade 1410 may both be single use, replaceable sub-assembly. In some embodiments, the entire cutter 1400 may be single use. In other embodiments the blade 1410 may be stationary during cutting and housing 1452 may move and advance over the blade 1410.

Proximal cutter 1400 is configured to fit within retractor 1100, with both the guide 1200 and harvester 1300 removed. Housing width Wm may approximate a width W of retractor. Proximal cutter 1400 may slide along graft strip and along retractor 1100 to the proximal end of tendon, seen best in FIG. 9.

FIGS. 10-15 disclose a second system embodiment configured to harvest a tendon. This system includes a retractor 2100 for improving visualization of the tendon, in a manner similar to retractor 1100. The system 2000 may also include at least one modular insert (2150, 2200), a dual harvester 2250 and a proximal cutter 2300. Retractor 2100 includes a means to couple with modular inserts (2150, 2200), that guide the formation of a consistent graft strip from a native QT.

Similar to retractor 1100, retractor 2100 is preferably flexible and may be collapsed and then placed through an incision under the skin. Upon release, retractor 2100 forms a “tent”, providing the surgeon visualization of the surgical site. Retractor 2100 may be tapered along its length, having the larger distal opening 2120 for inserting instruments and modular inserts therethrough. Retractor proximal end 2125 may be closed so that tissue and fluid cannot enter the working cavity 2130. Retractor base 2140 may engage an anterior surface of the QT and may include means to engage modular inserts (2150, 2200). Base 2140 may include rails 2145 for example that received inserts (2150, 2200) therein to assist the surgeon in performing the incisions required to harvest the tissue.

More specifically, the system may include a retractor 2100, a longitudinal floor insert 2150, a proximal floor insert 2200, a double blade harvester 2250 for use with the longitudinal floor insert 2200 and a proximal cutter or scalpel 2300 for use with the proximal floor insert 2300.

A method of use may include making an incision through patient's skin near the patella and inserting a proximal end