Abstract:
An apparatus for inserting a staple into torn tissue such as the meniscus of the knee. The apparatus includes a pair of shafts individually movable in a longitudinal directing which are actuable from a handle mechanism. The shafts are movable sequentially so that the shafts disjunctively advance the prongs of the staple which is releasably held adjacent distal end portions of the shafts. A further embodiment of the device consists of a pair of needles detachably secured to a pair of anchoring members having a plurality of barb-like projections extending outwardly therefrom. The anchoring members are joined by a suture which connects adjacent the trailing ends of the anchoring members opposite the penetration end of the needles. The needles are engaged with the anchoring members to transmit a first pushing force applied to the needles to advance the anchoring members into the tissue, and are releasable from their engagement with the anchoring members responsive to a second pulling force applied to the needles in a direction opposite the pushing direction.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This is a continuation of application Ser. No. 08/449,175 filed on May 24, 1995, now abandoned, which is a divisional of Ser. No. 08/345,539 filed on Nov. 28, 1994, now U.S. Pat. No. 5,643,319 which is a continuation of Ser. No. 07/947,753 filed on Sep. 21, 1992, now abandoned which is a CIP of Ser. No. 07/699,991 filed on May 13, 1991 now U.S. Pat. No. 5,269,783. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to the field of laparoscopic or endoscopic surgery, and more particularly to a device for advancing a surgical staple into torn tissue such as the meniscus of the knee for repairing the torn meniscus. 
     2. Discussion of the Prior Art 
     A technique has been developed using arthroscopic instruments which provides for meniscal repair through the use of a pair of surgical needles which are inserted through cannuli into the knee on opposite sides of the tear in the meniscus to be repaired. The needles are linked by a single suture which is pushed down through the cannuli and across the tear. An incision is made in the skin at the point where the needle exit the knee joint so that the leading end of each needle may be grasped and pulled through the joint. The ends of the sutures are then grasped after the needles are removed from the suture ends and the suture is then tied outside the skin so that a horizontal suture is created in the meniscus. This procedure is repeated for placement of as many suture as necessary to repair the meniscus tear. This process is very time consuming, and the strength of the repair is dependent upon the tension created by the knot tied in the suture. 
     An additional procedure and instrument is known from U.S. Pat. No. 5,002,562, in which a barbed clip and instrument for applying the clip for repairing peripheral meniscal tears is disclosed. The instrument has a pair of opposed arcuate jaws which are shaped to hold a complementary-shaped curved surgical clip therebetween, such that the barbs of the clip are retained within notches in the jaws until the clip is inserted. The legs of the clip are typically joined by a flexible material, such as a suture. The jaws are biased in a normally open position, and as the jaws are pushed into the tissue, the jaws are scissored or closed together until they preferably overlap to move the legs of the clip together until they cross. The jaws are then reopened and backed out of the tissue, with the barbs of the clip retaining the clip in position in the tissue. 
     However, a disadvantage of such a device lies in the fact that the scissoring or cutting action of the jaws necessary to move the legs of the clip together may further damage the surrounding meniscal tissue. Consequently, there remains a need for a tool for applying tacks or staples which avoids incidental damage to the tissue during insertion of the staple. The need exists for a device for repairing torn tissue, such as the meniscus of the knee, which obviates the disadvantages encountered in the prior art and provides an efficient, suture-type device which expedites the surgical procedure and reduces the amount of precision necessary on the part of the surgeon during the procedure. 
     SUMMARY OF THE INVENTION 
     It is therefore an aim of the present invention to provide a tool which avoids any incidental damage to surrounding tissue during repair of torn tissue, such as a procedure for repair of the meniscus. The present invention provides such a tool for linearly inserting a resorbable staple into the mensicus. In order to insert the staple linearly, the tool includes longitudinally movable shaft members, which are advanced longitudinally to advance the staple held at the distal ends of the shafts linearly into the meniscus. To accomplish longitudinal movement of the shaft members, a pair of squeezable handles are provided which are movable toward one another to move the shafts distally to advance the staple linearly into the meniscus. Means are provided for translating movement of the handles into the linear advancement of the shaft members, in the form of a rack and pawl mechanism, which translates the pivotal motion of the handles toward each other to longitudinal motion to move the shafts distally. 
     The tool of the present invention provides for sequential advancement of the staple member in that the legs are advanced one at a time. A first leg is advanced into position in the tissue, followed by advancement of the second leg so that the flexible material is positioned across the tear in the meniscus. After the first leg is positioned in the tissue, the pawl member associated with the first shaft member is disengaged from its rack member to terminate further advancement of the first leg. The second leg member is then advanced into the tissue so that the suture material is positioned across the tear. The tool further includes means for releasing the shaft members after insertion of the staple to return the shafts to their original position so that the tool may be withdrawn from the surgical site. 
     In a second embodiment, the device for repairing torn tissue and muscles of the present invention comprises a pair of surgical needles, each of which is engaged with one of a pair of anchoring leg members, which essentially comprise absorbable rods having outwardly projecting barbs. Each anchoring leg member is secured adjacent a second end opposite the penetration end to an absorbable flexible material such as a suture which extends between the two anchoring leg members. The means of engagement between the needles and anchoring leg members allows for a first pushing force applied axially to the needles in a first direction to be transmitted to the anchoring leg members to advance the anchoring members into the torn tissue, while allowing for the release of the needles responsive to a second pulling movement applied in an opposite direction to the pushing force. The means of engagement between the needles and anchoring members may be provided by a frictional engagement between a channel in each of the anchoring members and the needles. 
     The tool of the present invention thus reduces the incidental trauma to tissue caused during the insertion of a staple by providing for linear insertion of the staple. The tool expedites the surgical process by providing for quick loading of the staple and insuring accurate placement at the tissue tear. 
     The staple member for use with the tool of the present invention preferably includes a pair of anchoring leg members constructed with a plurality of outwardly directed barb members along their length. The material of which the leg members are formed is preferably a substantially rigid bioresorbable material which allows for penetration of the legs into the meniscal tissue. The barb members permit forward penetration but restrict or prevent reverse movement of the barbs, thereby preventing the legs from backing out of the tissue after placement. Preferably, the leg members are formed by injection molding techniques. 
     The leg members include a longitudinal slot or channel which accepts a needle member which is positioned at the distal end of each shaft member of the tool of the present invention. The leg members are loaded onto the needles for placement into the tissue, such that the needles penetrate the tissue so that the leg members may be driven behind the needles into position. Preferably, the leg members are joined at their rearward ends by a flexible material such as a suture. After the leg members are secured in the tissue, the needles, and the tool, are withdrawn leaving the leg members and suture anchored in the tissue. 
     The needles for use with the invention may have a uniform cross section, with one of the needles being positioned in each channel. In order to provide a suitable engagement therebetween, each channel maybe provided with a narrower uniform cross section suitable to provide a frictional engagement with the needle so that a first pushing force applied axially to the needles is transmitted to the anchoring members to advance the anchoring members into the torn tissue, while a second pulling force applied in the opposite direction to the pushing force releases the needles from their engagement with the anchoring members. 
     With other embodiments, the needles may similarly have a uniform cross section, and each channel may taper or narrow to a suitable diameter less than the diameter of the needles. The needles may instead be tapered in the direction of their sharp, penetration tip, and each channel may have a uniform cross section. Alternatively, each of the channels may taper or narrow in the direction of the penetration end of the anchoring member, and each needle positioned therein may have a corresponding taper in the direction of its sharp, penetration tip. In a further alternative embodiment, each needle may be provided with a shoulder, and each channel may be provided with a uniform cross section somewhat wider than the needle positioned therein for longitudinal motion of the needle therein. In this embodiment, each anchoring member provides an abutment portion around the distal end of the channel against which the shoulder abuts to provide an abutting relationship to transmit the pushing force to the anchoring members while allowing for easy withdrawal of the needles from the anchoring members responsive to movement rearwards in a direction opposite the pushing force. 
     With each of the preferred embodiments, the barbs of the anchoring member have a tapered configuration towards the penetration end of the needles so that as the needles are pushed through the tissue, the barbs easily pass through the tissue with the needle. The configuration of the barbs is such that the anchoring members pass easily through the tissue in the forward direction, but are prevented from moving in the reverse direction. The barbs are provided to anchor the device in the tissue. 
     The connection between the anchoring members and the suture may include adhesives, swaging, crimping or the like. Preferably, both the suture and the anchoring members are constructed of a bioresorbable material. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The foregoing features of the present invention will become more readily apparent and may be understood by referring to the following detailed description of an illustrative embodiment of device according to the present invention, taken in conjunction with the accompanying drawings, in which: 
     FIG. 1 illustrates a perspective view of a preferred embodiment of the device for applying surgical staples according to the present invention; 
     FIG. 2 illustrates a top cut-away view of the embodiment of FIG. 1; 
     FIG. 3 illustrates a side cut-away view showing the internal frame of the device of FIG. 1; 
     FIG. 4 illustrates a cut-away side view with the internal frame removed taken along lines  4 — 4  of FIG. 2; 
     FIG. 5 illustrates a side view of the opposite side of the device in relation to FIG. 3 showing the internal frame of the device of FIG. 1; 
     FIG. 6 illustrates a bottom cut-away view taken along lines  6 — 6  of FIG. 3; 
     FIG. 7 illustrates a top detailed view of the distal end of the device of FIG. 1; 
     FIG. 8 illustrates a partially cut-away side view of the distal end of the device of FIG. 7; 
     FIG. 9 illustrates a cut-away top view of the distal end of the device of FIG. 7; 
     FIG. 10 illustrates a perspective view of an alternate embodiment of the device of the present invention; 
     FIG. 11 illustrates a side view of the connecting members of the embodiment of FIG. 10 along with their suture interconnection; 
     FIG. 12 illustrates a perspective posterior view of the muscular structure of the knee; 
     FIG. 13 illustrates a cut-away perspective view of the knee of FIG. 12 along line  13 — 13  showing the device according to FIG. 10 in position during the meniscal repair procedure; 
     FIG. 14 illustrates a perspective anterior view of the knee of FIG. 12 with the device according to FIG. 10 in position during the meniscal repair procedure; 
     FIG. 15 illustrates a side view of one of the connecting members of the embodiment of FIG. 10 showing the entry of the needle as it is being inserted into the channel of the connecting member; 
     FIG. 16 illustrates a side view of the embodiment of FIG. 10; 
     FIG. 17 illustrates a side view of another embodiment of the device of FIG. 10; 
     FIG. 18 illustrates a side view of a further embodiment of the device of FIG. 10; 
     FIG. 19 illustrates a side view of an additional embodiment of the device of FIG. 10; 
     FIG. 20 illustrates a side view of another embodiment of the device of FIG. 10; 
     FIG. 21 illustrates a cross-sectional view of the embodiments of FIGS. 10, and  16 - 19 ; and 
     FIG. 22 illustrates a cross-sectional view of an additional alternative embodiment. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     Referring in detail to the drawings, in which like reference numerals identify similar or identical elements throughout the views, FIG. 1 illustrates a first embodiment of the staple applying device shown generally as  10 . A housing  12  is provided and encloses an internal frame having left and right halves  14  and  16 , which are separated by front and rear spacers  18  and  20  as best seen in FIG.  2 . Extending outwardly from housing  12  is an elongated tubular member  24  which encloses a pair of spaced, elongated shafts  26  and  28 , as best seen FIGS. 2,  8  and  9 . Device  10  is suitable for inserting a resorbable meniscal staple  30 , which is removably held at the distal ends of shafts  26 ,  28 , linearly into torn tissue such as the meniscus. A handle member  32  is pivotally movable toward and away handle member  34  to move shafts  26 ,  28  longitudinally as described hereinafter to insert meniscal staple  30  linearly into the meniscus. 
     Tubular member  24  allows the distal meniscal staple  30  to be inserted through a small incision in the body for placement within the meniscus or other similar bodily tissue to be repaired, thus allowing surgical procedures to be performed thereon without the need of severe incisions in adjacent body tissues. 
     Referring now to FIGS. 2 and 4, a pair of longitudinally movable elongated rack members  38  and  40  are positioned between frame halves  14  and  16 . A pair of spaced pin members  44  project laterally from opposite sides of racks  38  and  40  through frame halves  14  and  16 . 
     Each pin member  44  slidably extends into an elongated slot  48  in frame halves  14  and  16 , as shown in FIG.  3 . Rack  40  is longitudinally movable between an initial rearward position, in which pin members  44  abut against the rearward shoulder portions  52  of slots  48  as shown in FIGS. 3 and 5, and a second forward position, in which pin members  44  abut against the forward shoulder portions  56  of slots  48 . Rack  38  is provided with slots  49  similar to slots  48 . 
     Shaft  28  extends longitudinally from the forward end of rack  40  so that shaft  28  moves longitudinally with rack  40  between an initial rearward position and a second forward position. Shaft  28  is attached to rack  40  by suitable means  41  such as pins, screws, rivets or the like which are retained within bores in the coupling portion  68  or rack  40 . Similarly, shaft  26  extends longitudinally from the forward end of rack  38 , as at coupling portion  72 , so that shaft  26  moves longitudinally with rack  38  between an initial rearward position and a second forward position. 
     Front spacer  18  is provided with a bore through which tubular member  24  and shafts  26  and  28  longitudinally extend. A nose piece  76  located at the front end of spacer  18  surrounds tubular member  24 , and provides additional support for tubular member  24 . 
     Handle  32  is pivotally attached between frame halves  14 ,  16  by a pivot pin  78 . A handle return spring  88  is connected between the end of a lateral extension  90  of handle  32  and an anchor pin  92  extending between frame halves  14 ,  16  of handle  34 . Spring  88  returns handle  32  from its second position to its first position. 
     A pair of spaced front pawls  94 ,  95  engage with racks  40 ,  38 , respectively, to prevent the rearward movement of racks  38 ,  40 . Pawls  94 ,  95  are pivotally mounted between frame halves  14 ,  16  on a front pawl pin  96 , which further maintains the spacing between pawls  94 ,  95 . A spring member  98  biases the tongue end of pawls  94 ,  95  upward so that pawls  94 ,  95  engage racks  38 ,  40 . 
     A pair of spaced rear pawls  102 ,  103  individually engage with racks  40 ,  38 , respectively to selectively cause incremental forward longitudinal movement of racks  38 ,  40  in the direction of arrow A, as described hereinafter in relation to FIG. 4, when handle  32  is moved toward handle  34 . Pawls  102 ,  103  are pivotally mounted between frame halves  14 ,  16  on a rear pawl pin  106 , which is adapted to maintain the spacing between pawls  102 ,  103 . A spring member  108  biases the tongue end of each pawl  102 ,  103  upward so that pawls  102 ,  103  individually engage its adjacent ratchet rack  38 ,  40 . Together, pawls  102 ,  103  and racks  38 ,  40  provide a translating means for translating the pivotal motion of handle  32  toward handle  34  to incremental longitudinal motion to selectively move shafts  26 ,  28  longitudinally. 
     Referring to FIG. 3, a longitudinally movable elongated disconnect lever  112  is shown slidably mounted along the outer surface of frame half  16 . Disconnect lever  112  is movable via finger pressure, which may be applied against a thumb piece  113 , which may extend outside of housing  12  and extend laterally from disconnect lever  112 . Disconnect lever  112  is provided with a pair of spaced, longitudinally aligned, elongated slots  114 . A shoulder pin  116  extends laterally from frame half  16  through each slot  114 . Together, shoulder pins  116  and slots  114  limit the longitudinal movement of disconnect lever  112  between a forward position as shown in FIG. 3, in which pines  116  abut against rear shoulder portions of slots  114 , and a rearward position, as indicated by phantom lines  118  in which pines  116  abut against front shoulder portions of slots  114 . 
     A spring detent  122  extends outwardly from the side of frame half  16 . Disconnect lever  112  is provided with a pair of spaced recesses  124  and  126  along its lower surface. When disconnect lever  112  is moved to its first or initial forward position, spring detent  122  engages with rear recess  124  to retain disconnect lever  112  in the position shown in FIG.  3 . When disconnect lever  112  is moved rearwardly from the forward position to the rearward position, detent  122  engages with front recess  126  to retain disconnect lever  112  in the rearward position. 
     Disconnect lever  112  is movable between its initial position and its second rear position. In the initial position as shown in FIG. 3, disconnect lever  112  allows both rear pawls  102 ,  103  to engage racks  40 ,  38 , respectively to translate the pivotal motion of handle  32  toward handle  34  to longitudinal motion to move both racks  38 ,  40  and shafts  26 ,  28  longitudinally forward. FIG. 4 shows rear pawl  102  engaging rack  40 . In its second rear position, disconnect lever  112  disengages right rear pawl  102  from rack  40 . Thus, the pivotal motion of handle  32  toward handle  34  is translated to only move rack  38  and shaft  26  longitudinally forward. To achieve this disengagement of right rear pawl  102  from rack  40  a cam shoulder  130  formed on level  112  is provided which engages a disconnect pin  132 , which extends laterally from pawl  102 , to move the rearward end of pawl  102  upward. The upward movement of the rearward end of pawl  102  disengages the forward tongue end  134  of pawl  102  from rack  38 . 
     Referring to FIG. 5, a longitudinally movable elongated release lever  136  is slidably mounted on the outer surface of frame half  14 . Release lever  136  is movable via finger pressure applied against a release button  138  positioned adjacent the rear of housing  12 . Release lever  136  is movable longitudinally between an initial rear position and a second forward position, as indicated by phantom lines  144 , and is provided with a pair of spaced, longitudinally aligned, elongated slots  146 . A shoulder pin  148  extends laterally from frame half  14  through each slot  146 . Together, shoulder pins  148  and slots  146  limit the longitudinal movement of release lever  136  between a rear position, as shown in FIG. 5, in which pins  148  abut against forward shoulder portions of slots  146 , and a forward position in which pins  148  abut against rear shoulder portions of slots  146 . 
     Release lever  136  is movable to its forward position via finger pressure to disengage front and rear pawls  94 ,  95  and  102 ,  103  from racks  40 ,  38 . This allows racks  38 ,  40  to be returned rearwardly to their initial positions. In order that release lever  136  may disengage pawls  94 ,  95  and  102 ,  103  from racks  40 ,  38 , release lever  136  is provided with a pair of spaced cam extensions  152 , which extend laterally from release lever  136 . When release lever  136  is moved to its forward position, cam extensions  152  engage against the bottom rearward end portions of pawls  94 ,  95  and  102 ,  103  to move the rearward ends of pawls  94 ,  95  and  102 ,  103  upward. This pivots the pawls to disengage the forward tongue ends of pawls  94 ,  95  and  102 ,  103  from racks  40 ,  38  to releas the racks  40 ,  38  for longitudinal rearward movement. 
     Return springs  154  and  160 , as seen in FIG. 2, are connected to racks  40  and  38 , respectively, and pin  46 . Return springs  154  and  160  return racks  38  and  40  rearwardly to an initial position when pawls  94 ,  95  and  102 ,  103  are disengaged. The movement of racks  38 ,  40  rearwardly to their initial position returns shafts  26 ,  28  to their initial position. When release lever  136  is released, a biasing spring  166  returns lever  136  to its initial rear position. 
     Referring to FIG. 9, each shaft  26 ,  28  may be segmented to include push pin segments  174  and push bar segments  182  which are ultimately connected to elongated needle holders  178 . Of course, shafts  26  and  28  may be single rod-like members if desired. A clip member  186  may be provided to join push bars  182  to needle holders  178  in a detachable manner as shown in FIG. 8, whereby clip  186  engages and retains a ball  188 , which extends axially from the rearward end of the needle holder  178 . 
     At the distal end of each shaft  26 ,  28  is an elongated needle member  190  which extends longitudinally from an end portion of each needle holder  178 . As described in detail below, staple  30  includes a pair of resorbable anchor segments  194  joined at their rear portions by a resorbable flexible web  198 , which may preferably be in the form of a suture. Each anchor segment  194  may be provided with a plurality of barb-like projections  206  for anchoring the staple  30  in the tissue to which it is applied. Anchor segment  194  further includes an elongated channel or groove along its length which receives the needle  190 . Each channel and needle  190  cooperate so that longitudinal forward movement of shafts  26 ,  28  in the direction of arrow B advances anchor segments  194  forwardly. Needles  190  are releasable from the channels when shafts  26 ,  28  are withdrawn longitudinally rearward, thus allowing needles  190  to be withdrawn rearwardly from anchor segments  194  while staple  30  remains in the tissue. 
     Referring to FIG. 7, the distal end of tubular member  24  is provided with a notch  202 , which allows for loading of staple  30  and further allows visual observation of the anchor segments  194  of staple  30  by the surgeon during positioning of staple  30  within the meniscus to be repaired. Notch  202  provides for rotatable orientation of tubular member  24  to align staple  30  with the tear in the meniscal tissue. 
     In use, tubular member  24  is inserted through an incision and, with the aid of an endoscope or arthroscope, the surgeon positions the distal tip  204  of tubular member  24  adjacent the meniscal tissue to be repaired. 
     When handles  32 ,  34  are squeezed together, both rear pawls  102 ,  103  are pivoted to move left and right ratchet racks  38 ,  40  longitudinally forward in the direction of arrow A, as shown in FIG.  4 . Springs  108  bias the forward ends of pawls  102 ,  103  upward, causing pawls  102 ,  103  to engage with ratchet racks  38 ,  40 . Consequently, the forward motion of rear pawls  102 ,  103  causes ratchet racks  38 ,  40  to move distally forward under the influence of the forward pivotal movements of pawls  102 ,  103 . As may be appreciated forward pawls  94 ,  95 , which remain engaged with racks  38 ,  40  during the return motion of handle  32 , prevent rack return springs  154 ,  160  from prematurely moving racks  38 ,  40  rearwardly as handles  32 ,  34  are repeatedly squeezed and released to incrementally advance ratchet racks  28 ,  40  longitudinally forward. 
     In the initial position of shafts  26 ,  28 , one needle  190  is positioned ahead of the other needle  190  so that movement of ratchet racks  38 ,  40  causes one anchor segment  194  of staple  30  to advance linearly ahead of the other anchor segment  194 . After sufficient distal movement of the shafts  26 ,  28  to position the first anchor segment  194  fully into the meniscal tissue, disconnect lever  122  may now be actuated rearwardly under the influence of finger pressure from its initial position to its second rearward position to disengage right rear pawl  102  from ratchet rack  40 . As discussed in detail above, spring detent  122  retains disconnect lever  112  in its initial position and its second position. Consequently, further squeezing of handle  32  toward handle  34  will only cause distal forward longitudinal movement of left ratchet rack  38  to linearly advance the trailing anchor segment  194  into the meniscus. The disengagement of right rear pawl  102  from ratchet rack  40  prevents further longitudinal movement of the first anchor segment  194  linearly into the meniscus. 
     After both anchor segments  194  are inserted and anchored in the desired position by the barb-like projections  206  with web  198  positioned accurately across the tear in the meniscus, release button  138  may be pressed inwardly to disengage front and rear pawls  94 ,  95 , and  103  from ratchet racks  38 ,  40  and thereby allow ratchet racks  38 ,  40  to move rearward to their original initial position under the influence of return springs  154 ,  160 . 
     Pressing inward on release button  138  causes release lever  136  to move distally forward and causes lateral cam extensions  152  to engage against the rearward portions of pawls  94 ,  95  and  103  and rotate pawls  94 ,  95  and  103  to disengage their forward tongue ends from racks  38 ,  40 , thus allowing return springs  154 ,  160  to return racks  38 ,  40  and shafts  26 ,  28  longitudinally to their initial position. 
     Return of shafts  26 ,  28  to their initial position pulls the needles  190  rearwardly out of the channels of anchor segments  194  and withdraws needles  190  from the tissue. The barb-like projections  206  along anchor segments  194  retain staple  30  in the meniscus, with web  198  held across the tear in the meniscus. Tubular member  24  may then be withdrawn from the incision. 
     Turning now to FIG. 10, there is shown an alternate embodiment of the repair device  300  of the present invention. Repair device  10  generally comprises a pair of needles  302 , preferably constructed of stainless steel or other surgical grade metal alloy, having a sharp tip  303  at one end to facilitate penetration through tissue, and a blunt end  305  at the other end. In this embodiment, along with the other preferred embodiments described hereafter, the length of each needle is between 6 inches and 10 inches. However, this is not intended to be limiting, as clearly needles of various lengths may be utilized. 
     Engaged with needles  302  are a pair of anchoring or connecting leg members  304  which are similar to anchor segments  194  described above. Anchoring member  304  are constructed of a bioresorbable material, such as homopolymers and copolymers of lactide, glycolide, pplydioxanone, trimethylene carbonate, polyethylene oxide or other bioabsorbable materials or blends of these copolymers. Preferably, the anchoring members  304  are injection molded and are formed of a copolymer of lactide and glycolide. Anchor members  304  are linked by a flexible material  306  such as a suture, also constructed of a bioresorbable material, such as a lactide/glycolide copolymer. Flexible material  306  is similar to web  198  described above and allows for movement of anchoring members  304  with respect to one another. Anchor members  304  of this embodiment, along with the other preferred embodiments described hereafter, preferably have a length of between about 0.25 inch and 2 inches. However, this is not intended to be limiting as clearly anchor members of various lengths may be utilized. Flexible material  306  of this embodiment, along with the other preferred embodiments described hereafter, preferably has a length of between about 0.25 inch and 2 inches. Likewise, this is not intended to be limiting as clearly flexible material of various lengths may be utilized. 
     Needles  302  provide a piercing means that is engaged with anchor members  304  as discussed in detail hereafter so that a pushing force applied axially to needles  302  in a first direction is transmitted to anchor members  304  to advance anchor members  304  into the torn tissue, while a second pulling force applied in the opposite direction to the initial pushing force releases needles  302  from their engagement with anchoring members  304 . As best seen in FIG. 11, anchor members  304  are secured to suture  306  as a joint  307  by suitable means such as insert molding. 
     Anchor members  304  are provided with an anchoring means in the form of a plurality of barb-like projections  308  which serve to anchor device  300  in the tissue to be repaired. Barbs  308  have a tapered shape to allow anchor members  304  to be pushed through tissue or muscle, such as the meniscus of the knee, in a first forward direction and to prevent anchor members  304  from traveling in a reverse or opposite direction. As may be appreciated, barb-like projections  308  may taper rearwardly toward the penetration end of anchoring members  304  to facilitate movement of tissue anchoring members  304  forwardly through the tissue. Although as shown in FIG. 10 six barbs  308  are provided, any number may be provided, so long as the barbs penetrate the tissue to anchor the device  300 . Similarly, with the other embodiments hereafter described, the number of barbs is also six, although any number of barbs may likewise be provided, so long as the barbs penetrate the tissue to anchor the device. 
     Referring to FIG. 11, each anchor member  304  is provided with a channel  310  which may extend laterally into the body of each anchor member  304  along the length of anchor member  304 . Preferably, each channel  310  has a cross section which may be circular. Further, as shown in detail in FIG. 21, it is preferred that each channel  310  intersect with one of the sides of anchor member  304  so that each channel  310  may be exposed narrowly along its longitudinal length to reduce the thickness of each anchor member  304 . As best shown in FIG. 10, one of the needles  302  is positioned longitudinally in each of the channels  310 , and may be retained therein, exposed along the open length of channel  310 . Alternatively as shown in detail in FIG. 22, the channel may instead be a bore  313  that extends longitudinally through the body  304 ′ of each anchor member. Referring to FIG. 15, channel  310  allows for needles  302  to be inserted in anchor member  304  in the direction of arrow  311  so that the sharp penetration tip  303  of needle  302  protrudes outwardly from the body of anchor member  304  as shown in FIG. 10 to provide a penetration end for anchor member  304 . 
     As shown in FIG. 11, channel  310  extends longitudinally from the trailing or distal end  312  of each anchor member  304  opposite the penetration or proximate end of each anchor member  304 . A means of engagement is provided between needles  302  and anchoring members  304  so that anchoring members  304  may be carried forward by needles  302  as they are inserted forward into the tissues of the body. The means of engagement may be provided by a frictional engagement between channel  310  in anchoring members  304  and the needle  302  positioned longitudinally therein. In this embodiment, each channel  310  may have a uniform cross section, and needles  302  may likewise have a uniform cross-section, with each channel  310  having a narrower uniform cross section to provide a frictional engagement with needle  302  therein. Consequently, a first pushing force applied axially to the needles  302  is transmitted to anchoring members  304  to advance anchoring members  304  into the torn tissue, while a second pulling force applied in the opposite direction to the pushing force releases the needles from their engagement with the anchoring members. The pulling force applied rearwards to needles  302 , overcomes the frictional engagement between needles  302  and anchor members  304 , thus releasing needles  302  from the anchoring members  304 . 
     FIG. 12 illustrates the muscular and ligament structure of the knee  320 , including the pertinent components of the knee to which the present invention is directed. As is well known, the femur  322  is joined to tibia  324  and fibula  326  by muscles, tendons and ligaments, and these bones are separated and cushioned by the medial meniscus  328  and lateral meniscus  330 . Condyles  332  of femur  322  rest on the meniscus, and the bones are joined and supported by anterior cruciate ligament  334 , ligament of Wrisberg  338 , posterior cruciate ligament  336 , and transverse ligament  338  (see FIG.  14 ). The joint capsule is formed by tibial collateral ligament  340  and fibular collateral ligament  342 . 
     FIGS. 13 and 14 illustrate the device  300  of the present invention in use, with FIG. 13 showing knee  320  along lines  13 — 13  of FIG.  12 . During arthroscopic surgery, a surgeon will make an incision in the skin and tissue in the area of the knee to be repaired. The lateral meniscus  330  of a knee  320  having a tear  344  is repaired with the present invention by inserting the device and pushing needles  302  through the meniscus on one side of the tear, and through the torn region. The engagement between needles  302  and anchor members  304  advances anchor members  304  and their barb-like projections  308  into the tissue as needles  302  are pushed forward in a first direction along the axis of the needles. Continued pushing on needles  302  will advance anchor members  304  into the tissue and suture  306  across the tear. 
     When flexible member  306  becomes substantially flush with meniscus  330  and is pulled taut, pushing is discontinued. Barbs  308  of anchor members  304  anchor the device in the meniscus  330  and prevent the device from backing off, so that tear  344  is maintained in an abutting relationship against itself to facilitate healing. 
     Needles  302  may then be removed from anchoring members  304  by a second pulling motion applied to the needles in the opposite direction to the pushing force, thus releasing needles  302  from the anchoring members  304  while allowing anchor members  304  to remain in position in the tissue of the body with suture  306  substantially flush with meniscus  330 . Consequently, tear  344  is maintained in its abutting relationship against itself to facilitate healing. The material of which anchor members  304  and suture  306  are constructed are preferably bio-resorbable materials that are resorbed at a rate which is slow enough to facilitate healing of the tear in the tissue. After removal of needles  302 , the incision is stitched closed. 
     Turning now to FIG. 17, another embodiment  350  of the invention is shown. Device  350  includes a pair of elongated needles  302 , a pair of elongated anchor members  352  similar to anchor members  304  that are joined by a flexible member or suture  306 . Barb-like projections  308  protrude from anchor members  352 . Device  350  also includes an elongated channel  354  that extends laterally into each anchor member  352  from the trailing or proximal end  312  opposite the penetration or distal end  356  of each anchor member  352 . One of the needles  302  is positioned longitudinally in each of the channels  354 . Needles  302  are provided with an essentially constant diameter, while channel  354  tapers or narrows in the direction of the penetration end  356  to a cross sectional area somewhat less than the diameter of needles  302 . Accordingly, anchor members  352  and needles  302  may be provided with a suitable frictional engagement that is sufficient to allow anchor members  352  and their barb-like projections  308  to be advanced into the tissue as needles  302  are pushed forward in a first direction. The frictional engagement between anchor members  352  and needles  302  may be overcome by a second pulling force applied to needles  302  in the opposite direction as the pushing force while allowing anchor members  352  to remain in position in the tissue of the body with the suture  306  contacting the tissue adjacent the tear. 
     Referring to FIG. 18, there is shown a further embodiment  360  of the device of the present invention. Device  360  includes a pair of elongated needles  302 , a pair of elongated anchor members  362  similar to elongated anchor members  304  that are joined by a flexible member or suture  306  barb-like projections  308 . As shown in the figure, device  360  also includes an elongated channel  364 . Channel  364  has an essentially constant cross sectional area, and needles  302  taper or narrow in the direction of their penetration ends  303 . 
     Turning now to FIG. 19, an additional embodiment  370  of the present invention is shown. Device  370  similarly includes a pair of elongated needles  302  a pair of elongated anchor members  372  that are joined by a flexible member or suture  306  and a plurality of barb-like projections  308 . As shown in the figure, device  370  also includes an elongated channel  374  that extends laterally into each anchor member  372 . Each channel  374  may taper or narrow from the trailing or distal end in the direction of the penetration end of the anchor member, and each needle  302  has a corresponding taper in the direction of its sharp penetrating tip  303 . When needle  302  is pushed in the axial direction, needle  302  and anchor member  372  have an abutting relationship along the length of channel  374 , which evenly transmits the pushing force applied to needle  302  to anchor member  372 . 
     Referring to FIG. 20, a further embodiment  380  of the present invention is shown. Device  380  includes a pair of elongated needles  302 , a pair of elongated anchor members  382  similar to elongated anchor members  304  that are joined by a flexible member or suture  306  and include a plurality of barb-like projections  308 . As shown in the figure, device  380  also includes an elongated channel  384  that extends laterally into each anchor member  382  from the trailing or distal end  386 . Each channel  384  may have an essentially constant cross section, and each needle  302  may be provided with a shoulder  388  a suitable distance from its sharp penetration tip  303 . Trailing end  386  provides an abutment surface against which shoulder  388  may abut. When needles  302  are pushed in the axial direction, shoulders  388  abut against trailing end  386 , thus allowing the pushing force applied to needle  302  to be transmitted to anchor members  382 . 
     While the invention has been particularly shown and described with reference to the preferred embodiments, it will be understood by those skilled in the art that various modifications and changes in form and detail may be made therein without departing from the scope and spirit of the invention. Accordingly, modifications such as those suggested above, but not limited thereto, are to be considered within the scope of the invention.