Patent Publication Number: US-2022211365-A1

Title: Systems For Soft Tissue Repair

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S Application No. 16/219,263, filed on Dec. 13, 2018, the disclosure of which is incorporated herein by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     The present invention relates generally to medical devices and methods for repairing soft tissue. More particularly, the present invention relates to devices and methods for reattaching torn soft tissue ends such as a ruptured Achilles tendon in a minimally invasive manner. 
     Soft tissue damage, particularly a ruptured Achilles tendon, is often a debilitating event that necessitates surgery. Reattaching a ruptured Achilles tendon generally requires that the torn or ripped ends of the tendon be coapted by passing one or more sutures through each damaged end. Each of the torn ends may then be drawn towards one another by tightening the sutures to restore the connecting muscles and tendon to their original lengths. 
     Accessing the damaged tissue, however, generally requires relatively large incisions, or multiple smaller incisions, for effecting adequate purchase and sufficient suturing of the damaged tendon to ensure proper healing of the tendon. Nonetheless, relatively large incisions, or multiple incisions, increase the likelihood of infections and result in prolonged recovery periods. 
     Minimally invasive devices, which may be inserted through relatively smaller incisions, are generally limited in their application for repairing particular tissue regions. For instance, while minimally invasive devices may enable a surgeon to pass sutures through tissue, these instruments are often limited in their ability to pass multiple sutures through non-supported tissue structures in an efficacious manner. Moreover, many such devices are insufficient in supporting unsupported tissue structures such as a ruptured Achilles tendon during suturing. 
     Nevertheless, due to the complications of open surgical operations, minimally invasive tissue repair systems are of continued interest. Two such tissue repair systems, are disclosed in U.S. Pat. No. 8,936,611 and U.S. Pat. No. 9,289,205, each of which is assigned to Applicant and incorporated herein by reference in its entirety. 
     BRIEF SUMMARY OF THE INVENTION 
     In repairing damaged regions of tissue, the elongated housing disclosed herein may be introduced through a single incision to access damaged tissue such as a ruptured or torn Achilles tendon and to pass multiple sutures through the tendon. Thus, the tendon repair assembly may generally include a housing, a rotatable shaft at least partially disposed within the housing, and first and second curved needles. The housing defines a gap between a first edge of the housing and a second edge of the housing, the gap being adapted to receive tissue. The first and second curved needles are articulable within the housing from a delivery position, at which the first and second needles are spaced from the gap, to a deployed position, at which the first and second needles extend through the gap. Rotation of the shaft simultaneously articulates the first and second needles such that the first needle enters the gap before the second needle enters the gap. 
     A base end of the first needle and a base end of the second needle are mounted on an outer surface of the rotatable shaft along an axis that extends parallel to a longitudinal axis of the rotatable shaft. The first and second needles and the rotatable shaft may be a single monolithic structure and the first needle may have a greater length than the second needle. 
     The first needle may include a first notch spaced a first distance from a piercing tip of the first needle and the second needle may include a second notch spaced a second distance from a piercing tip of the second needle such that the first distance is greater than the second distance. The first needle may define a suture channel along an outer portion of the first needle and the second needle may define a suture channel along an outer portion of the second needle. 
     The tissue repair apparatus may further include a suture having a first portion disposed in the suture channel of the first needle forming a first loop, and a second portion disposed in the suture channel of the second needle forming a second loop. The first needle may include a first notch spaced a first distance from a piercing tip of the first needle and the second needle may include a second notch spaced a second distance from a piercing tip of the second needle such that the first distance is greater than the second distance and the first portion of the suture spans the first notch and the second portion of the suture spans the second notch. 
     The system may further include a stylet adapted to carry a cinching suture. The stylet may be slidably disposed within a locking channel defined within a wall of the housing. The first needle may include a first notch spaced a first distance from a piercing tip of the first needle and the second needle may include a second notch spaced a second distance from a piercing tip of the second needle, the first distance being greater than the second distance, such that when the first needle and the second needle are in the deployed position, the first notch and the second notch are longitudinally aligned with one another along the locking channel. 
     In another embodiment, a tissue repair apparatus includes a housing defining a gap between a first edge of the housing and a second edge of the housing, a rotatable shaft at least partially disposed within the housing, and a plurality of curved needles connected to the rotatable shaft. The gap is adapted to receive tissue. The plurality of curved needles is articulable from a delivery position in which the plurality of curved needles is spaced from the gap to a deployed position in which the plurality of curved needles extends through the gap. Rotation of the shaft simultaneously articulates the plurality of curved needles and each one of the plurality of curved needles enters the gap in a sequential order. 
     When the plurality of needles are in the delivery position, each one of the plurality of needles is at least partially positioned within a wall of the housing and on a single side of the gap. A base end of each of the plurality of needles may by be mounted on an outer surface of the rotatable shaft along an axis that extends parallel to a longitudinal axis of the rotatable shaft. The plurality of curved needles may include a first curved needle having a first arc length, a second curved needle having a second arc length, and a third curved needle having a third arc length such that the first arc length is longer than the second arc length and the second length is longer than the third arc length. Each one of the first curved needle, the second curved needle, and the third curved needle may define a suture channel along an outer radial edge of the needle. 
     The first curved needle may include a first notch spaced a first distance from a piercing tip of the first needle, the second curved needle may include a second notch spaced a second distance from a piercing tip of the second needle, and the third needle may include a third notch spaced a third distance from a piercing tip of the third needle such that the first distance is greater than the second distance and the second distance is greater than the third distance. 
     When the plurality of needles are in the deployed position, the first notch, the second notch, and the third notch are longitudinally aligned with one another along a locking channel provided within the housing. 
     The tissue repair apparatus may further include a stylet adapted to carry a cinching suture, the stylet being slidably disposed within the locking channel. In some instances, the locking channel may be at least partially disposed within a wall of the housing. The tissue repair apparatus may also include a contiguous suture having a first portion disposed in the suture channel of the first needle forming a first loop, a second portion disposed in the suture channel of the second needle forming a second loop, and a third portion disposed in the suture channel of the third needle forming a third loop. 
     A piercing end of at least one of the plurality of needles may include dual prongs and at least a portion of the suture channel may be provided between the prongs. Additionally, or alternatively, a piercing end of at least one of the plurality of needles may include a single prong. The single prong may be substantially triangular in shape and tapered from a first lateral side of the single prong to a second lateral side of the single prong. 
     In yet another embodiment, a method for repairing a tissue region includes positioning a portion of a ruptured or torn tendon tissue within a tissue receiving gap defined in a housing of a suture delivery assembly and simultaneously actuating first and second needles at least partially through the tissue receiving gap such that the first and second needles respectively pierce the ruptured or torn tendon tissue at first and second locations with the first needle entering the tissue receiving gap before the second needle enters the tissue receiving gap. 
     The first needle may define a first stylet clearance slot spaced a first distance from a piercing tip of the first needle and the second needle may define a second stylet clearance slot spaced a second distance from a piercing tip of the second needle, the first distance being greater than the second distance. When the first needle and the second needle are in a deployed position, the first stylet clearance slot and the second stylet clearance slot are longitudinally aligned with one another along a locking channel of the housing. 
     The method may further include the step of passing a suture through the ruptured or torn tendon tissue at the first location and the second location and advancing a stylet carrying a cinching suture in a longitudinal direction through the suture delivery assembly and through the first stylet clearance slot and the second stylet clearance slot. 
     Introduction of the suture delivery assembly may include introducing the suture delivery assembly through a single incision along a posterior region of a leg. After the tissue region has been repaired, the first needle and the second needle may be retracted and the suture delivery assembly may be withdrawn from the incision. In some instances, the ruptured or torn tendon tissue may be the Achilles tendon. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1A  is a schematic representation of a human ankle and foot including the Achilles tendon. 
         FIG. 1B  is a schematic representation of the human ankle and foot and illustrating a ruptured Achilles tendon. 
         FIG. 2A  is a front facing perspective view of a suture delivery device according to an embodiment of the present disclosure. 
         FIG. 2B  is a rear facing perspective view of the suture delivery device of  FIG. 2A . 
         FIG. 2C  is an exploded view of the suture delivery device of  FIG. 2B . 
         FIG. 3A  is a bottom facing perspective view of a housing of the suture delivery device of  FIG. 2B . 
         FIG. 3B  is a bottom facing perspective view of the housing and needle assembly of  FIG. 2B  illustrating the needle assembly in a delivery position. 
         FIG. 3C  is a bottom facing perspective view of the housing and needle assembly of  FIG. 2B  illustrating the needle assembly shortly after it has been actuated. 
         FIG. 3D  a bottom facing perspective view of the housing and needle assembly of  FIG. 2B  illustrating the needle assembly in a deployed position. 
         FIG. 4A  is a perspective view of an exemplary needle assembly in which each needle has a single prong. 
         FIG. 4B  is a front plan view of one of the needles shown in  FIG. 4A . 
         FIG. 4C  is a perspective view of the needle shown in  FIG. 4B . 
         FIG. 4D  is a top view of the needle shown in  FIG. 4B . 
         FIG. 5A  is a bottom plan view of another exemplary needle assembly in which each needle has a double pronged tip. 
         FIG. 5B  is a bottom plan view of another exemplary needle assembly in which each needle has a double pronged tip. 
         FIGS. 6A and 6B  is a schematic illustration depicting the manner in which a suture is weaved through an Achilles tendon using the needle assembly of  FIG. 2B . 
         FIGS. 7A-7E  are schematic views showing the use of the suture delivery device of  FIG. 2B  for attaching one or more sutures to first and second Achilles tendon portions and securement of the first and second portions to one another. 
     
    
    
     DETAILED DESCRIPTION 
       FIG. 1A  is a schematic representation of an Achilles tendon AT, the ropelike band of fibrous tissue located in the posterior region of the ankle that couples the plantaris (not shown), gastrocnemius G and soleus muscles S to the calcaneus bone C. These muscles, acting via the Achilles tendon, cause plantar flexion and dorsiflexion of the foot at the ankle and flexion at the knee. 
     As a result of direct trauma to the tendon or injury to the lower leg, foot, or ankle, the Achilles tendon may rupture, as shown in  FIG. 1B , when a sudden force is placed on the tendon that is greater than the tendon can endure. Once the Achilles tendon has ruptured or been severed into a first Achilles tendon portion AT 1  and a second Achilles tendon portion AT 2 , flexion at the foot and knee is no longer possible, rendering basic functions of the foot, such as walking, incredibly difficult. As a result, a ruptured Achilles tendon often requires surgery to coaptate the severed ends of the tissue and restore proper function to the foot and ankle. 
     The devices and methods described herein are configured to suture the severed ends of the first and second Achilles tendon portions AT 1 , AT 2  to one another in a minimally invasive manner. Although the devices and methods are described herein in connection with the repair of the Achilles tendon, it will be appreciated that these concepts may be equally applicable to the repair of other tendons or tissue regions. 
     A tissue repair device  10 , as shown in  FIGS. 2A-2C , includes a housing  12 , a stylet  13 , and an elongated shaft  14  having a plurality of needles  16 ,  18 ,  20  (collectively “needle assembly”) disposed within and articulable through the housing. 
     Housing  12  includes a handle  22  having an ergonomically shaped grip  24  for manipulating tissue repair device  10 . As shown, housing  12  and handle  22  are a monolithic component, however, it will be appreciated that the handle may also be connected to or otherwise coupled to the housing. Handle  22  is preferably angled about a longitudinal axis L of housing  12 , for example, from about 30 degrees to about 90 degrees. This angled orientation allows the user to insert housing  12  through an incision in a posterior region of a patient&#39;s leg to access the Achilles tendon without interference from the patient&#39;s lower leg. 
     Handle  22  further includes actuator  26  for actuating rotation of shaft  14  and, in turn, articulating the needle assembly. Although actuator  26  is shown in  FIGS. 2A-2C  as a rotatable member extending generally perpendicular to handle  22 , it will be appreciated that the actuator may alternatively be formed as a pressable button, a trigger, or any other mechanism known in the art configured to cause rotation of shaft  14 . 
     Referring to  FIG. 3A-3D , housing  12  is generally elongated in shape with a hollow interior for receiving a ruptured Achilles tendon. Housing  12  extends along longitudinal axis L from a proximal end  28  nearest handle  22  to an opposing distal end  30  and may be a thin metal tube that acts as a cover or stiffening component for the features described below. 
     The distal end  30  of housing  12  may be rounded or otherwise atraumatic in shape to prevent damage of surrounding tissues when the housing is introduced into the leg of a patient. Housing  12  may have a length of about 5.6 cm, although the housing may be lengthened or shortened as desired. Moreover, housing  12  may have a semi-circular cross-sectional shape ranging, for example, from between 1 to 2.5 cm in diameter. In other variations, the cross-sectional shape may be elliptical or another shape conducive for atraumatic insertion into the patient&#39;s body. 
     Housing  12  has an opening  32  extending along a bottom side  34  of the housing that allows a ruptured Achilles tendon to be inserted into the hollow interior. The bottom side  34  of housing  12  may be inwardly tapered to assist a user in sliding Achilles tendon portions AT 1 , AT 2  into the hollow interior. Housing  12  further defines a shaft cavity  36  in which shaft  14  is rotatably secured. 
     Shaft cavity  36  divides the interior of housing  12  into a first side having a pre-deployment wall  38  and a second side having deployment wall  40  such that a gap  42  is formed therebetween. Gap  42  is defined by the inner most edges of the pre-deployment and deployment walls  38 ,  40 . Both pre-deployment and deployment walls  38 ,  40  may be generally convex in shape relative to longitudinal axis L. 
     Pre-deployment wall  38  defines a plurality of needle recesses  44 ,  46 ,  48  in which needles  16 ,  18 ,  20  are respectively housed in a delivery position (e.g., before actuation). As shown in  FIG. 3B , needle recesses  44 ,  46 ,  48  have a depth sufficient to completely conceal needles  16 ,  18 ,  20  behind an interior face of pre-deployment wall  38  such that the needles do not extend into gap  42  when the needle assembly is in the delivery position. Although illustrated with needle recesses  44 ,  46 ,  48 , it will be appreciated that housing  12  may include any number of needles recesses including fewer than three recesses or more than three recesses such that the number of needle recesses correspond to the number of needles provided in the needle assembly. 
     Deployment wall  40  defines a plurality of needle receiving slots  50 ,  52 ,  54  that respectively oppose needle recesses  44 ,  46 ,  48  and receive needles  16 ,  18 ,  20  when the needle assembly is in a deployed position (e.g., after actuation) as shown in  FIG. 3D . 
     Housing  12  also defines a stylet channel  56  that wraps around a perimeter of the housing. Stylet channel  56  is preferably concealed behind an interior face of pre-deployment wall  38  and an interior face of deployment wall  40  such that the stylet channel extends through needle receiving slots  50 ,  52 ,  54 . 
     Referring to  FIG. 3C , the portion of stylet channel  56  that extends from the proximal end  28  of housing  12  toward the distal end  30  of the housing and is located behind pre-deployment wall  38  is referred to herein as the loading portion  57 . The portion of stylet channel  56  that extends from the distal end  30  of housing  12  toward the proximal end  28  of the housing and is located behind deployment wall  40  is referred to herein as the locking channel  59 . The arcuate portion of stylet channel  56  that extends along the distal end  30  of housing  12  from loading portion  57  to locking channel  59  is referred to herein as the transition section  60 . 
     As is shown in  FIGS. 2C, 3C and 3D , stylet  13  may be an elongated, thin, flexible ribbon having a bullet-shaped tip  61 , or guide runner, and an aperture  63  that acts as an eyelet for carrying a cinching suture  60 . Stylet  13  may be pre-loaded (or loaded by a user before operation) into stylet channel  56  via loading portion  57  and positioned as shown in  FIG. 3C , such that the tip is located at the distal end of locking channel  59 . Thus, as will be explained hereinafter, as stylet  13  slides through locking channel  59 , cinching suture  60  is passed through the locking channel and each one of needle receiving slots  50 ,  52 ,  54 . 
     With specific reference to  FIG. 3B , shaft cavity  36  may define a groove  64  that is adapted to receive a correspondingly shaped protrusion  66  provided on a proximal end of shaft  14 , and a pocket  68  at the distal end  30  of housing  12  for rotatably securing the shaft within the shaft cavity. 
     As shown in  FIGS. 4, 5A, and 5B , needles  16 ,  18 ,  20  may be integral with shaft  14  such that the needle assembly and the shaft are formed as a single monolithic piece. Alternatively, the needle assembly may be connected to or otherwise coupled to shaft  14  after formation of each component. Each one of needles  16 ,  18 ,  20  are curved or arcuate in shape and include base ends  70 ,  72 ,  74  extending from an outer surface of shaft  14  towards free ends or needle tips  76 ,  78 ,  80 . The base ends  70 ,  72 ,  74  of needles  16 ,  18 ,  20  may be mounted on an outer surface of rotatable shaft  14  along an axis that extends parallel to a longitudinal axis of the rotatable shaft. 
     Needle  16  has a first arc length L 1 , needle  18  has a second arc length L 2  that is greater than the first arc length of needle  16 , and needle  20  has a third arc length L 3  that is greater than the second arc length of needle  18 . For example, L 1  may be about 0.38 cm to about 0.43 cm, L 2  may be about 0.43 cm to about 0.46 cm, and L 3  may be about 0.47 cm to about 0.53 cm although other dimension are contemplated. In one embodiment, L 1  is 0.41 cm, L 2  is 0.45 cm, and L 3  is 0.49 cm. In another embodiment, based on the arc length of the shortest needle, each successively larger needle can be about 10% longer. Moreover, needle  16  is spaced a first distance L 4  from needle  18  and needle  18  is spaced a second distance L 5  from needle  20 . As is shown in  FIG. 5A , the first distance L 4  may be equal to the second distance L 5 , for example, L 4  and L 5  may be about 0.75 cm. However, in alternative embodiments, L 4  may be less than, or greater than L 5 . In further embodiments, more than three needles can be provided, and the distance between adjacent needles at one end can be shorter than the distance between adjacent needles at the opposite end of the needle array. This can be useful where a more secure grip in the tissue is desired at an area closer to the tear, for example. 
     Each one of needles  16 ,  18 ,  20  may have an equal curvature, i.e. an equal radius of curvature about which they extend. Thus, when shaft  14  is rotated, each one of needles  16 ,  18 ,  20  simultaneously begins to articulate through housing  12  and needle tips  76 ,  78 ,  80  enter gap  42  in a sequential order (e.g., needle tip  80  enters the gap first, followed by needle tip  78 , followed by the needle tip  76 ) as shown in  FIG. 3C . As a result, the needle assembly provided herein is configured to sequentially pierce a tendon (as opposed to concurrently). As used herein, sequential order or sequentially means at least one of the needles enters the gap at a different time than at least one of the other needles. By spacing out the times at which needles  16 ,  18 ,  20  pierce the tendon, the impact forces that are exerted on the tendon are reduced and the risk of trauma is minimized. 
     As shown in  FIGS. 3C, 4, and 5B  a notch  82  is provided in each one of needles  16 ,  18 ,  20 . Notches  82  may be provided in an inner circumferential edge  84  ( FIG. 4 ) or an outer circumferential edge  90  ( FIG. 5B ) of needles  16 ,  18 ,  20  and may be provided an equal distance from base members  70 ,  72 ,  74 . In other words, the notch of needle  16  is spaced a first distance D 1  from needle tip  76 , the notch of needle  18  is spaced a second distance D 2  from needle tip  78 , the second distance being greater than the first distance, and the notch of needle  20  is spaced a third distance D 3  from needle tip  80 , the third distance being greater than the second distance. This spacing ensures that each one of the notches  82  are aligned with one another along an axis that extends parallel to the longitudinal axis L of housing  12  throughout articulation of the needle assembly. Thus, when needles  16 ,  18 ,  20  are in the deployed position ( FIG. 3D ) and received within needle receiving slots  50 ,  52 ,  54 , each one of the notches  82  are aligned along locking channel  59  such that stylet  13  may be passed through the notches. 
     Each one of needles  16 ,  18 ,  20  also defines a suture channel  88  formed along an outer surface of the needle, for example, along a length of the needle&#39;s outer circumferential edge  90 . A first suture S 1 , which may be a single continuous suture or may be formed of multiple sutures tied to one another, is wrapped around the needle assembly as follows. 
     With reference to  FIG. 3C , first suture S 1  may, for example, enter the proximal end  28  of housing  12  and extend to the base end  70  of needle  16  where it is wrapped around needle  16  in the suture channel thereof, the first suture may then extend to the base end  72  of needle  18  where it is wrapped around needle  18  in the suture channel thereof, the first suture may then extend to the base end  74  of needle  20  where it is wrapped around needle  20  in the suture channel thereof before it connected to a distal end of stylet  13 . As a result, when needles  16 ,  18 ,  20  pierce the Achilles tendon, first suture S 1  is weaved through the tendon as shown in  FIG. 6  to form a first suture loop  92 , a second suture loop  94 , and a third suture loop  96 . 
     Suture loops  92 ,  94 ,  96  are formed behind the interior face of the deployment wall  40  and in needle receiving slots  50 ,  52 ,  54 . Cinching suture  60  (e.g., the portion of the suture S 1  located between the third suture loop and stylet  13 ) may then be pulled through the first, second and third suture loops  92 ,  94 ,  96  for cinching first suture S 1  to the tendon. 
       FIGS. 4, 5A, 5B  illustrate exemplary needle assemblies. As shown, each of these needle assemblies include needles  16 ,  18 ,  20 . However, it will be appreciated that either needle assembly may include any number of needles including fewer than three needles or more than three needles. In an embodiment, in which the needle assembly only includes needles  16 ,  18 , the needles have arc length L 1 , L 2 . In embodiments in which the needle assembly includes three or more needles, two or more of the needles may have the same or different arc lengths, for example, L 1 , L 1 , L 2 . Moreover, although the needle assemblies illustrated in  FIGS. 4, 5A, 5B , have arc lengths L 1 , L 2 , L 3  that increase in length from the proximal end of shaft  14  to the distal end of the shaft, it will be appreciated that the arc lengths of each of the needles need not be in an ascending order, for example, needle  16  may have an arc length L 2 , needle  18  may have an arc length L 1 , and needle  20  may have an arc length L 3 , so long as the needles enter gap  42  simultaneously (i.e., at least one needle enters the gap at a different time than at least one of the other needles). 
     With specific reference to  FIGS. 4A-4D , needle tips  76 ,  78 ,  80  include a single prong  98 . Prong  98  may extend from a lateral edge of needles  16 ,  18 ,  20  and have a tetrahedron or pyramid shape. Prong  98  includes a first lateral edge  99  that is substantially flush with the lateral edge of the needle from which it extends and a second lateral edge  100  that tapers toward an opposing lateral edge of the needle in front of suture channel  88 . Thus, when needles  16 ,  18 ,  20  pierce a tendon, lateral edge  100  diverts tissue away from suture channel  88  and shields the suture channel, preventing the suture channel from being clogged. 
     With specific reference to  FIG. 5A and 5B , illustrating a different needle assembly, needle tips  76 ,  78 ,  80  include a dual pronged tip  102  such that each one of the prongs is positioned on a lateral side of suture channel  88 . Prong  102  may be tapered from the inner circumferential edge  84  of needles  16 ,  18 ,  20  toward outer the circumferential edge  90  of the needles to reduce trauma during piercing of the Achilles tendon. 
     With reference to  FIGS. 7A-7E , use of tissue repair device  10  will now be described. A surgeon may introduce housing  12  into a single incision located in the posterior region of a patient&#39;s leg, superior to the foot and in proximity to a ruptured or damaged Achilles tendon. As shown in  FIG. 7A , which illustrates a posterior view of a ruptured tendon, housing  12  may be introduced through a single, small incision, for example, 3 cm in length. The incision may be in proximity to the rupture, inferior to the first Achilles tendon portion AT 1  and superior to the second Achilles tendon portion AT 2 . Because handle  22  is angled relative to housing  12 , grip  24  may be angled away from the patient&#39;s foot and remain freely operable without interference. 
     Once housing  12  has been introduced through the incision, a first portion of the ruptured Achilles tendon AT 1  may be may be slid through the opening  32  of the housing and positioned at least partially in gap  42 . Once suitably positioned, actuator  26  may be rotated or otherwise actuated to rotate shaft  14 , causing needles  16 ,  18 ,  20  to simultaneously articulate. Because needles  16 ,  18 ,  20  are mounted along an axis extending parallel to the longitudinal axis L of housing  12  and have arc lengths L 1 , L 2 , L 3 , respectively, needle tips  76 ,  78 ,  80  will pierce and pass through the first portion of the Achilles tendon AT 1  in a sequential order. More specifically, needle tip  80  first pierces the first portion of the Achilles tendon at a first location, needle tip  78  then pierces the first portion of the Achilles tendon at a second location, and needle tip  76  will then pierce the first portion of the Achilles tendon at a third location. The sequential piercing of the Achilles tendon reduces trauma on the Achilles tendon. 
     After needles  16 ,  18 ,  20  have articulated through the first Achilles tendon portion AT 1  to the deployed position, needle tips  76 ,  78 ,  80  are positioned in corresponding needle receiving slots  50 ,  52 ,  54  as described above and illustrated in  FIG. 3D . At this time, notches  82  of needles  16 ,  18 ,  20  are aligned with stylet channel  56  and first suture Si has been passed through the Achilles tendon as shown in  FIG. 4  forming suture loops  92 ,  94 ,  96 . 
     A user may then push stylet  13  through locking channel  56  (from the position shown in  FIG. 3C  to the position shown in  FIG. 3D ). After tip  61  has emerged from locking channel  56 , the user may pull the tip in the proximal direction to pull a rear end of stylet  13  through transition section  60  and locking channel  59 . This, in turn, passes cinching suture  60  through suture loops  92 ,  94 ,  96 , as illustrated in  FIG. 7B  and causes suture Si to slide off of needles  16 ,  18 ,  20  as the suture is tensioned over its entire length and to the first portion of the Achilles tendon AT 1 . Each one of needles  16 ,  18 ,  20  may then be retracted to their pre-deployment positions, for example, by actuating actuator  26  in a reverse direction. 
     With the first portion of Achilles tendon AT 1  secured, the tissue repair assembly  10  may then be removed from the incision and the same tissue repair device  10  (or a second device) with a second suture S 2  may be re-introduced through the same incision in the opposing direction. The second portion of the Achilles tendon AT 2  may then be positioned within the gap  42  of housing  12  as shown in  FIG. 7C . The suture delivery assembly  10  may then again be actuated as described above to secure second suture S 2  to the second Achilles tendon portion AT 2  as shown in  FIG. 7D . Suture delivery assembly  10  may then again be removed and the first and second sutures S 1 , S 2  may be tied to one another to approximate and secure the terminal ends of the first and second Achilles tendon portions AT 1 , AT 2  against one another to facilitate healing as shown in  FIG. 7E . 
     Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims.