Tissue fastening devices and methods for sustained holding strength

• US 6,626,916 B1
• Filed: 12/01/1999
• Issued: 09/30/2003
• Est. Priority Date: 12/31/1998
• Status: Expired due to Term

• Current Assignee: Kensey Nash Corporation (DSM-Firmenich AG)
• Original Assignee: Jeffrey E. Yeung, Teresa T. Yeung
• Inventors: Yeung, Teresa T., Yeung, Jeffrey E.
• Primary Examiner(s): Jackson, Gary
• Application Number:
  US09/445,011
• Time in Patent Office: 1,399 Days
• Field of Search: 606/144, 606/139, 606/151, 606/157, 606/158, 606/219, 606/72, 24/727, 247/111, 247/041
• US Class Current: 606/139
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• CPC Class Codes: A61B 17/083 Clips, e.g. resilient
• CPC Class Codes: A61B 17/1227 Spring clips
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable, resorptive for implantable prostheses A61F2210/0004
• CPC Class Codes: A61B 2017/00429 with a roughened portion
• CPC Class Codes: A61B 2017/00805 Treatment of female stress urinary incontinence
• CPC Class Codes: A61B 2017/00862 elastic or resilient for sutures A61B2017/0618
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/00938 hydrophobic
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0462 One way system, i.e. also tensioning the suture
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0646 for insertion into cartillege, e.g. meniscus
• CPC Class Codes: A61B 2017/0648 threaded, e.g. tacks with a screw thread
• CPC Class Codes: A61B 2017/2927 : the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61F 2002/30092 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2210/0014 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: Y10S 606/911 : Memory material

Abstract

A fastener (13) and fastener delivery device (73) for guiding, delivering and deploying the fastener (13) into tissue to provide sustained gripping forces and methods of use. The fastener (13) is curved with a spring-like or shape memory material (15) and gripping elements (14). The fastener (13) is resiliently straightened and loaded into a cartridge (7) within a needle (1). The needle (1) and cartridge (7) both contain a slit (2, 8), and the slits (2, 8) extend to the distal openings (16, 17) of the needle (1) and cartridge (7). When the slits (2, 8) are not aligned, out-of-phase with each other, the fastener (13) remains resiliently straightened in the needle (1). When the slits (2, 8) overlap, in-phase with each other, the fastener (13) resiliently curves and deploys from the slits (2, 8), elastically gripping adjacent tissue. The device (73) is free to be withdrawn, allowing the fastener (13) to slide out from the distal openings (16, 17) of both cartridge (7) and needle (1).

Claims

1. A fastener delivery device for delivering a resilient fastener, comprising:

a hollow, tubular needle having a distal end, a proximal end and a passage extending therethrough and a slit extending through a side thereof, said passage sized and configured to entirely contain at least one of the resilient fastener,

a handle coupled with said needle,

and a fastener deployment actuator coupled with said needle.

2. The fastener delivery device of claim 1 wherein said slit in said needle has two straight, generally parallel edges.

3. The fastener delivery device of claim 1 wherein said slit has a first substantially straight edge and a second substantially straight edge and wherein said first edge and said second edge are nonparallel.

4. The fastener delivery device of claim 3 wherein said slit is wider at a distal end of said slit than at a proximal end of said slit.

5. The fastener delivery device of claim 1 wherein said slit has a first edge and a second edge and wherein said first and second edges are generally parallel to one another and nonparallel to a longitudinal axis of said needle such that said slit is slanted along said needle.

6. The fastener delivery device of claim 1 further comprising a plurality of penetration markings located on said needle.

7. The fastener delivery device of claim 1 further comprising a first orientation line along a length of said needle.

8. The fastener delivery device of claim 7 wherein said first orientation line has a first visual appearance, said fastener delivery device further comprising a second orientation line opposite said first orientation line and having a second visual appearance, said first and second visual appearances being distinct.

9. The fastener delivery device of claim 1 further comprising a protective sleeve locatable around said needle.

10. The fastener delivery device of claim 9 wherein said protective sleeve further comprises a tissue manipulation element located on a distal end thereof.

11. The fastener delivery device of claim 9 further comprising a sliding track along said needle and wherein said protective sleeve moves along said sliding track.

12. The fastener delivery device of claim 1 in combination with a ligament holder having at least one guide opening sized to receive said needle.

13. The fastener delivery device of claim 1 further comprising a fastener advancement plunger extending through a proximal portion of said needle.

14. The fastener delivery device of claim 1 further comprising a coating on a surface of said needle.

15. The fastener delivery device of claim 14 wherein said coating is image enhancing.

16. The fastener deliver device of claim 15 wherein said image enhancing coating is chosen from the group of image enhancing coatings including radiopaque and ultrasound echoing coatings.

17. The fastener delivery device of claim 14 wherein said coating is lubricious.

18. The fastener deliver device of claim 17 wherein said lubricious coating is chosen from the group of lubricious coatings including silicone oil, plasma coating and polytetrafluoroethylene (PTFE).

19. The fastener delivery device of claim 1 wherein said needle is curved.

20. The fastener delivery device of claim 19 further comprising a flexible cartridge.

137. The fastener delivery device of claim 19 wherein said slit is configured to hold said entire fastener within said needle proximal to said slit.

21. A fastener delivery device for delivering a resilient fastener, comprising:

a hollow, tubular needle having a distal end, a proximal end and a passage extending therethrough and a slit extending through a side thereof,

a handle coupled with said needle,

a fastener deployment actuator coupled with said needle,

and a plurality of tapered fastener holding elements located within said needle proximate said slit.

22. The fastener delivery device of claim 21 wherein said tapered fastener holding elements are grooves within said needle and extending from at least one side of said slit wherein said plurality of grooves are sized to engage a plurality of gripping elements on the resilient fastener.

23. The fastener delivery device of claim 21 wherein said slit has a first side and a second side and an interior surface of said needle has said plurality of tapered fastener holding elements and wherein said fastener holding elements are sloped grooves extending to said first and second sides of said slit.

24. A fastener delivery device for delivering a resilient fastener, comprising:

a hollow, tubular needle having a distal end, a proximal end and a passage extending therethrough and a slit extending through a side thereof,

a handle coupled with said needle,

a fastener deployment actuator coupled with said needle,

and a fastener-holding cartridge located within said needle.

25. The fastener delivery device of claim 24 wherein said cartridge has a generally U-shaped cross section.

26. The fastener delivery device of claim 24 wherein said cartridge has a slit in a side thereof, said slit extending from a distal end thereof.

27. The fastener delivery device of claim 26 wherein said slit in said cartridge extends along a full length of said cartridge.

28. The fastener delivery device of claim 24 wherein said cartridge has an opening at a distal end thereof.

29. The fastener delivery device of claim 24 wherein said cartridge is rotatable within said needle.

30. The fastener delivery device of claim 24 wherein said cartridge has an in-phase position and an out-of-phase position, wherein in said out-of-phase position said cartridge closes said slit in said needle, and wherein in said in-phase position said slit in said needle is open.

31. A fastener delivery device for delivering a resilient fastener, comprising:

a hollow, tubular needle having a distal end, a proximal end and a passage extending therethrough and a slit extending through a side thereof, said slit having a first edge and a second edge, wherein said first edge is substantially straight and said second edge has a step therein, said step creating a first region and a second region, said second region having a greater width than said first region,

a handle coupled with said needle,

and a fastener deployment actuator coupled with said needle.

32. The fastener delivery device of claim 31 wherein said second region extends from said distal end of said needle and said first region is proximal to said second region.

33. A fastener delivery device for delivering a resilient fastener, comprising:

a hollow, tubular needle having a distal end, a proximal end and a passage extending therethrough and a slit extending through a side thereof, said slit having a first edge and a second edge, wherein said first edge and said second edge each have a step therein, said steps creating a first region and a second region, said second region being offset from said first region,

a handle coupled with said needle,

and a fastener deployment actuator coupled with said needle.

34. The fastener delivery device of claim 33 wherein said slit has a plurality of grooves located both proximal to and distal to at least one of said steps in said slit.

35. The fastener delivery device of claim 33 wherein said step in said first edge and said step in said second edge are substantially equal such that said first region and said second region have approximately equal widths.

36. A fastener delivery system, comprising:

a fastener delivery device, including;

a hollow, tubular needle having a distal end, a proximal end and a passage extending therethrough and a slit extending through a side thereof,

a handle coupled with said needle,

and a fastener deployment actuator coupled with said needle,

and a resilient fastener loaded within and entirely contained by said needle.

37. The fastener delivery system of claim 36 wherein said slit in said needle is at least as wide as said resilient fastener.

38. The fastener delivery system of claim 36 wherein said fastener is symmetrically curved.

39. The fastener delivery system of claim 36 wherein said fastener is asymmetrically curved.

40. The fastener delivery system of claim 36 wherein said fastener is made of a polymer.

41. The fastener delivery system of claim 36 wherein said fastener is made of metal.

42. The fastener delivery system of claim 36 wherein said fastener is biodegradable.

43. The fastener delivery system of claim 36 wherein said fastener is connected to a fastening device.

44. The fastener deliver system of claim 43 wherein said fastening device is a suture.

45. The fastener delivery system of claim 36 wherein said fastener has an opening.

46. The fastener delivery system of claim 45 wherein said opening passes through said fastener and has a suture located therethrough.

47. The fastener delivery system of claim 45 wherein said opening is a tissue ingrowth hole extending through said fastener.

48. The fastener delivery system of claim 45 wherein said opening is a tissue ingrowth groove cut out of a side of said fastener.

49. The fastener delivery system of claim 36 wherein said fastener contains a substance chosen from the group of substances consisting of lubricants, biocompatible coatings, antibiotics, growth factors, tissue sealing materials, hydrophilic materials, hydrophobic materials, drugs, drug releasing substances, swellable components, coatings and plasma coatings.

50. The fastener delivery system of claim 36 wherein said fastener delivery device is loaded with a plurality of said resilient fasteners.

51. A fastener delivery system, comprising:

a fastener delivery device, including;

a hollow, tubular needle having a distal end, a proximal end and a passage extending therethrough and a slit extending through a side thereof,

a handle coupled with said needle,

a fastener deployment actuator coupled with said needle,

and a fastener-holding cartridge located within said needle,

and a resilient fastener loaded within said needle.

52. The fastener delivery device of claim 51 wherein said cartridge has a slit in a side thereof, said slit extending from a distal end thereof.

53. The fastener delivery device of claim 51 wherein said cartridge is rotatable within said needle.

54. A fastener delivery device for delivering a resilient fastener, comprising:

needle means for piercing tissue, said needle means have a slit along a side thereof;

cartridge means for holding at least one of the resilient fasteners constrained in an extended, open position,

handle means for holding and manipulating said fastener delivery device,

and deployment means for deploying the resilient fastener through said slit.

55. The fastener delivery device of claim 54 further comprising advancement means for advance the resilient fastener into a position ready for deployment.

56. The fastener delivery device of claim 54 wherein said deployment means deploys a first end of the fastener prior to deploying a second end of the fastener, thereby allowing the user to manipulate the surrounding tissue by moving the fastener.

57. The fastener delivery device of claim 54 used in combination with a plurality of the resilient fasteners, said resilient fasteners having gripping means for gripping tissue into which said resilient fasteners are deployed.

58. The fastener delivery device of claim 54 further comprising tissue manipulation means for moving the tissue during use of said fastener delivery device.

59. The fastener delivery device of claim 58 wherein said tissue manipulation means includes a sleeve located around said needle means.

60. The fastener delivery device of claim 54 wherein said slit in said needle means has a first edge and a second edge, wherein said first edge and said second edge each have steps therein, said steps creating a first region and a second region, said second region being offset from said first region.

61. A method of delivering a resilient fastener into human or animal tissue, the method comprising the steps of:

(a) inserting a needle into tissue, said needle having at least one resilient fastener constrained in an extended, open position and contained entirely within said needle;

(b) deploying said resilient fastener into the tissue by rotating said needle around a cartridge located therewithin to an in-phase position, thereby aligning a slit in said needle with a slit in said cartridge;

(c) causing said resilient fastener to move towards a predisposed clamping position;

(d) and withdrawing said needle.

62. The method of claim 61 wherein step (c) is accomplished by releasing said resilient fastener from its constrained condition, thereby allowing it to assume said predisposed clamping position.

63. The method of claim 61 wherein step (b) is accomplished by:

(i) deploying a first end of the fastener;

(ii) and separately deploying a second end of the fastener.

64. The method of claim 63 further comprising the step of:

(iii) manipulating the tissue by moving the fastener between step (i) and step (ii).

65. The method of claim 64 wherein said first end of the fastener is a distal end and the tissue is manipulated by pulling the fastener.

66. The method of claim 64 wherein said first end of the fastener is a proximal end and the tissue is manipulated by pushing the fastener.

67. The method of claim 61 further comprising the steps of:

(e) reinserting the needle to a new tissue location;

(f) and deploying a following fastener.

68. The method of claim 67 wherein steps (e) and (f) are repeated until the tissue is secure.

69. The method of claim 61 wherein said fastener is deployed to repair damage to a meniscus.

70. The method of claim 69 wherein said fastener is deployed entirely within the meniscus.

71. The method of claim 69 wherein step (b) is accomplished by:

(i) deploying a first end of said fastener;

(ii) moving a torn portion of the meniscus back towards a pre-damaged position;

(iii) and deploying a second end of said fastener.

72. The method of claim 71 wherein movement of the torn portion of the meniscus is accomplished by pulling said needle.

73. The method of claim 71 wherein movement of the torn portion of the meniscus is accomplished by pushing said needle.

74. The method of claim 61 wherein a plurality of fasteners are deployed in a single tissue puncture by said needle, thereby securing the tissue.

75. The method of claim 61 wherein said fastener is deployed to repair damage to a ligament or tendon.

76. A method of delivering a resilient fastener into human or animal tissue, the method comprising the steps of:

(a) inserting a needle into tissue, said needle having at least one resilient fastener constrained in an extended, open position therein;

(b) deploying said resilient fastener into the tissue;

(c) causing said resilient fastener to move towards a predisposed clamping position by elevating the temperature of the resilient fastener towards body temperature;

(d) and withdrawing said needle.

77. A method of delivering a resilient fastener into human or animal tissue, the method comprising the steps of:

(a) inserting a needle into tissue, said needle having at least one resilient fastener constrained in an extended, open position therein said constrained condition being created by mechanical restraint of said fastener delivery device while said resilient fastener is located within said needle;

(b) deploying said resilient fastener into the tissue;

(c) causing said resilient fastener to move towards a predisposed clamping position;

(d) and withdrawing said needle.

78. A method of delivering a resilient fastener into human or animal tissue, the method comprising the steps of:

(a) inserting a needle into tissue, said needle having at least one resilient fastener constrained in an extended, open position and contained entirely within said needle;

(b) deploying said resilient fastener into the tissue;

wherein step (b) is accomplished by;

(i) deploying a first, distal end of the fastener;

(ii) separately deploying a second end of the fastener;

(iii) and manipulating the tissue by pulling the fastener between step (i) and step (ii);

(c) causing said resilient fastener to move towards a predisposed clamping position;

(d) withdrawing said needle;

(e) deploying a second end of a second fastener;

(f) manipulating the tissue by pushing the second fastener;

(g) and deploying a first end of the second fastener.

79. A method of delivering a resilient fastener into human or animal tissue, the method comprising the steps of:

(a) inserting a needle into tissue, said needle having at least one resilient fastener constrained in an extended, open position and contained entirely within said needle;

(b) deploying said resilient fastener into the tissue;

wherein step (b) is accomplished by;

(i) deploying a first. proximal end of the fastener;

(ii) separately deploying a second end of the fastener;

(iii) and manipulating the tissue by pushing the fastener between step (i) and step (ii);

(c) causing said resilient fastener to move towards a predisposed clamping position;

(d) withdrawing said needle;

(e) deploying a second end of a second fastener;

(f) manipulating the tissue by pulling said second fastener;

(g) and deploying a first end of said second fastener.

80. A method of delivering a resilient fastener into human or animal tissue, the method comprising the steps of

(a) inserting a needle into tissue, said needle having at least one resilient fastener constrained in an extended, open position therein;

(b) deploying said resilient fastener into the tissue by rotating a cartridge within said needle to an in-phase position thereby aligning a slit in said needle with a slit in said cartridge;

(c) causing said resilient fastener to move towards a predisposed clamping position;

(d) and withdrawing said needle.

81. The method of claim 80 further comprising the steps of:

(e) rotating said cartridge to an out-of-phase position, thereby placing said slit in said needle and said slit in said cartridge out of alignment;

(f) and advancing a following fastener to a position ready for deployment.

82. The method of claim 81 further comprising the steps of:

(g) rotating the needle within the tissue;

(h) and deploying the following fastener.

83. The method of claim nd wherein steps (e) through (h) are repeated until the tissue is secure.

84. A method of delivering a resilient fastener into human or animal tissue, the method comprising the steps of:

(a) inserting a needle into tissue, said needle having at least one resilient fastener constrained in an extended, open position and contained entirely within said needle;

(b) deploying said resilient fastener into the tissue to repair damage to a ligament or tendon;

(c) causing said resilient fastener to move towards a predisposed clamping position;

(d) withdrawing said needle;

(e) and deploying a second generally semicircular fastener opposite said first fastener thereby creating a first ring.

85. The method of claim 84 further comprises the step of:

(f) deploying at least one elongated fastener through said first ring.

86. The method of claim 84 further comprising the step of:

(f) deploying a third and a fourth generally semi-circular fastener to form a second ring.

87. The method of claim 86 further comprising the step of:

(f) deploying at least one elongated fastener through said first and second rings.

88. A method of delivering a resilient fastener into human or animal tissue, the method comprising the steps of:

(a) inserting a needle into tissue, said needle having at least one resilient fastener constrained in an extended, open position and contained entirely within said needle;

(b) deploying said resilient fastener into the tissue to repair damage to a ligament or tendon;

(c) causing said resilient fastener to move towards a predisposed clamping position;

(d) withdrawing said needle;

(e) and deploying a second ligament supporting fastener opposite said first fastener thereby forming a first ligament support fortifying and tying fibers of the ligament.

89. The method of claim 88 further comprising the step of:

(f) deploying at least one generally linear fastener through said first ligament support.

90. The method of claim 88 further comprising the step of:

(f) deploying a third and fourth ligament supporting fastener to form a second ligament support.

91. The method of claim 90 further comprising the step of:

(g) deploying at least one generally linear fastener through said first and second ligament supports.

92. A method of delivering a resilient fastener into human or animal tissue, the method comprising the steps of:

(a) inserting a needle into tissue, said needle having at least one resilient fastener constrained in an extended, open position and contained entirely within said needle;

(b) deploying said resilient fastener into the tissue to repair damage to a ligament or tendon;

(c) causing said resilient fastener to move towards a predisposed clamping position;

(d) withdrawing said needle;

(e) piercing the bone to create an opening;

(f) and deploying said fastener such that one end of the fastener is located within the opening in the bone.

93. The method of claim 92 wherein the needle has a sharp tip and the bone is pierced by the sharp tip of the needle.

94. The method of claim 92 wherein a trocar is used to pierce the bone.

95. The method of claim 92 wherein the bone is pierced by drilling a hole in the bone.

96. A fastener delivery device for delivering a resilient fastener, comprising:

a hollow, generally tubular needle having a distal end, a proximal end and a passage extending therethrough, said passage sized and configured to entirely contain at least one of the resilient fastener,

a handle coupled with said needle,

and a fastener deployment actuator coupled with said needle.

97. The fastener delivery device of claim 96 further comprising a plurality of penetration markings located on said needle.

98. The fastener delivery device of claim 96 further comprising a protective sleeve locatable around said needle.

99. The fastener delivery device of claim 98 wherein said protective sleeve further comprises a tissue manipulation element located on a distal end thereof.

100. The fastener delivery device of claim 98 further comprising a sliding track along said needle and wherein said protective sleeve moves along said sliding track.

101. The fastener delivery device of claim 98 further comprising a slit extending through a side of said needle.

102. The fastener delivery device of claim 96 further comprising a fastener advancement plunger extending through a proximal portion of said needle.

103. The fastener delivery device of claim 96 wherein said needle is curved.

104. The fastener delivery device of claim 103 further comprising a slit extending through a side of said needle.

105. The fastener delivery device of claim 96 wherein said needle is coated with an image enhancing material.

106. The fastener delivery device of claim 105 further comprising a slit extending through a side of said needle.

107. A fastener delivery device for delivering a resilient fastener, comprising:

a hollow, generally tubular needle having a distal end, a proximal end and a passage extending therethrough,

a handle coupled with said needle,

a fastener deployment actuator coupled with said needle,

a first orientation line along a length of said needle, said first orientation line having a first visual appearance,

and a second orientation line opposite said first orientation line and having a second visual appearance, said first and second visual appearances being distinct.

108. The fastener delivery device of claim 107 further comprising a slit extending through a side of said needle.

109. A fastener delivery device for delivering a resilient fastener having a fastener length, said fastener delivery device comprising:

a hollow, tubular needle having a distal end, a proximal end and a passage extending therethrough and a slit extending through a longitudinal side thereof, said slit sized and configured with a slit width wide enough to allow the resilient fastener to pass entirely therethrough and a slit length longer than the fastener length,

a handle coupled with said needle,

and a fastener deployment actuator coupled with said needle.

110. The fastener delivery device of claim 109 further comprising a plurality of tapered fastener holding elements located within said needle proximate said slit.

111. The fastener delivery device of claim 109 wherein said needle has a plurality of grooves within said needle and extending from at least one side of said slit wherein said plurality of grooves are sized to engage a plurality of gripping elements on the resilient fastener.

112. The fastener delivery device of claim 109 wherein said slit has a first side and a second side and an interior surface of said needle has a plurality of sloped grooves extending to said first and second sides of said slit.

113. The fastener delivery device of claim 109 further comprising a fastener-holding cartridge located within said needle.

114. The fastener delivery device of claim 113 wherein said cartridge has a slit in a side thereof, said slit extending from a distal end thereof.

115. The fastener delivery device of claim 114 wherein said slit in said cartridge extends along a full length of said cartridge.

116. The fastener delivery device of claim 114 wherein said cartridge has an opening at a distal end thereof.

117. The fastener delivery device of claim 113 wherein said cartridge is rotatable within said needle.

118. The fastener delivery device of claim 113 wherein said cartridge has an in-phase position and an out-of-phase position, wherein in said out-of-phase position said cartridge closes said slit in said needle, and wherein in said in-phase position said slit in said needle is open.

119. The fastener delivery device of claim 109 wherein said slit in said needle has a first edge and a second edge, wherein said first edge is substantially straight and said second edge has a step therein, said step creating a first region and a second region, said second region having a greater width than said first region.

121. The fastener delivery device of claim 109 wherein said slit in said needle has a first edge and a second edge, wherein said first edge and said second edge each have a step therein, said steps creating a first region and a second region, said second region being offset from said first region.

122. The fastener delivery device of claim 121 wherein said slit has a plurality of grooves located both proximal to and distal to at least one of said steps in said slit.

123. The fastener delivery device of claim 121 wherein said step in said first edge and said step in said second edge are substantially equal such that said first region and said second region have approximately equal widths.

124. The fastener delivery device of claim 109 wherein said slit has a first substantially straight edge and a second substantially straight edge and wherein said first edge and said second edge are nonparallel.

125. The fastener delivery device of claim 124 wherein said slit is wider at a distal end of said slit than at a proximal end of said slit.

126. The fastener delivery device of claim 109 wherein said slit has a first edge and a second edge and wherein said first and second edges are generally parallel to one another and nonparallel to a longitudinal axis of said needle such that said slit is slanted along said needle.

127. The fastener delivery device of claim 109 further comprising a first orientation line along a length of said needle.

128. The fastener delivery device of claim 127 wherein said first orientation line has a first visual appearance, said fastener delivery device further comprising a second orientation line opposite said first orientation line and having a second visual appearance, said first and second visual appearances being distinct.

129. The fastener delivery device of claim 109 further comprising a protective sleeve locatable around said needle.

130. The fastener delivery device of claim 129 wherein said protective sleeve further comprises a tissue manipulation element located on a distal end thereof.

131. The fastener delivery device of claim 129 further comprising a sliding track along said needle and wherein said protective sleeve moves along said sliding track.

132. The fastener delivery device of claim 109 in combination with a ligament holder having at least one guide opening sized to receive said needle.

133. The fastener delivery device of claim 109 wherein said needle is curved.

134. The fastener delivery device of claim 133 further comprising a flexible cartridge.

135. The fastener delivery device of claim 109 wherein said needle contains at least one of said resilient fastener.

136. The fastener delivery device of claim 109 further comprising advancement means for advancing the resilient fastener into a position ready for deployment.

120. The fastener delivery device of 119 wherein said second region extends from said distal end of said needle and said first region is proximal to said second region.