Abstract: A percutaneous access system is disclosed that includes a needle and an inner cannula. The needle includes an internal passageway. At a distal end, the needle includes an expandable section. A distal section of the internal passageway of the needle, which corresponds to the expandable section, is tapered to enable the expandable section to expand and collapse as the inner cannula is positioned within and/or moves through the tapered distal section. The inner cannula may enable grasping and/or aspiration of a sample from a location of interest within a subject's body. Biopsy methods are also disclosed.

Abstract: A targeting set for use with positioning a biopsy device within a patient. The targeting set includes an obturator and an actuator. The actuator includes a housing and a lock array. The lock array extends inwardly within a hollow interior defined by the housing. The obturator is configured for insertion into the housing of the actuator such that at least a portion of the obturator engages the lock array. The lock array is configured to selectively lock the obturator in a plurality of axial positions relative to the housing.

Abstract: Instrument coupling interfaces and related methods are disclosed herein, e.g., for coupling a surgical instrument to a navigation array or other component. An exemplary coupling can include a first coupling interface associated with a first object, such as a surgical instrument, and a second coupling interface associated with a second object, such as a navigation array. The coupling interfaces can be configured to ensure that, when mated, the first and second objects are disposed in a known position and orientation relative to one another and blocked from relative movement in all six degrees of freedom. The interfaces can have a geometry that is not overdetermined, minimizing or eliminating navigation inaccuracy associated with system tolerances.

Abstract: It is provided an invasive instrument for the treatment of a vessel, which possibly includes secondary vessels, with a tip formed for the dissection of tissue at the distal end of a shaft to be introduced into the body. The tip includes at least one recess, in particular a vessel receptacle, which is arranged and formed such that in the operating condition of the instrument always at least one functional unit of the shaft is kept clear, so that working on the vessel, a secondary vessel and/or on the surrounding tissue is possible using or by means of the functional unit.

Abstract: Methods and apparatuses are disclosed for closing a patent foramen ovale. Some of the disclosed apparatuses include an elongate body having a proximal end and a distal end, with first and second suture clasp arms adapted to hold end portions of a suture when in an extended position. A first suture catch mechanism is slidably housed in the elongate body and moves in a proximal-to-distal direction to engage the suture end held by the first suture clasp arm, and a second suture catch mechanism is slidably housed in the elongate body and moves in a distal-to-proximal direction to suture end held by the second suture clasp arm. The first suture clasp arm can be positioned around the septum primum to deliver a suture thereto, and the second suture clasp arm can be positioned around the septum secundum to deliver a suture thereto.

Abstract: An articulated tool positioning apparatus comprising a base member, an intermediate member, an end member and a first tool holder arranged in succession, each of the base member, intermediate member, end member and tool holder having a respective central opening. A first plurality of coupled guides id positioned between the base member and the intermediate member and a second plurality of coupled guides is positioned between the intermediate member and the end member. A third plurality of coupled guides is diposed between the end member and the tool holder. The base member, intermediate member, end member, first tool holder and first second and third pluralities of coupled guides all have a central opening and guide openings or securing points for securing pluralities of flexible control links to the base member or to an object separated from the base member.

Abstract: The present invention relates to a minimally invasive surgical instrument having an articulation immobilising structure. The present invention is a s minimally invasive surgical instrument and includes a shaft, an end effector connected towards one end of the shaft, a wire for controlling the articulated movement of the end effector, and an immobilising structure adapted to immobilise the state of articulated movement of the end effector. The immobilising structure includes a resilient member covering the wire, and the resilient member holds the wire when an internal space therein contracts.

Abstract: A surgical site retractor is configured to retract tissue, such as in an intercostal procedure. The retractor may be formed from non-radiopaque material for improved monitoring via x-ray imaging. The retractor may have a rigid retractor and a soft tissue retractor, where the rigid retractor has a plurality of legs and the soft tissue retractor extends between the legs to prevent soft tissue from extending between said legs. The retractor may have a bendable arm with an implement holder, such as distal cuff or clip adapted to resiliently hold an implement such as a tube of an elongated port-access device. A method involves partly installing the surgical site retractor, expanding the surgical site retractor, deploying the surgical implement from outside the body through the incision and into the patient, resiliently capturing the implement with the holder of the arm, and bending the arm to hold the implement in a desired position.

Abstract: The invention relates to a device (10) for reducing the retraction of the margins of an opened fascia of a patient having an open soft-tissue defect, wherein the device (10) has a holding element (11) which, at a first distance from the patient (1), can be fixed with respect to the patient (1), and an attachment element (12) with a multiplicity of attachment points (13) which are configured for the attachment of tensioning means (14) which are connectable to a margin of the fascia (4), wherein the attachment element (12) is connected to the holding element (11) in such a way that it is arranged at a second distance from the patient (1) which is shorter than the first distance, wherein the attachment element (12) is connected to the holding element (11) via precisely one tensile force transmission element (15).

Abstract: A system and associated method for manipulating tissues and anatomical or other structures in medical applications for the purpose of treating diseases or disorders or other purposes. In one aspect, the system includes a delivery device including a flexible portion that is suited to access target anatomy. The flexibility of an elongate portion of the delivery device can be varied. Additionally, the delivery device can include structure that maintains the positioning of the delivery device in patient anatomy.

Abstract: A soft tissue repair assembly. The assembly includes a flexible member having first and second ends, and a strand passing through the flexible member. The strand has first and second strand ends extending through the flexible member, such that pulling at least one of the first and second strand ends changes the flexible member from a first shape suitable for insertion through soft tissue to a second shape suitable for securely lodging the soft tissue repair assembly relative to soft tissue.

Abstract: The variable or adjustable depth medical implants disclosed herein are cable of depth adjustment prior to implantation. The variable depth implants permit a single implant to provide multiple footprint configurations, allowing a surgeon adjustability in the operating room. The implants can comprise a metallic lattice designed for specific physical properties, such as an elastic modulus. In some examples, the main body of the implant is taller than the adjustable portion of the implant so that the physical properties of the main body of the implant are controlling at the implant site. In some embodiments, the variable implant is constructed in an additive process as a single unit. Disclosed herein is, in some embodiments, a multi-segment bone anchor configured to allow variable bone ingrowth or attachment between each segment.

Abstract: A suture anchor comprises a tubular body having an axial bore therethrough and having one or more purchase enhancements on an exterior surface of the body adapted to enhance purchase of the body within a bone hole, such as threads. A lateral port passes through the body from the bore to the exterior surface and is formed of a slot entering the body from its proximal end. A length of suture for attaching soft tissue to bone passes down along the exterior surface over the one or more purchase enhancements, over a distal end of the body, up into the bore through and then back out of the bore and up along the exterior surface over the one or more purchase enhancements.

Abstract: Embodiments of an implant that is configured with materials to prevent degradation or corrosion. The implant can comprise an elongate body and a degradation-delaying element disposed thereon, where the degradation-delaying element can be configured to reduce or retard corrosion of the elongate body.

Abstract: In one embodiment, an adjustable implant system includes a bone anchor having first and second ends, a bone engagement surface adjacent the first end, and a housing extending between the first and second ends. The adjustable implant system can further include a non-invasively actuatable driving element within the housing and coupled to an adjustment component configured to couple to a flexible elongate tension member which is capable of engaging a patient's soft tissue (e.g., rotator cuff or ACL). Non-invasive actuation of the driving element can cause the adjustment component to change the amount of tension on the flexible elongate tension member and consequently on the patient's soft tissue. The adjustable implant system can include an external adjustment device configured to be placed on or adjacent the patient's skin and comprising at least one energy transferring component configured to energize/actuate the driving element inside the housing of the adjustable implant.

Abstract: An apparatus includes first and second fixation members, a flexible member coupled to the first and second fixation members, and a limiting element coupled to the flexible member. The limiting element is movable relative to the second fixation member and acts to limit loosening of the flexible member relative to the second fixation member. The limiting element can be slidably received by the flexible member. The flexible member can be coupled to the fixation members such that pulling on a free end of the flexible member shortens a length of the flexible member between the fixation members.

Abstract: A suturing device for minimally invasive surgery is disclosed. The suturing device has a head defining one or more ferrule holders and a tissue bite area. The device also has a first needle comprising a flywheel portion and one or more curved arms extending from the flywheel portion, each of the one or more curved arms comprising a ferrule engaging tip, wherein the first needle is pivotably coupled to the head. The suturing device further has a first actuator coupled to the first needle and configured to rotate it from a retracted position, where the ferrule engaging tip of each of the one or more curved arms starts away from the one or more ferrule holders, through the tissue bite area, and to an engaged position where the ferrule engaging tip of each of the one or more curved arms is operationally aligned with the one or more ferrule holders.

Abstract: A device is configured for closing an aperture in a wall of a blood vessel. An embodiment of the device includes a body and at least one suture element held within the body. A suture capture rod is positioned within the body and is operatively associated with the suture element and arranged to pass the suture element through a vessel wall such that opposed portions of the suture element extend from the vessel wall. A removable guidewire segment is removably attached to a distal end of the body.

Abstract: Disclosed herein are suture clip delivery devices that can be loaded with several flat, disk-shaped suture clips and can deploy the suture clips one after another onto respective sutures without reloading the device with additional suture clips. An exemplary device includes a handle portion with an actuation mechanism that is coupled to a shaft portion that holds and deploys the suture clips. The shaft portion includes a mandrel on which the suture clips are mounted and a retainer that restricts the suture clips from moving proximally when the actuation mechanism pulls the mandrel proximally, which causes a distal-most suture clip to slide off the mandrel and be deployed onto one or more suture. The mandrel and remaining suture clips can them move distally to prepare to deploy the next suture clip.

Abstract: A buttress is applied to an end effector of a surgical stapler. The buttress is loaded on a platform of a buttress applier cartridge. The end effector is closed upon the platform. An adhesive layer of the buttress secures the buttress to the end effector. The buttress is thus adhered to the end effector when the end effector is opened. The end effector is then actuated on tissue of a patient, thereby stapling the buttress to the tissue.

Abstract: A surgical stapling apparatus (stapler) is provided. The stapler includes a housing, elongated member, and a reload. A cartridge is configured to selectively couple to a first jaw member of the reload and includes one or more resilient members thereon. An anvil operably supported on a second jaw member of the reload is configured to compress one or more fasteners ejected from the cartridge. The anvil includes one or more locking members thereon. A knife is configured to translate through the cartridge and anvil when the first and second jaw members are in a closed configuration. Engagement between the knife and the resilient member(s) causes the resilient member(s) to move from an initial configuration that allows the knife to travel distally past the locking member(s) to a final configuration that allows the locking member(s) to engage the knife.

Abstract: The present disclosure is directed to an endoscopic surgical stapler having an articulation locking mechanism that functions to prevent straightening of a tool assembly of the surgical stapler when the surgical stapler is fired with the tool assembly in an articulated position. In embodiments, a mounting assembly supports a notched member on a proximal end of the tool assembly and the notched member defines a series of notches. An articulation member supported adjacent to the mounting assembly includes a locking member defining protrusions or teeth that are movable from a first unlocked position spaced from the notches of the mounting assembly to a second locked position received within the notches to lock the tool assembly in one of a plurality of articulated positions. In embodiments, the locking member is biased towards the unlocked position by a biasing member and is urged toward and retained in the locked position via engagement with a drive assembly of the surgical stapler.

Abstract: Staple delivery devices are disclosed herein that include a plunger that translate to engage an elastic bridge of a staple to pivot legs of the staple outwardly to a strained state. Two or more pins retain the staple to the delivery device.

Abstract: The present invention relates to surgical sutures and threads for introducing skin-augmenting materials into human tissues, such as the skin.

Abstract: A soft tissue repair device can include a housing having a handle, a deployment system having an actuation member, and an insertion system having an inserter and a slider. The slider can be coupled to the actuation member and movable relative to the inserter between deployed and retracted positions. First and second anchors can be carried on an external surface of the slider such that the anchors are spaced apart and portions of the anchors are coaxial with the slider and each other. A flexible strand can couple the anchors. The insertion system can cooperate with the deployment system to move the slider to the deployed position to deploy the first anchor upon activating the actuation member a first time, and to move the slider to the deployed position from the retracted position to deploy the second anchor upon actuating the actuation member a second time after the first time.

Abstract: An end effector for use by a surgeon to staple an anatomical structure of a patient during a minimally invasive procedure, the anatomical structure having a first side and a second side, the end effector including an anvil that includes a first end, a second end, and a face, and a cartridge that is configured to house a plurality of staples and that includes a first end, a second end, and a face, and an engagement element that movably couples the first end of the anvil to the first end of the cartridge, and a knife, the knife having a first flange, a second flange, and a web including a cutting edge, and where the second end of the anvil is movably coupled to the second end of the cartridge, each of the anvil and the cartridge is insertable through a trocar, and the end effector is remotely operable from outside the patient.

Abstract: A surgical system includes a handle having a controller and a motor, an adapter releasably coupled to the handle, and a loading unit releasably coupled to the adapter. The motor is coupled to a drive shaft of the handle. The adapter including an adapter identification device in communication with the controller, configured to store adapter data, and to communicate the adapter data to the controller. The loading unit configured to affect tissue in response to a force transmitted by the adapter from the drive shaft. The loading unit including a loading unit identification device in communication with the controller, configured to store loading unit data, and to communicate the loading unit data to the controller. The controller is configured to adjust output of a motor based on at least one of the adapter data or the loading unit data.

Abstract: The present disclosure relates to repair devices, repair systems, and methods for repair of regurgitant tricuspid valves. A repair method includes positioning a repair device at a tricuspid valve. The repair device includes a pair of proximal arms and a pair of corresponding opposing distal arms, with each proximal arm and corresponding opposite distal arm forming an arm pair. The arms are actuated so that leaflet tissue is grasped between the proximal and distal arms, with a first leaflet being grasped by a first arm pair and a second leaflet being grasped by a second arm pair. A suture line is anchored at the second leaflet. Then, the repair device is pivoted to grasp and suture a third tricuspid leaflet to tie the second and third leaflets together. The clip remains deployed to tie the first and third leaflets together.

Abstract: A loading unit for engagement with a surgical instrument. The loading unit includes a proximal body portion, an end effector, an actuation sled, and pushers. The actuation sled is longitudinally translatable within a cartridge assembly. The pushers are disposed within the cartridge assembly. Each pusher includes a camming surface configured for engagement with the actuation sled. The camming surface of each pusher in a first row is longitudinally aligned with the camming surface of each pusher in a second row. The first row of pushers is laterally offset from the second row of pushers.

Abstract: An anastomosis suturing device includes a dismantable casing, a first tubular section having a proximal section encased in the casing and a distal section insertable in a tubular body of a living creature, and a second tubular section having a proximal section encased in the casing and a distal section insertable in a tubular body of the living creature.

Abstract: An endoscopic device, includes a clip assembly and a driving assembly. The clip assembly includes a first jaw, a second jaw, a pivot, a housing having an internal channel, and a release portion connecting to the first and second jaws. At least a portion of the first and second jaws is disposed within the internal channel, the first and second jaws selectively move along with the internal channel. The driving assembly includes an outer sheath, an inner tube, movably disposed within the outer sheath, and a driver, movably disposed within the inner tube, and removably received within the release portion. The driver is unbrokenly released from the release portion by a predetermined pull force. The housing and the outer sheath form a releasable handshake engagement. The inner tube extending into the housing prevents the handshake engagement from disengaging.

Abstract: An elastic band ligation device for the treatment of haemorrhoids, comprising an inner tube (60), a deployer (40), and a grasper (26), the grasper including at least two gripping arms (23) and slidably mounted within the inner tube (60) to open and close the gripping arms. In a closed position, retaining a haemorrhoid, the gripping arms are within the body, and the deployer is positioned to release one of a plurality of ligation bands (50). The grasper handle (31) and the deployer trigger (62) are operable by a single hand. Preferably the device is disposable and the deployer includes a ratchet so that it may only be moved forward towards the bands. In an alternative device (FIGS. 12-13), the body (20, 120) is moved to close the gripping arms.

Abstract: An endovascular surgical tool may include a flexible, electrically-conductive delivery tube, a return conductor, a resistive heating element attached to the distal end of the delivery tube, and a therapeutic payload attached to a loop of the resistive heating element by a coil connecting member. The delivery tube may include at least one segment at its distal end which includes a plurality of transverse slots. Each slot of the plurality of slots includes an origin on the perimeter of the delivery tube, a terminus closer to a central axis of the delivery tube than the origin, and a depth between the origin and terminus. The origins of at least two slots of the plurality of slots may be located at different angular positions relative to the central axis. The return conductor may be electrically insulated from and positioned within the delivery tube.

Abstract: Devices for the occlusion of body cavities, such as the embolization of vascular aneurysms and the like, and methods for making and using such devices. The devices may be comprised of novel expansile materials, novel infrastructure design, or both. The devices provided are very flexible and enable deployment with reduced or no damage to bodily tissues, conduits, cavities, etceteras.

Abstract: A surgical clip includes a spring pretensioning two outer double-armed clip parts and a double-armed clip part rotatably mounted. Each outer double-armed clip part includes one operating arm configured to be pressed together into an open clip position by an applying forceps and one clamping arm. The middle clip part has a clamping arm arranged between the clamping arms of the two outer clip parts and an operating arm arranged between the operating arms of the two outer clip parts. The middle clip part's operating arm is configured to be opened in relation to either of the operating arms of the two outer clip parts by the applying forceps engaging a respective side of the middle clip part's operating arm associated with the operating arm of either of the two outer clip parts to open the middle clip part's clamping arm and the respective middle clip part's clamping arm.

Abstract: An apparatus for application of surgical clips to body tissue is provided and includes a handle assembly; a shaft assembly including a housing extending distally from the handle assembly and defining a longitudinal axis; a plurality of surgical clips disposed within the shaft assembly; a jaw mounted adjacent a distal end portion of the shaft assembly, the jaw being movable between an open spaced-apart condition and a closed approximated condition; and a pusher bar reciprocally disposed within the housing of the shaft assembly and being detachably connectable to the housing of the shaft assembly, the pusher bar being configured to load a distal-most surgical clip into the jaws during distal movement and remain connected to the housing of the shaft assembly and in a distally advanced position during an approximation of the jaws.

Abstract: An endoscopic surgical clip applier (10) includes a handle assembly (100) configured to releasably engage at least two different endoscopic assemblies (200,300). The handle assembly (100) is configured to transition from a non-ratcheting use condition to a ratcheting use condition when an endoscopic assembly (200,300) configured for ratcheting use is engaged with the handle assembly (100). The handle assembly (100) is maintained in the non-ratcheting use condition when an endoscopic assembly (200,300) configured for non-ratcheting use is engaged with the handle assembly (100). Endoscopic assemblies (200,300) for use with the handle assembly are also provided.

Abstract: The invention provides improved medical devices, therapeutic treatment systems, and treatment methods for treatment of the lung. A lung volume reduction system includes an implantable device having an elongate body that is sized and shaped for delivery via the airway system to a lung airway of a patient. The implant is inserted and positioned while the implant is in a delivery configuration, and is reconfigured to a deployed configuration so as to locally compress adjacent tissue of the lung, with portions of the elongate body generally moving laterally within the airway so as to laterally compress lung tissue. A plurality of such implants will often be used to treat a lung of a patient.

Abstract: Devices, systems, and methods to precondition, arterialize, and/or occlude a mammalian luminal organ. In an exemplary embodiment of a device for preconditioning, arterializing, and/or occluding a mammalian luminal organ of the present disclosure, the device comprises a frame comprising a plurality of struts, wherein at least one strut of the plurality of struts forms a local general perimeter or boundary of the device, and an expandable occluder coupled to the frame and comprising a membrane or other expandable material that can generally expand and/or unfold as device shifts from a first configuration to a second configuration.

Abstract: A hemostatic device including a band that is wrapped around a limb of a living body at a site of the living body where bleeding is to be stopped and an inflatable portion which is inflated by injection of gas to cause the inflatable portion to press the site where bleeding is to be stopped. The hemostatic device includes an injection part that injects gas into the interior of the inflatable portion. The injection part includes a hole penetrating the injection part and communicating the housing space with outside environment. The hemostatic device includes a first support plate and a second support plate positioned adjacent one another along the longitudinal direction of the band. The second support plate is movably connected to the first support plate. The inflatable portion is on the first support plate and the injection part is on the second support plate.

Abstract: Disclosed are methods and devices for obtaining hemostasis. The device comprises a band having an inflatable bladder for applying a pressure to an artery. The method comprises applying a pressure to the homolateral ulnar artery and applying a pressure to the radial artery at the access site to obtain hemostasis at the access site.

Abstract: Disclosed is a method of reducing a dosage of an anticoagulant when performing a catheterization procedure at an access site of an artery. The method comprises administering the anticoagulant at a dose less than a conventional dose, reducing a contact time of blood at the access site of the artery, and maintaining the contact time of blood at a reduced level for a period of time during the catheterization procedure.

Abstract: Disclosed are methods and devices for obtaining patent hemostasis of the radial artery by compressing the uninstrumented ulnar artery to increase radial artery flow. The device comprises a band having an inflatable bladder for applying blunt pressure to the ulnar artery. The method comprises applying a pressure to the homolateral ulnar artery and applying a pressure to the radial artery at the access site to obtain hemostasis at the access site.

Abstract: A blade coupling mechanism for a hand-held surgical cutting instrument includes a first coupling member including a first blade-contacting surface and a first outer perimeter sidewall adjacent the first blade contacting surface. It also includes a second coupling member including a second blade-contacting surface facing the first blade-contacting surface of the first coupling member. The second coupling member includes a second outer perimeter sidewall adjacent the second blade contacting surface. The second blade-contacting surface and the second outer perimeter sidewall meet to define an outer edge. The second coupling member including a bore through the second blade contacting surface. The bore and the second blade contacting surface meeting to define an inner edge. Blade-engaging protrusions project from at least one of the first and second blade-contacting surfaces. The protrusions are spaced closer to the outer edge than the inner edge.

Abstract: The present invention provides an osteotomy device with an in-vitro alignment component comprising a first body component, a second body component and an in-vitro alignment component. The first body component has an upper guide edge for forming a cutting track. The second body component has a lower guide edge disposed below the upper guide edge. A guide slot is formed between the upper guide edge and the lower guide edge for guiding the saw blade to cut. The guide slot has a connecting member for connecting the upper guide edge and the lower guide edge. The in-vitro alignment component has an engaging member and at least one aiming hole. The engaging member is engaged with the connecting member. The aiming hole is used to confirm the direction of cutting.

Abstract: The present invention provides a surgical method of osteotomy device with an in-vitro alignment component comprises the steps of: placing a first body component and a second body component on the surface of a bone; engaging an engaging member with a connecting member; inserting at least one aiming bone pin in at least one aiming hole to confirm the cutting direction; inserting at least one fixation bone pins in a plurality of fixation holes to fix the osteotomy device with an in-vitro alignment component; cutting along a guide slot to produce an osteotomy; spreading the osteotomy; placing a bone plate to maintain the osteotomy.

Abstract: An osteotomy surgical apparatus according to the present invention includes a bone cutting blade used for cutting bone tissue and a guard disposed so as to overlap the bone cutting blade in a side view of the bone cutting blade. A distal end of the guard is disposed at a position retracted rearward relative to a blade edge of the bone cutting blade.

Abstract: A surgical instrument for making femoral resections for seating a femoral implant on a distal femur, the instrument configured for orientation relative to an intramedullary rod. The instrument includes a medial distal cut guide having a cut guide portion, the cut guide portion having a cut slot therein for use in resecting a medial distal condyle of the femur. A medial distal cut paddle supports the medial distal cut guide. The medial distal cut paddle is configured to mount on the intramedullary rod to orient the medial distal cut slot substantially along an anterior-medial slope of the medial distal condyle when the medial distal cut paddle is mounted on the intramedullary rod to thereby define an anterior-medial approach for making a medial distal resection of the medial distal condyle.

Abstract: In order to improve a surgical instrumentarium for preparing a femur and a tibia for the implantation of the knee joint endoprosthesis, which instrumentarium comprises a first sawing template with three guidance slots for guiding a saw blade, which three guidance slots define three intersecting cutting planes, in such a way that the number of necessary instruments of the instrumentarium may be reduced, it is proposed that the instrumentarium comprises a second sawing template, that the second sawing template has a fourth guidance slot for guiding a saw blade, and that the first sawing template and the second sawing template are coupled to each other in a force- and/or form-fitting manner in a coupling position and are separated from each other in a separating position.

Abstract: A notch preparation guide for engagement with a femoral trial component according to some embodiments includes an anterior portion having an anterior slot arranged to receive a portion of a first cutting instrument therein, and a posterior portion having a posterior slot arranged to receive a portion of a second cutting instrument therein. The anterior slot and the posterior slot are arranged to capture a portion of a distal femur there between for removal by either the first cutting instrument or the second cutting instrument. In some embodiments, the first cutting instrument is a saw and the second cutting instrument is a chisel. In some embodiments, the notch preparation guide includes a lock adapted to move between an open position wherein the notch preparation guide is detachable from the femoral trial component and a closed position wherein the notch preparation guide is fixedly attached to the femoral trial component.