Meniscal repair delivery device

Abstract

A tissue repair device includes a pusher assembly including a rod portion configured to be advanced through a needle to expel a first implant and a second implant from the needle, a ratchet coupled to a proximal section of the rod portion and configured to advance the rod through the needle by axial and rotational movement, and a pusher member having a linear axis of travel including a first bore connected to a second bore. The first bore has a diameter that is less than a diameter of the second bore such that the first bore and the second bore include a stop. The rod portion has mechanical properties optimized to both conform to a needle curvature and provide sufficient compressive strength to expel the implants from the device.

Description

Technical Field

[0001] This disclosure relates to apparatus and methods for repairing tissues. Background Technology

[0002] Areas in the body where tissue can be surgically reattached to bone or surgically repaired when a tear forms within the tissue include, but are not limited to, the biceps tendon, lateral collateral ligament of the knee, medial collateral ligament of the knee, meniscus of the knee, and popliteal ligament of the leg. Fibrous tissue wounds such as muscle, ligament, and meniscus tears can be repaired arthroscopically using sutures. Traditionally, to close fibrous tissue wounds, surgeons insert two suture needles into the sutured tissue, pass the suture through the wound, and then tie a knot to secure the free end of the suture within the tissue.

[0003] To simplify wound closure and improve fixation, various types of devices and tools for delivering these devices have been developed. For example, some current meniscus repair devices utilize a bent, rigid needle tip to aid in reaching the appropriate area of ​​the damaged meniscus. Two implants, joined together by sutures, are held in place by the needle. Once the desired meniscus repair position is reached, the needle is pushed through the meniscus, and a push-type delivery mechanism unfolds the first implant. The needle is then retracted from the meniscus, repositioned on the opposite side of the tear, and pushed through the meniscus again. The second implant is then unfolded. The device is then removed, leaving a length of suture knotted to close the distance between the two implants when pulled. The knot is tightened by pulling the length of the suture, and the suture is cut near the knot.

[0004] Typical repair devices employ a user-operated push mechanism to move a first implant distally (in the push direction) from the needle tip, followed by a passive retraction step that positions the push mechanism behind a second implant, which is then moved distally (in the push direction). These devices lack a retraction (pull) mechanism for the user-operated push mechanism. For example, many all-internal technology meniscus repair devices use a push-type delivery mechanism including a push rod. The push rod is coupled to a user-operated knob or trigger that moves the push rod distally to eject the first implant. The push rod must then retract to a position close to the second implant so that the implant can be subsequently ejected when the knob or trigger is moved. Push rod retraction mechanisms include compression springs, torsion springs, constant force springs, etc. When certain forces (such as friction in the push mechanism) exceed the spring force, the push rod cannot retract to a position suitable for deploying the second implant.

[0005] Furthermore, typical implantation devices employ rigid pushers that cannot readily conform to the geometry of a bent needle tip. The pusher is typically coupled to a user-operated knob or trigger that moves the pusher distally to eject one or more implants. Pushers are typically made of austenitic stainless steel, precipitation-hardening stainless steel, or nickel-titanium alloys such as nitinol. These materials exhibit the required compressive strength to withstand the compressive loads required to eject the implant. However, the mechanical properties of common pusher materials are not optimized for conforming to needle curvature. Typically, needle curvature is altered during use by manually bending the device before entering the joint space or by applying a force to bend the needle tip while it is in the joint space. This altered needle curvature can cause the push-delivery mechanism to malfunction. Malfunction occurs when excessive force is applied or when the pusher portion of the mechanism damages the needle groove where the implant is located. Malfunction also occurs when the pusher fails to retract, preventing the subsequent ejection of a second implant when the knob is pushed forward. The mechanical properties of common pusher materials are not optimized for maintaining low friction under increased curvature or tortuous paths.

[0006] Furthermore, current techniques for pulling on sutures to close the gap between two implants involve wrapping the free end of the suture around the user's finger, hand, or surgical instruments (such as a pair of forceps). The suture is then pulled until the required tension in the repair is achieved. Depending on the force required to tighten the repair, tightening the suture can be strenuous for the user and may even cause pain, as the suture may cause their finger to contract uncomfortably. Additionally, given the high lubricity of the materials typically used in the construction of the suture, it may slip during shortening when wrapped around a wet-gloved finger. Summary of the Invention

[0007] This document describes a tissue repair device that provides a push-pull delivery mechanism that allows a push rod to retract independently of a spring force on the rod. The device includes a shank having a longitudinal axis and an elongated needle extending from the shank and defining an axial opening; a first and a second implant connected by a suture and at least partially disposed within the axial opening of the needle; the second implant disposed proximal to the first implant; and a push assembly. The push assembly includes: a rod portion configured to advance through the needle to expel the first and second implants; a ratchet coupled to a proximal section of the rod portion and configured to advance the rod through the needle by axial and rotational movement; and a push member having a linear travel axis and including a first opening connected to the second opening. The diameter of the first opening is smaller than the diameter of the second opening, such that both the first and second openings include stops. The push-pull mechanism has mechanical properties optimized to both conform to the needle curvature and provide sufficient compressive strength to expel the implant from the device. This disclosure also provides a compliant push rod or a portion thereof that allows for more reliable implant deployment via needles with different degrees of curvature. Finally, this disclosure also provides a suture with bifurcated sections that act as finger rings to facilitate tightening of the suture.

[0008] On one hand, this disclosure relates to a tissue repair device. The device may include a shank having a longitudinal axis and an elongated needle extending from the shank and defining an axial opening. The needle may include a proximal end and a distal end. Furthermore, the device includes a first implant and a second implant connected by a suture and at least partially disposed within the axial opening of the needle, the second implant being disposed proximal to the first implant. Additionally, the device may include a propulsion assembly. The propulsion assembly may include: a lever portion configured to propel through the needle to discharge the first and second implants from the distal end of the needle; and a ratchet coupled to a proximal segment of the lever portion and configured to propel the lever through the needle by axial and rotational movement. The propulsion assembly may include a propulsion member coupled to the ratchet member, the propulsion member having a linear travel axis and including a first opening connected to the second opening. The diameter of the first opening is smaller than the diameter of the second opening, such that the first and second openings define a stop. Furthermore, the propulsion assembly may include a push-pull mechanism movable along the linear travel axis, including a mating lever. The first opening of the propulsion member may receive a segment of the mating lever. The mating rod may have a stop member including a barb at its distal end. In a first position, the push-pull mechanism engages the stop member, and in a second position, the push-pull mechanism approaches the stop member.

[0009] In some embodiments, the rod comprises nitinol. In some embodiments, the nitinol is martensitic nitinol. In some embodiments, the tensile strain of the nitinol is about 50 ksi.

[0010] In some embodiments, the advance assembly includes a plunger to allow a user to engage a push-pull mechanism to advance the first and second implants from the distal end of the needle.

[0011] In some embodiments, the distal end of the needle includes a groove. In some embodiments, at least one of the first and second implants includes a body having a cross-section approximating an axial opening of the needle; and a protrusion that engages with the groove to prevent rotation of the implant within the needle.

[0012] In some embodiments, the device further includes a depth tube that limits the depth to which the needle can be inserted into tissue. In some embodiments, the depth tube has a depth tube lock for locking the linear position of the depth tube. In some embodiments, the depth tube includes a tapered distal portion.

[0013] In some embodiments, the device further includes a needle housing coupled to the shank. In some embodiments, a depth tube lock is operatively coupled to the needle housing.

[0014] In some embodiments, the distal end of the needle has a curved geometry. In some embodiments, the curve of the curved geometry coincides with a groove at the distal end of the needle. In some embodiments, the curve of the curved geometry is away from the groove at the distal end of the needle.

[0015] In some embodiments, the device further includes one or more stops configured to restrict the ratchet member from advancing in a predetermined increment.

[0016] In some embodiments, the ratchet member is configured to return to a final position proximal to the starting position of the ratchet member after at least one of the first and second implants has been expelled.

[0017] In some embodiments, the suture includes a sliding knot.

[0018] In some embodiments, the inner surface of the propulsion member includes a plurality of teeth configured to engage a ratchet member.

[0019] In some embodiments, the ratchet member includes two radially extending tabs configured to alternately engage and disengage with a plurality of channels located within the propulsion member.

[0020] In some embodiments, the barb includes an introduction portion configured to facilitate press-fitting into a first opening in the propulsion member.

[0021] On the other hand, this disclosure relates to a tissue repair method. The method may include inserting a first anchor into tissue including a tear, the first anchor being inserted into the tissue on a first side of the tear. The method may further include inserting a second anchor into a second side of the tear, the second anchor being connected to the first anchor via a knotted flexible member having a finger-engageable forked portion. The method may further include using the forked portion to pull on the flexible member to shorten the length of the flexible member between the first and second anchors, thereby closing the first and second sides of the tear. In some embodiments, the size of the forked portion is fixed. Attached Figure Description

[0022] The following discussion, with reference to the accompanying drawings, discusses various aspects of at least one embodiment of the present disclosure. It should be understood that, for the sake of simplicity and clarity, the elements shown in the drawings are not necessarily drawn accurately or to scale. For example, for clarity, the dimensions of some elements may be enlarged relative to other elements, or several physical components may be included in a single functional block or element. Additionally, reference numerals may be repeated between figures where deemed appropriate to indicate corresponding or similar elements. For clarity, not every component may be labeled in every figure. The drawings are provided for illustrative and explanatory purposes and are not intended to be limiting of the invention.

[0023] Figure 1A and 1B A system for tissue repair according to certain embodiments is shown;

[0024] Figure 2A and 2B A ratchet mechanism of a tissue repair system according to certain embodiments is shown;

[0025] Figure 3 and Figure 4 A push-pull mechanism of a tissue repair system according to certain embodiments is shown;

[0026] Figure 5A -C further illustrates a push-pull mechanism of a tissue repair system according to certain embodiments;

[0027] Figure 6A and 6B Another system for tissue repair according to certain embodiments is shown; and

[0028] Figure 7 The illustration shows sutures for use with systems for tissue repair, according to certain embodiments. Detailed Implementation

[0029] In the following detailed description, numerous specific details are set forth in order to provide a thorough understanding of embodiments of the present disclosure. Those skilled in the art will understand that these embodiments can be practiced without some of these specific details. In other instances, well-known methods, procedures, components, and structures may not have been described in detail to avoid obscuring the described embodiments.

[0030] Before describing at least one embodiment in detail, it should be understood that the application of the claims is not limited to the details of the construction and arrangement of the components set forth in the following description or shown in the drawings. Furthermore, it should be understood that the wording and terminology used herein are for descriptive purposes only and should not be considered limiting.

[0031] Figure 1A An example of the tissue repair apparatus 100 of this disclosure is shown in an assembled view. The apparatus 100 generally includes a handle 110, a knob-equipped plunger 120 coupled to the handle 110, a stationary housing 130 disposed within the knob-equipped plunger 120 and the handle 110, and a needle housing 170 coupled to the stationary housing 130. A depth tube lock 140 is disposed within the needle housing 170 and coupled to a depth tube 150. A needle 180 extends through the depth tube 150 and has an axial opening 188 (…). Figure 1BThe device 100 contains a first implant 182 and a second implant 184 connected by a suture 186 for deployment from the needle 180 into the tissue. The suture 186 includes a sliding knot 187 to shorten the length of the suture 186 between the implants 182 and 184. The two implants 182 and 184 reside in the distal portion of the needle 180 before deployment. The depth tube may include a tapered distal portion for easy access into the tissue. The depth tube 150 and depth tube lock 140 provide means to limit needle penetration. The interface between the knobbed plunger 120 and the shank 110 is a sliding fit, as is the fit between the implants 182 and 184 and the needle 180. In use, the user typically holds the device 100 by positioning the shank 110 or the needle housing 170 on either side of the knobbed plunger 120. The user pushes the knob-operated plunger 120 forward to deploy the first implant 182 from the distal tip of the needle 180. After repositioning the needle on the opposite side of the tear, a second user operation of the knob-operated plunger 120 is required to deploy the second implant 184. The suture 186 is then pulled or otherwise tightened to shorten the length of the suture 186 between the implants 182 and 184 to close the tear. Other non-limiting examples of the handle 110, the knob-operated plunger 120, the stationary housing 130, the depth tube lock 140, the depth tube 150, the needle housing 170, the needle 180, and the implants 182 and 184 are disclosed in U.S. Patent Nos. 8,888,798 and 2018 / 0116654 to Smith & Nephew, the entire contents of which are incorporated herein by reference.

[0032] Figure 2A Shown in cross-sectional view Figure 1A Part of the tissue repair device 100. For example... Figure 2A As shown, the inner surface of the knobbed plunger 120 includes a plurality of teeth 122. The teeth 122 are configured to continuously engage a ratchet member 124, which is rotatably and axially coupled to an actuation mechanism 126 to continuously deploy implants 182, 184. A cylindrical rod portion 128 of the actuation mechanism 126 is contained within a needle 180. A compression spring 160 provides a linear force designed to maintain contact between the ratchet member 124 and the teeth 122 of the knobbed plunger 120. The spring 160 also provides a retraction force to the actuation mechanism 126 after implant deployment. The spring 160 further facilitates rotation of the ratchet member 124 relative to the teeth 122 of the knobbed plunger 120. The engagement of the ratchet member 124 with each consecutive tooth 122 and the engagement between the sidewall of the tab 125 of the ratchet member 124 and the channel wall of the stationary housing 130 provide tactile and audible indications of the deployment of the corresponding first implant 182 or second implant 184.

[0033] like Figure 2BAs shown, the ratchet member 124 includes two radially extending tabs 125 that alternately engage and disengage with a plurality of channels radially positioned within the wall of the stationary housing 130 during forward deployment. The tabs 125 of the ratchet member 124 slide within the internal channels along the axis of the stationary housing 130 to provide radial alignment before deployment of each implant 182, 184. When the user retracts the knob-operated plunger 120, the actuating mechanism 126 moves distally along the travel axis A. The distal tip of the actuating mechanism 126 extends linearly until the tabs 125 of the ratchet member 124 contact the first discrete stop member 136 of the stationary housing 130, resulting in the deployment of the first implant 182. The discrete stop member is radially aligned with the internal channels of the stationary housing 130 to prevent the actuating mechanism 126 from advancing during the deployment of the implants 182, 184.

[0034] like Figure 3 As shown, the actuating mechanism 126 and the knob-equipped plunger 120 share a common linear travel axis A. The knob-equipped plunger 120 has an internal opening 132 configured to receive the rod portion 128 of the actuating mechanism 126. The internal opening 132 of the knob-equipped plunger 120 is connected to the distal opening of the needle 180 (…). Figure 1A The push mechanism 126 is combined to maintain alignment. The push mechanism 126 also includes a stop feature, such as an annular barb 134. The internal opening 132 of the knob-operated plunger 120 includes a proximal first portion 132a, the inner diameter of which is selected to be larger than that of the distal second portion 132b, to create a countersunk hole 138 between the first and second portions 132a. The outer diameter of the barb 134 is selected to be larger than that of the second portion 132b of the internal opening 132, but smaller than that of the first portion 132a. When assembled, the linear position of the barb 134 is close to the linear position of the countersunk hole 138 in the knob-operated plunger 120, such that a gap 142 exists between the barb 134 and the countersunk hole 138.

[0035] Figure 4 The device 100 is shown after the knob-operated plunger 120 has been pushed distally until the tab 125 of the ratchet member 124 contacts the first discrete stop member 136, thereby deploying the first implant 182. A spring 160 generates a retraction force sufficient to slightly retract the push mechanism 126. This slight retraction allows the ratchet member 124 to rotate and positions the push mechanism 126 in a temporary stationary position. However, the push mechanism 126 will not retract when the combined frictional and bending forces between the lever portion 128 of the push mechanism 126 and the internal opening 188 of the needle 180 exceed the spring force. This prevents radial alignment of the ratchet member 124, thus preventing the push mechanism 126 from being advanced distally to deploy the second implant 184.

[0036] Figure 5A and5B The diagram illustrates the relative positions of the actuating mechanism 126 and the knobbed plunger 120 when the user retracts the plunger 120. As shown, the retraction of the knobbed plunger 120 causes contact between the mating axial wall of the barb 134 in the actuating mechanism 126 and the annular countersunk hole 138 of the knobbed plunger 120. Therefore, the actuating mechanism 126 retracts along with the knobbed plunger 120 to restore device functionality impaired due to usage-related errors. Figure 5C As shown, the barb 134 of the push mechanism 126 includes an inlet portion 134a for press-fitting into the internal opening 132 of the knobbed plunger 120. An annular feature 134b on the barb 134 provides sufficient structural strength to resist forces impeding proximal axial movement of the push mechanism 126. The diameter interference is sufficient to resist axial forces impeding proximal axial movement, but not high enough to hinder the assembly of the two components. During retraction, the normal operating clearance 142 between the barb 134 of the push mechanism 126 and the countersunk hole 138 decreases until the mating surfaces contact. Once contact is made, the push mechanism 126 moves proximally along the travel axis A when the user pushes the knobbed plunger 120. The push mechanism 126 retracts together with the knobbed plunger 120 until the knobbed plunger 120 reaches the proximal stop position. Therefore, the delivery device of this disclosure provides an alternative to the retraction push mechanism 126 and allows the ratchet member 124 to rotate to a radial position suitable for deploying the second implant 184 when the spring force alone is insufficient to retract the push mechanism 126.

[0037] In some embodiments not shown, the annular connection feature may be created in the knobbed plunger 120, wherein a corresponding undercut is present in the actuation mechanism 126. Multi-component connection features may also provide equivalent functionality. For example, after assembly into the opening 132 of the knobbed plunger 120, the retaining ring may be pressed onto the actuation mechanism 126.

[0038] like Figure 6A As shown, another example of the tissue repair device 200 of this disclosure includes a needle 280 and an actuation mechanism 226 sharing a common linear travel axis A. Two implants 282, 284 reside in the distal end of the needle 280. Figure 6AA needle 280 with significant curvature is also shown. In this example, the curvature of the needle 280 coincides with a groove 290 in the distal portion of the needle 280. The actuation mechanism 226 includes a rod portion 228 configured to advance through the needle 280 to expel a first implant 282 and a second implant 284 from the distal end of the needle 280. In this example, the rod portion 228 is made of martensitic nitinol at the operating temperature. Martensitic nitinol advantageously exhibits a lower elastic modulus than austenitic materials. For a given diameter of the rod portion 228, the martensitic rod maintains residual strain at a lower thrust than an austenitic rod with the same cross-sectional area and shape. When the material is mechanically loaded at a temperature below the martensitic transformation completion temperature (Mf) or is fully martensitic, the material retains strain upon subsequent unloading. The original shape can be recovered upon heating to above the austenitic transformation completion temperature (Af). In the example, the stress of Nitinol measured at 3% strain during tensile loading was approximately 50 ksi.

[0039] Figure 6B A device 200 is depicted having a needle curvature (reverse curvature) in a direction opposite to the groove 290. This curvature direction presents a challenge because the distal tip of the rod portion 228 is unsupported during distal advancement. Ordinary push rod materials exhibit sufficient mechanical stiffness to deform the groove 290 and disrupt the needle opening 288. Upon disruption, the push rod 228 will not expel the implant 284. The rod portion 228 of this disclosure conforms to the reverse needle curvature by having optimized mechanical properties and deforming in the region of the groove 290 at a lower force than required to disrupt the opening 288 of the needle 280. It maintains proper function during distal advancement of the push mechanism 226 to expel the implant from the distal end of the needle 280. In the example, at least one of the first implant 282 and the second implant 284 includes a body 292 having a cross-section approximating an axial opening 288 of the needle 280; and a protrusion 294 that engages with the groove 290 to prevent the implants 282, 284 from rotating in the needle 280.

[0040] In some embodiments, the push rod 228 may be manufactured having one or more portions having a low flexural modulus, achieved by heat-treating a portion of the push rod 228 to achieve the desired flexural strength. A multi-segment push rod 228 may include a distal tip portion having a first diameter and a proximal rod portion having a second diameter smaller than the first diameter. A multi-part push rod 228 may have tip portions made of different materials to reduce friction. The push rod 228 may include a distal tip portion with material removed (cutouts) to increase flexibility.

[0041] Figure 7A suture 386 with a proximal end 386a and a distal end 386b is shown. The distal end 386b is configured for attachment to an implant of a tissue repair device (such as the tissue repair devices 100, 200 described above). The proximal end 386a is configured to exit the joint space and includes a bifurcation segment 386c and a tail 386d. The bifurcation segment 386c acts as a loop to allow multiple fingers of the user to pass through. In the bifurcation segment 386c, half of the fiber bundle used to generate the suture 386 forms each segment of the loop to effectively form the branching and convergence of the suture 386. The bifurcation segment 386c is large enough to accommodate multiple fingers, allowing the user to pull the suture 386 to the desired repair tension. The bifurcation segment 386c has a fixed diameter and does not cause any user discomfort when under tension. In this example, reinforcement technology ensures that the bifurcation segment 386c remains open and easily visible to the user, even when wet. These strengthening techniques may include thermosetting or “shaping” the suture 386 by heating it to its glass transition temperature and allowing it to cool around a mandrel of a specific shape and size. Other examples of strengthening techniques include providing a monofilament core in each segment of the bifurcation segment 386c. In other examples not shown, the suture 386 may comprise a full loop rather than bifurcation segments 386c to maintain the same diameter along the entire length of the suture 386 and exclude the tail 386d. It is further envisioned that the suture 386 may comprise multiple bifurcation segments 386c of the same or different sizes along the length of the suture 386.

[0042] It should be recognized that, for clarity, certain features of the invention described in the context of individual embodiments may also be provided in combination in a single embodiment. Conversely, for brevity, various features of the invention described in the context of individual embodiments may also be provided individually or in any suitable sub-combination.

[0043] While many changes and modifications to this disclosure will undoubtedly become apparent to those skilled in the art after reading the foregoing description, it should be understood that the specific embodiments shown and described in an illustrative manner are by no means intended to be limiting. Furthermore, although the subject matter has been described with reference to specific embodiments, variations will occur to those skilled in the art within the spirit and scope of this disclosure. It should be noted that the foregoing examples are provided for illustrative purposes only and should in no way be construed as limiting this disclosure.

[0044] Although this disclosure has been described herein with reference to specific embodiments, it is not intended to be limited to the details disclosed herein; rather, it extends to all functionally equivalent structures, methods, and uses, for example, within the scope of the claims.

Claims

1. A tissue repair device, comprising: A handle with a longitudinal axis; An elongated needle extending from the shank portion and defining an axial opening, the needle including a proximal end and a distal end; A first implant and a second implant connected by sutures and at least partially disposed within the axial opening of the needle, the second implant being disposed close to the first implant; as well as Propulsion assembly, the propulsion assembly comprising: A rod portion, the rod portion being configured to be advanced through the needle to expel the first implant and the second implant from the distal end of the needle; A ratchet member, the ratchet member being coupled to a proximal section of the lever portion and configured to advance the lever portion through the needle by axial and rotational movement; A propulsion member, coupled to the ratchet member, having a linear travel axis, including a first opening connected to a second opening, the diameter of the first opening being smaller than the diameter of the second opening, such that the first opening and the second opening define a stop; and A push-pull mechanism, movable on the linear travel axis, includes a mating rod, wherein a first opening of the propulsion member receives a section of the mating rod, the mating rod having a stop member including a barb at its distal end, wherein in a first position the push-pull mechanism engages the stop member, and in a second position the push-pull mechanism approaches the stop member.

2. The tissue repair device according to claim 1, wherein the rod portion comprises nitinol.

3. The tissue repair device according to claim 2, wherein the nickeltinol is martensitic nickeltinol.

4. The tissue repair device according to claim 3, wherein the tensile strain of the nickel-titanium is about 50 ksi.

5. The tissue repair device of claim 1, wherein the advancement assembly includes a plunger that allows a user to engage the push-pull mechanism to advance the first implant and the second implant from the distal end of the needle.

6. The tissue repair device according to claim 1, wherein: The distal end of the needle includes a groove; and At least one of the first implant and the second implant includes a body having a cross-section approximating an axial opening of the needle; and a protrusion that engages with the groove to prevent the at least one of the first implant and the second implant from rotating within the needle.

7. The tissue repair apparatus of claim 1, further comprising a depth tube that limits the depth to which the needle can be inserted into the tissue.

8. The tissue repair apparatus of claim 7, wherein the depth tube includes a depth tube lock for locking the linear position of the depth tube.

9. The tissue repair apparatus of claim 8, further comprising a needle housing coupled to the shank, wherein the depth tube lock is operatively coupled to the needle housing.

10. The tissue repair device of claim 1, wherein the distal end of the needle has a curved geometry.

11. The tissue repair apparatus of claim 10, wherein the curve of the curved geometry coincides with the groove at the distal end of the needle.

12. The tissue repair apparatus of claim 10, wherein the curve of the curved geometry is away from the groove at the distal end of the needle.

13. The tissue repair apparatus of claim 1, further comprising one or more stops configured to restrict the ratchet member from advancing in a predetermined increment.

14. The tissue repair device of claim 1, wherein the ratchet member is configured to return to a final position proximal to the starting position of the ratchet member after expelling at least one of the first implant and the second implant.

15. The tissue repair apparatus of claim 1, wherein the suture comprises a sliding knot.

16. The tissue repair apparatus of claim 1, wherein the inner surface of the propulsion member includes a plurality of teeth configured to engage the ratchet member.

17. The tissue repair device of claim 1, wherein the ratchet member includes two radially extending tabs configured to alternately engage and disengage with a plurality of channels located within the propulsion member.

18. The tissue repair apparatus of claim 1, wherein the barb includes an introduction portion configured to facilitate press-fitting into a first opening of the propulsion member.

Images