Minimally invasive surgery poses high demands on tool design. The goal was to measure the influence of drill bit geometry on maximum thrust forces required for drilling, and compare this relative to the known influence of feed rate and bone composition. Blind holes were drilled perpendicular to the iliac crest up to 10 mm depth in cadaveric pelvic bones of 20 pigs (adolescent) and 11 goats (full grown) with eight substantially different drill bits of ∅ 3-3.2 mm. Subsequently, boreholes were drilled perpendicular to the ilium with the same drill bits at three different feed rates (0.58 mm/s, 0.83 mm/s, 1.08 mm/s). The mean maximum thrust force ranges from 10 to 110 N for cortical bone, and from 3 to 65 N for trabecular bone. The results show that both drill bit geometry and feed rate have a significant influence on the maximum thrust forces, with a dominant influence of drill bit geometry in terms of shape of the flutes, sharpness of cutting edges and value of point angle. The differences in thrust forces between cortical and trabecular bone are substantial for all measured conditions. The measured values can be used for drill design.

Articular cartilage has limited regeneration capacities. One of the factors that appear to affect the in vitro cultivation of articular cartilage is mechanical stimulation. So far, no combination of parameters has been identified that offers the best results. The goal is to review the literature in search of the best available set of quantitative mechanical stimuli that lead to optimal in vitro cultivation.The databases Scopus and PubMed were used to survey the literature, and strict in‐ and exclusion criteria were applied regarding the presence of quantitative data. The review was performed by studying the type of loading (hydrostatic compression or direct compression), the loading magnitude, the frequency and the loading regime (duration of the loading) in comparison to quantitative evidence of cartilage quality response (cellular, signaling and mechanical).Thirty‐three studies met all criteria of which 8 studied human, 20 bovine, 2 equine, 1 ovine, 1 porcine and 1 canine cells using four different types of cultivated constructs. Six studies investigated loading magnitude within the same setup, three studies the frequency, and seven the loading regime. Nine studies presented mechanical tissue response. The studies suggest that a certain threshold exits for enhanced cartilage in vitro cultivation of explants (>20 % strain and 0.5 Hz), and that chondrocyte‐seeded cultivated constructs show best results when loaded with physiological mechanical stimuli. That is a loading pressure between 5–10 MPa and a loading frequency of 1 Hz exerted at intermittent intervals for a period of a week or longer. Critical aspects remain to be answered for translation into in vivo therapies.

As minimally invasive operations are performed through small portals, the limited manipulation capability of straight surgical instruments is an issue. Access to the pathology site can be challenging, especially in confined anatomic areas with few available portals, such as the knee joint. The goal in this paper is to present and evaluate a new sideways-steerable instrument joint that fits within a small diameter and enables transmission of relative high forces (e.g., for cutting of tough tissue). Meniscectomy was selected as a target procedure for which quantitative design criteria were formulated. The steering mechanism consists of a crossed configuration of a compliant rolling-contact element that forms the instrument joint, which is rotated by flexural steering beams that are configured in a parallelogram mechanism. The actuation of cutting is performed by steel wire that runs through the center of rotation of the instrument joint. A prototype of the concept was fabricated and evaluated technically. The prototype demonstrated a range of motion between −22° and 25° with a steering stiffness of 17.6 Nmm/rad (min 16.9 – max 18.2 Nmm/rad). Mechanical tests confirmed that the prototype can transmit an axial load of 200 N on the tip with a maximum parasitic deflection of 4.4°. A new sideways steerable mechanical instrument joint was designed to improve sideways range of motion while enabling the cutting of strong tissues in a minimally invasive procedure. Proof of principle was achieved for the main criteria, which encourages the future development of a complete instrument.