Abstract:
A method and apparatus for securing soft tissue to bone can include loading a suture through an eyelet of a suture anchor. The suture anchor can have a longitudinal axis and a distal tip. An anchor inserter assembly can be positioned in contact with the suture anchor. The anchor inserter assembly can include a sleeve portion and an impacting portion. The suture can be engaged with a suture engaging member on the suture inserter assembly at a location adjacent to the eyelet. The sleeve portion can be translated relative to the impacting portion from an alignment position to an insertion position thereby moving the suture a first distance offset from the eyelet in a direction away from the distal tip. The anchor insert assembly can be advanced to a driven position thereby advancing the suture anchor into the bone. The suture engaging member can be released from the suture.

Description:
RELATED APPLICATIONS 
       [0001]    This application claims the benefit of priority from U.S. Provisional Application No. 61/843,660, filed Jul. 8, 2013, which is incorporated by reference herein in its entirety. 
     
    
     FIELD 
       [0002]    The present disclosure relates generally to an apparatus and method for use in orthopedic surgical procedures. More particularly, the present disclosure relates to a suture anchor system and method for securing soft tissue, tendons and ligaments to bone during orthopedic surgical procedures. 
       BACKGROUND 
       [0003]    The background description provided herein is for the purpose of generally presenting the context of the disclosure. Work of the presently named inventors, to the extent it is described in this background section, as well as aspects of the description that may not otherwise qualify as prior art at the time of filing, are neither expressly nor impliedly admitted as prior art against the present disclosure. 
         [0004]    Surgical or medical procedures are often performed on a body, for example, a human body or anatomy, to repair or replace various portions thereof. For example, the soft tissues of the body may need to be reattached to bones due to trauma, overuse, surgical intervention, or disease. Soft tissue can be reattached to bone using devices such as screws, staples, and various types of suture anchors. One means to fix the soft tissue to the selected area is to provide a suture through a selected portion of the soft tissue and fix the other end of the suture to a selected area on the bone using a suture anchor and a pre-formed hole in the bone, which can require various different instruments and tying a knot to secure the suture to the anchor. Accordingly, there is a need for improvement in the relevant art. 
       SUMMARY 
       [0005]    This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features. 
         [0006]    A method for securing soft tissue to bone can include loading a suture through an eyelet of a suture anchor. The suture anchor can have a longitudinal axis and a distal tip. An anchor inserter assembly can be positioned in contact with the suture anchor. The anchor inserter assembly can include a sleeve portion and an impacting portion. The suture can be engaged with a suture engaging member on the suture inserter assembly at a location adjacent to the eyelet. The sleeve portion can be translated relative to the impacting portion from an alignment position to an insertion position thereby moving the suture a first distance offset from the eyelet in a direction away from the distal tip. The anchor insert assembly can be advanced to a driven position thereby advancing the suture anchor into the bone. The suture engaging member can be released from the suture. 
         [0007]    According to additional features, a desired amount of tension can be applied on the suture subsequent to translating the sleeve portion. The suture anchor can be advanced into the bone a second distance. The first and second distances can be substantially equivalent such that the desired amount of tension on the suture is substantially constant from the insertion position to the driven position. In one example, the sleeve portion can be threadably advanced relative to the impacting portion. Translating the sleeve portion can cause the suture engaging member to slidably engage the suture while the suture engaging member moves from the alignment position to the insertion position. In the alignment position, a hook of the suture engagement member is aligned with the eyelet. 
         [0008]    In other features, releasing the suture engaging member can include rotating the sleeve relative to the impacting portion around a longitudinal axis of the anchor inserter assembly. Engaging the suture with the suture engaging member can include engaging a first portion of the suture extending out of one side of the eyelet with the suture engaging member. A desired amount of tension on the suture can be confirmed on a portion of the suture extending out of an opposite side of the eyelet. Advancing the suture anchor into the bone can include impacting an impacting plate on the impacting portion. The impacting can cause an impacting force to be transferred from the impacting portion to the suture anchor. Positioning the anchor inserter assembly can include advancing a proximal stem of the suture anchor into a blind bore of the impacting portion. A terminal proximal end of the proximal stem can be contacted with an engaging surface of the blind bore. 
         [0009]    A suture securing assembly for use in securing a suture relative to bone can include an impacting portion, a sleeve portion and an anchor. The impacting portion can extend along a first longitudinal axis. The impacting portion can have a strike plate and a shaft portion that defines a suture anchor engaging surface. The sleeve portion can be movably coupled to the impacting portion. The sleeve portion can have a central passage that receives the impacting portion therethrough. The sleeve portion can have a suture engaging member formed at a distal end. The anchor can have an anchor body that includes a distal tip portion and an impactor engaging surface. The anchor body can define an eyelet. The proximal stem portion can be configured to be slidably received by the suture anchor engaging surface. The sleeve portion can be configured to translate relative to the impacting portion along the first longitudinal axis from an alignment position where the suture engaging member is aligned with the eyelet to an insertion position where the suture engaging member moves the suture to a location offset a distance from the eyelet in a direction away from the distal tip. 
         [0010]    According to additional features, the sleeve portion can be threadably coupled to the impacting portion. Rotation of the sleeve portion about the first longitudinal axis can cause the sleeve portion to translate relative to the impacting portion. The suture engaging member can comprise a hook. The strike plate can be configured to engage the sleeve portion at the insertion position thereby inhibiting further relative translation of the sleeve portion and the impacting portion. The anchor body can include a solid anchor portion and a porous anchor portion. The eyelet can be defined by the solid anchor portion. 
         [0011]    A suture anchor for securing a suture relative to bone can include an anchor body that extends along a longitudinal anchor body axis. The anchor body can include a distal tip portion and a proximal body portion. The anchor body can define an eyelet. The anchor body can further comprise a solid anchor portion and a porous anchor portion wherein the eyelet is defined by the solid anchor portion. 
         [0012]    According to additional features, the anchor body can further comprise a first and a second longitudinal opening extending from a proximal terminal end surface of the anchor body to the eyelet. The first and second longitudinal openings can be defined by the solid anchor portion. The first and second longitudinal openings can be parallel to the longitudinal anchor body axis. In one example, the anchor body can include at least one flexible wing portion extending outwardly from the anchor body. The flexible wing portion can be configured to contract during insertion into bone and provide a radially outwardly biasing force onto surrounding bone subsequent to insertion. 
         [0013]    According to still other features, the eyelet can be formed through the anchor body from a first opening at the proximal terminal end surface of the anchor body to a second opening through an outer cylindrical wall of the anchor body. First and second flexible wings can be formed on diametrically opposed portions the suture anchor. The first opening can be defined through the first flexible wing. 
         [0014]    According to yet other features, an insertion tool can selectively and removably couple with the suture anchor for driving the suture anchor into bone. The insertion tool can comprise a distal tip that selectively keys with a central opening of the anchor body. The distal tip can define longitudinal slits formed therealong that are configured to permit suture to pass through. The distal tip can create a friction fit with the central opening of the anchor body. The distal tip can include at least one of an increased outer diameter portion and an o-ring. 
         [0015]    Further areas of applicability of the present disclosure will become apparent from the description provided hereinafter. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure. 
     
    
     
       DRAWINGS 
         [0016]    The present teachings will become more fully understood from the detailed description, the appended claims and the following drawings. The drawings are for illustrative purposes only and are not intended to limit the scope of the present disclosure. 
           [0017]      FIG. 1  a perspective view of a suture anchor constructed in accordance to one example of the present disclosure; 
           [0018]      FIG. 2  is a cross-sectional view of the suture anchor taken along lines  2 - 2  of  FIG. 1 ; 
           [0019]      FIG. 3  is a side view of an exemplary flexible member securing assembly in accordance with various aspects of the present disclosure and shown in an alignment position cooperating with a suture and the suture anchor of  FIG. 1 ; 
           [0020]      FIG. 4  is a cross-sectional view of the flexible member securing assembly taken along lines  4 - 4  of  FIG. 3 ; 
           [0021]      FIG. 5  is a side view of the flexible member securing assembly of  FIG. 3  and shown in an insertion position; 
           [0022]      FIG. 6  is a side view of the flexible member securing assembly of  FIG. 5  and shown in a driven position subsequent to driving the suture anchor into bone; 
           [0023]      FIG. 7  is a side view of the flexible member securing assembly of  FIG. 6  shown with a sleeve portion rotated to free an end of the suture anchor from a suture engaging portion on the sleeve portion; 
           [0024]      FIG. 8  is a partial exploded perspective view of a suture anchor and insertion tool constructed in accordance to additional features of the present disclosure; 
           [0025]      FIG. 9  is a cross-sectional view of a suture anchor constructed in accordance to additional features of the present disclosure; 
           [0026]      FIGS. 10-11  depict an exemplary method of using a primary and secondary suture anchor according to the present disclosure; 
           [0027]      FIG. 12  is a perspective view of another suture anchor constructed in accordance to additional features of the present disclosure; 
           [0028]      FIG. 13  is a cross-sectional view taken along lines  13 - 13  of the suture anchor of  FIG. 12 ; 
           [0029]      FIG. 14  is a side view of an exemplary insertion tool constructed in accordance to one example of the present disclosure; 
           [0030]      FIG. 15  is a side view of an inserter tip constructed in accordance to additional features; 
           [0031]      FIG. 16  is a side view of another inserter tip constructed in accordance to further features of the present disclosure; and 
           [0032]      FIG. 17  is a side view of another inserter tip constructed in accordance to additional features of the present disclosure. 
       
    
    
     DETAILED DESCRIPTION 
       [0033]    The following description is merely exemplary in nature and is not intended to limit the present disclosure, its application, or uses. Although the following description is related generally to methods and apparatus for securing a flexible member to bone, it should be appreciated that the methods and apparatus discussed herein can be applicable to various bones and/or joints of the anatomy and can be utilized with various flexible members and rigid bodies or anchors. 
         [0034]    Exemplary embodiments are provided so that this disclosure will be thorough, and will fully convey the scope to those who are skilled in the art. Numerous specific details are set forth such as examples of specific components, devices, systems and/or methods, to provide a thorough understanding of exemplary embodiments of the present disclosure. It will be apparent to those skilled in the art that specific details need not be employed, that exemplary embodiments may be embodied in many different forms and that neither should be construed to limit the scope of the disclosure. In some exemplary embodiments, well-known processes, well-known device structures, and well-known technologies are not described in detail. 
         [0035]    The present teachings provide a flexible member securing assembly and a method for using the same to secure a flexible member to bone. In an exemplary aspect, the flexible member can be a suture and the rigid body can be an anchor. In an exemplary aspect, the flexible member securing assembly can include an impacting portion and a sleeve portion movably coupled to each other and provided preassembled in a kit. In another exemplary aspect, the kit can further include an anchor. The present teachings further disclose various alternate insertion tools that are selectively and removably coupled to the anchor. 
         [0036]    With initial reference to  FIGS. 1-7 , a suture anchor constructed in accordance to one example of the present disclosure is shown and generally identified at reference numeral  10 . The suture anchor  10  can be provided together such as in a kit with an inserter assembly  12  as a suture securing assembly  14 . As will become appreciated from the following discussion, the inserter assembly  12  can cooperate with the suture anchor  10  and be used to drive the suture anchor  10  into bone. While the suture anchor  10  and inserter assembly  12  will be described herein as cooperating as a suture securing assembly  14 , it will be appreciated that the suture anchor  10  and the inserter assembly  12  can be used separately. In this regard, the suture anchor  10  can be used with other inserter assemblies while the inserter assembly  12  can be used to drive other suture anchors into bone. 
         [0037]    With particular reference to  FIGS. 1 and 2 , the suture anchor  10  will be further described. The suture anchor  10  generally comprises an anchor body  20  that extends along a longitudinal anchor body axis  22 . The anchor body  20  can include a distal tip portion  24 , a proximal body portion  26  and an impactor engaging surface or proximal stem portion  28 . An eyelet  30  can be formed through the proximal body portion  26 . In the example shown, the eyelet  30  has a substantially oval shape; however, other configurations are contemplated. As will become appreciated from the following discussion, the eyelet  30  can be used during knotless suture fixation. 
         [0038]    The anchor body  20  can include a solid anchor portion  32  and a porous anchor portion  34 . In the example shown, the porous anchor portion  34  can have a nesting porous portion  36 , an intermediate porous portion  38  and a proximal porous portion  40 . The nesting porous portion  36  can be formed generally intermediate the distal tip portion  24  and the eyelet  30 . The intermediate porous portion  38  can be formed generally around the eyelet  30 . The proximal porous portion  40  can be formed generally proximal of the eyelet  30 . In the example shown, the eyelet  30  is formed exclusively by the solid anchor portion  32 . In one example, the solid anchor portion  32  can have a wall thickness  42  ( FIG. 2 ) at the eyelet  30  of at least 0.5 mm and preferably between 0.5 mm and 0.75 mm. Other configurations are contemplated. The solid anchor portion  32  that forms the eyelet  30  can provide a rigid structure for suture to engage. As will be described herein, the proximal stem portion  28  can be used to interface with the inserter assembly  12  and can be removed from the remainder of the suture anchor  10  subsequent to insertion of the suture anchor  10  into bone. 
         [0039]    The solid portion  32  of the suture anchor  10  can be formed of any appropriate biocompatible material including polymers, co-polymers, such as polyetheretherketone (PEEK), metals, such as titanium, and various alloys, formed from titanium, cobalt, chromium, etc. The porous portion  34  can include stainless steel, titanium, titanium alloys, cobalt-chromium alloys, PEEK, Polyetherketoneketone (PEKK) and other materials that are suited for use in a biocompatible environment including Regenerex™, a porous titanium construct manufactured from Ti-6Al-4V alloy and commercially available from Biomet, Inc., of Warsaw, Ind. The porous portion  34  can be adapted to receive bone ingrowth through interstitial space at ports defined therein. Furthermore, the porous portion  34  includes a rough surface that can facilitate initial fixation into bone. The porous portion  34  can create enhanced fixation to the bone in a shorter time frame compared to suture anchors formed exclusively of solid material. 
         [0040]    With particular attention now to  FIGS. 3-7 , the inserter assembly  12  will be further described. The inserter assembly  12  can generally include an impacting portion  60  and a sleeve portion  62 . The impacting portion  60  can extend along a longitudinal impacting portion axis  64  and have a strike plate  66  and a shaft portion  68 . The shaft portion  68  can define a suture engaging surface or blind bore  70  having a terminal engaging surface  72 . A first threaded portion  76  can be formed around the shaft portion  68 . 
         [0041]    The sleeve portion  62  can generally extend between a handle portion  80  and a distal suture engaging end  82 . The handle portion  80  defines a central passage  84 . The sleeve portion  62  can include a second threaded portion  88  that is configured to threadably mate with the first threaded portion  76  of the impacting portion  60 . The distal suture engaging end  82  includes a suture engaging member  90 . In the example shown, the suture engaging member  90  is in the form of a hook although other geometrical configurations suitable for grasping a suture are contemplated. The suture engaging member  90  defines an opening  92  ( FIG. 5 ) and a suture nesting slot  94 . 
         [0042]    As will be described herein, the inserter assembly  12  is movable between an alignment position ( FIGS. 3 and 4 ), an insertion position ( FIG. 5 ) and a driven position ( FIG. 6 ). In general, the inserter assembly  12  can be used to position a suture  100  in a desired location relative to the eyelet  30  to account for a length  102  ( FIG. 5 ) of the suture  100  that will be driven into bone  110 . Explained further, the suture engaging member  90  of the sleeve portion  62  can engage the suture  100  at an offset position ( FIG. 5 ) relative to the eyelet  30  to define the length  102  of the suture  100  that will be pulled into bone  110 . Because the length  102  of the suture  100  has been accounted for prior to driving the suture anchor  10  into the bone  110  ( FIG. 5 ), the suture  102  will not be over-tightened on tissue  112  as a result of advancing the suture anchor  10  into the bone  110  ( FIG. 6 ). 
         [0043]    An exemplary method of securing the soft tissue  112  to the bone  110  using the suture securing assembly  14  will now be described. Initially, the suture anchor  10  can be positioned with respect to the inserter assembly  12 . In one example, the proximal stem portion  28  of the suture anchor  10  can be inserted into the blind bore  70  of the shaft portion  68  of the inserter assembly  12 . The proximal stem portion  28  can be further advanced until a terminal proximal end  114  of the proximal stem portion  28  engages or bottoms out onto the engaging surface  72  ( FIG. 3 ). Additionally or alternatively, the proximal stem portion  28  can be advanced into the blind bore  70  until a distal engaging end  116  ( FIG. 3 ) on the shaft portion  68  engages a proximal engaging surface  118  on the suture anchor  10 . In one configuration, the long axis  22  of the suture anchor  10  is coaxial with the impacting portion axis  64 . 
         [0044]    The suture  100  can then be threaded through the eyelet  30 . It will be appreciated that the suture  100  may have been threaded through the eyelet  30  prior to advancing the proximal stem portion  28  into the blind bore  70 . Next, the suture engaging member  90  is hooked around the suture  100  ( FIGS. 3 and 4 ). In some examples, the suture  100  may be threaded through the eyelet  30  and the suture nesting slot  94  in one motion. At this point it is important to recognize that the strike plate  66  is offset from the sleeve portion  62  a first distance  120  ( FIG. 4 ). 
         [0045]    The distal tip  24  can be initially advanced slightly into the bone  110  as shown in  FIG. 5 . With the suture engaging member  90  hooked around the suture  100 , the sleeve portion  62  is rotated around the impacting portion axis  64  causing the sleeve portion  62  to move upwardly (as viewed from  FIG. 4 ) relative to the impacting portion  60 . Specifically, the first and second threaded portions  76  and  88  cooperate to permit the sleeve portion  62  to move from the alignment position ( FIG. 4 ) to the insertion position ( FIG. 5 ). Notably, as the first distance  120  closes, the suture engaging member  90  moves a second distance  122  upward and away from the distal tip  24 . As the sleeve portion  62  translates upward, the suture engaging member  90  slidably negotiates along the suture  100 . In the example provided, the first distance  120  is substantially equivalent to the second distance  122 . While the exemplary mechanical configuration described herein includes cooperating threaded portions  76  and  88 , other configurations are contemplated for providing relative movement between the sleeve portion  62  and the impacting portion  60 . Moreover, while the above description identifies the sleeve portion  62  as being rotated, it will be appreciated that one or both of the sleeve portion  62  and the impacting portion  60  can be rotated to cause relative movement therebetween. 
         [0046]    According to one exemplary method, once the inserter assembly  12  is in the insertion position ( FIG. 5 ) and the length  102  of suture  100  is accounted for, the suture  100  can be tightened relative to the tissue  112 . As explained above, because the length  102  of the suture  100  is created, driving the suture anchor  10  into the bone  110  will not further tighten the suture  100  on the tissue  112 . The inserter assembly  12  can then be used to drive the suture anchor  10  into the bone  110  ( FIG. 6 ). In one example, the strike plate  66  is impacted such as with an impacting tool (not shown) causing an impacting force to be communicated from the engaging surface  72  of the shaft portion  68  to the suture anchor  10  such as on the terminal proximal end  114  of the proximal stem portion  28 . The strike plate  66  may be impacted one or many times until the inserter assembly  12  reaches the driven position ( FIG. 6 ) and the suture anchor  10  is driven into the bone  110 . After the suture anchor  10  has been driven into the bone  110 , the sleeve portion  62  can be rotated until the suture engaging member  90  releases the suture  100  as depicted in  FIG. 7 . The inserter assembly  12  can then be removed from the suture anchor  10 . The proximal stem portion  28  can then be cut off or otherwise removed from a remainder of the suture anchor  10 . 
         [0047]    With reference now to  FIGS. 8-11 , a suture anchor  210  constructed in accordance to additional features of the present disclosure will be described. The suture anchor  210  can be provided together such as in a kit with an insertion tool  212  as a suture securing assembly  214 . Alternatively, the suture anchor  210  and the insertion tool  212  may be provided separately and do not require each other for operation. 
         [0048]    The suture anchor  210  generally comprises an anchor body  220  that extends along a longitudinal anchor body axis  222 . The anchor body  220  can include a distal tip portion  224 , and a proximal body portion  226 . The proximal body portion  226  can have a proximal terminal end surface  228 . An eyelet  230  can be formed through the proximal body portion  226 . In the example shown, the eyelet  230  has a substantially oval shape however other configurations are contemplated. 
         [0049]    The anchor body  220  can include a solid anchor portion  232  and a porous anchor portion  234 . The solid and porous anchor portions  232  and  234  can be formed from the materials described above with respect to the suture anchor  10 . The anchor body  220  can further define a first longitudinal opening  240 , a second longitudinal opening  242  and a central opening  244 . The first and second longitudinal openings  240  and  242  connect with the eyelet  230  ( FIG. 9 ). In one example, the eyelet  230 , the first longitudinal opening  240 , the second longitudinal opening  242  and the central opening  244  are all formed in the solid anchor portion  232  for increased strength. 
         [0050]    The insertion tool  212  can include an insertion tool body  250  and an inserter tip  252 . The inserter tip  252  can define an increased diameter portion  254  configured to provide a friction fit with the central opening  244 . The insertion tool  212  can further include longitudinal slits  260  that run along the inserter tip  252  and a portion of the insertion tool body  250 . As will be described, the longitudinal slits  260  provide a pathway to accommodate suture extending out of either the first or second longitudinal openings  240  and  242  ( FIG. 10 ). 
         [0051]    With particular attention now to  FIGS. 9 and 10 , an exemplary method of using the suture anchor  210  will be described. The suture anchor  210  is particularly versatile as it can be used for either primary fixation (solid suture  300 ,  FIG. 9 ) or secondary fixation (phantom suture  300 ,  FIG. 9 ). In this regard, the eyelet  230  can be used to receive suture  300  when used for secondary fixation. Those skilled in the art will recognize that secondary fixation is a knotless fixation where a portion of the suture  300  may be pinched between an inner diameter of the bone hole and an outer circumference of the suture anchor  310 . When the suture anchor  210  is used for secondary fixation, one of the first and second longitudinal openings  240  and  242  can be used to thread the suture  300  and the suture  300  can extend out of the eyelet  230  (phantom view suture  300 ,  FIG. 9 ). 
         [0052]    As viewed in  FIG. 9 , in one method, the suture (represented as solid line  300 ) can be threaded down one of the first and second longitudinal openings  240  and  242 , to the eyelet  230  and up the other of the first and second longitudinal openings  240  and  242 . In another method, the suture (represented as phantom line  300 ) can be threaded down one of the first and second longitudinal openings  240  and  242  and out the eyelet  230 . In either scenario, one end of the suture  300  that extends out from the proximal terminal end surface  228  will be free. In this regard, the suture  300  is free to slidably negotiate out of the first longitudinal opening  240  during driving of the suture anchor  210  into the bone. Further, a desired amount of tension can be applied to the suture  300  relative to the tissue  312 . Over-tightening of the suture  300  around the tissue  312  as a result of driving the suture anchor  210  into the bone can be avoided. 
         [0053]    In  FIG. 10 , the leftmost anchor  210  is shown with the suture  300  threaded for use in primary fixation. The rightmost anchor  210  is shown with the suture  300  in solid line threaded for primary fixation or alternately for secondary fixation (phantom line). In  FIG. 11  the rightmost anchor  210  is shown with the suture  300  threaded through the first and second longitudinal openings  240  and  242  for use in primary fixation. The leftmost anchor  210  is shown with the suture  300  threaded through the first longitudinal opening  240  and between an outer diameter of the suture and an inner diameter of the bone  310  for use in secondary fixation. 
         [0054]    With reference now to  FIGS. 12, 13 and 16 , a suture anchor  410  constructed in accordance to additional features of the present disclosure will be described. The suture anchor  410  can be provided together such as in a kit with an insertion tool  412  ( FIG. 16 ) as a suture securing assembly. Alternatively the suture anchor  410  and the insertion tool  412  may be provided separately and do not require each other for operation. 
         [0055]    The suture anchor  410  generally comprises an anchor body  420  that extends along a longitudinal anchor body axis  422 . The anchor body  420  can include a distal tip portion  424 , and a proximal body portion  426 . The proximal body portion  426  can have a proximal terminal end surface  428 . An eyelet  430  can be formed through the proximal body portion  426 . In the example shown, the eyelet  430  has a substantially oval shape however other configurations are contemplated. 
         [0056]    The anchor body  420  can include a solid anchor portion  432  and a porous anchor portion  434 . The solid and porous anchor portions  432  and  434  can be formed from the materials described above with respect to the suture anchor  10 . The anchor body  420  can further include a pair of flexible wing portions  436  extending outwardly from h anchor body  420 . The flexible wing portions  436  can be configured to contract during insertion and provide a radially outwardly biasing force onto surrounding bone once inserted to inhibit withdrawal of the suture anchor  410  from the bone. A central opening  438  can be formed in the proximal terminal end surface  428 . 
         [0057]    The eyelet  430  can be formed through the anchor body  420  from a first opening  440  at the proximal end surface  428  to a second opening  442  through an outer cylindrical wall of the anchor body  420 . In one example, the first opening  440  can extend through one of the flexible wing portions  436 . In one example, the eyelet  430  and the flexible wing portions  436  are all formed in the solid anchor portion  432 . 
         [0058]    One method of using the suture anchor  410  will now be described. A suture  500  can be threaded into the first opening  440  and out of the second opening  442 . Because the first opening  440  extends out through the proximal terminal end surface  428 , the suture  500  will not be pinched between the anchor body  420  and the inner diameter of the bone hole during insertion of the suture anchor  410 . In this regard, an end of the suture  500  extending out of the first opening  440  is free to slide during insertion of the suture anchor  410  into the bone hole. Similar to the function of the longitudinal openings  240  and  242  of the suture anchor  310 , a free end of the suture  500  can preclude over-tightening of the suture anchor  410  during insertion into bone. As a result, the suture anchor  410  can be particularly useful for secondary fixation. 
         [0059]    The insertion tool  412  can include an inserter tip  470  configured to be received into the central opening  438  of the suture anchor  410 . A raised diameter portion  472  can be in the form of an elastomeric member or o-ring. The raised diameter portion  472  can be configured to attain a friction or interference fit with the central opening  438 . Another insertion tool  480  shown in  FIG. 14  can include an inserter tip  482  and a handle  484 . The handle  484  can be connected to the inserter tip  482  by a shaft  486 . Another insertion tool  512  shown in  FIG. 15  includes an insertion tip  514  having a raised diameter portion  516 . The raised diameter portion  516  can be in the form of an elastomeric member or o-ring. The raised diameter portion  516  can be configured to attain a friction or interference fit with the central opening  244  or  438 . Another insertion tool  532  shown in  FIG. 17  includes an insertion tip  534  having a raised diameter portion  536 . The raised diameter portion  516  can be in the form of an elastomeric member or o-ring. The insertion tip  534  can include a pointed distal end  540  configured to extend through an anchor. 
         [0060]    While one or more specific examples or aspects have been described and illustrated, it will be understood by those skilled in the art that various changes may be made and equivalence may be substituted for elements thereof without departing from the scope of the present teachings as defined in the claims. Furthermore, the mixing and matching of features, elements and/or functions between various examples may be expressly contemplated herein so that one skilled in the art would appreciate from the present teachings that features, elements and/or functions of one example may be incorporated into another example as appropriate, unless described otherwise above. Moreover, many modifications may be made to adapt a particular situation or material to the present teachings without departing from the essential scope thereof. 
         [0061]    The terminology used herein is for the purpose of describing particular example implementations only and is not intended to be limiting. As used herein, the singular for “a,” “an,” and “the” may be intended to include the plural forms as well, unless the context clearly indicates otherwise. The term “and/or” includes any and all combinations of one or more of the associated listed items. The terms “comprises,” “comprising,” “including,” and “having,” are inclusive and therefore specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. The method steps, processes, and operations described herein are not to be construed as necessarily requiring their performance in the particular order discussed or illustrated, unless specifically identified as an order of performance. It is also to be understood that additional or alternative steps may be employed.