Abstract:
A method and apparatus for reattaching soft tissue to a boney structure using an expanding suture anchor. The method can include providing a suture anchor and forming a cavity in the boney structure for receipt of the suture anchor. The method can also include coupling the soft tissue to a suture and coupling the suture to the suture anchor. The method can further include deploying the suture anchor to fix the suture to the suture anchor and the suture anchor to the cavity.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]     This application is a continuation-in-part of U.S. patent application Ser. No. 11/006,398 filed on Dec. 7, 2005. The disclosure of the above application is incorporated herein by reference. 
     
    
     FIELD  
       [0002]     The present disclosure relates generally to suture anchors, and particularly to a method and apparatus for an expanding suture anchor having an actuator pin.  
       BACKGROUND  
       [0003]     The statements in this section merely provide background information related to the present disclosure and may not constitute prior art.  
         [0004]     Various procedures may be performed to repair soft tissue in the body. Generally, it is known to fix the soft tissue to a selected area on the bone by providing a suture through a selected portion of the soft tissue while securing the other end of the suture to the selected area on the bone using a suture anchor.  
         [0005]     Suture anchors may be retained in the selected area of the bone via a feature of the suture anchor. In hard bone, however, the suture anchor may not fully engage the bone because the surgeon is not able to apply sufficient force to the suture. Thus, the suture may become loose in the boney structure, which could lead to increased healing times or improper healing. In addition, some of the techniques used to lock the suture to the suture anchor can be labor intensive. Therefore, it may be desirable to provide a method and apparatus for an expanding suture anchor, and a method and apparatus for locking a suture to such a suture anchor.  
       SUMMARY  
       [0006]     A method for attaching a soft tissue to a boney structure. The method can include providing a suture anchor and forming a cavity in the boney structure for receipt of the suture anchor. The method can also include coupling the soft tissue to a suture and coupling the suture to the suture anchor. The method can further include deploying the suture anchor to fix the suture to the suture anchor and the suture anchor to the cavity.  
         [0007]     Also provided is a method for attaching a soft tissue to a boney structure. The method can include providing a suture anchor defining an aperture and forming a cavity in the boney structure for receipt of the suture anchor. The method can further include coupling the soft tissue to a suture and threading at least one end of the suture through the aperture of the suture anchor. The method can include disposing the suture anchor in the cavity and deploying the suture anchor to fix the suture anchor to the cavity. The deployment of the suture anchor can fix the suture to the suture anchor without the use of a knot.  
         [0008]     A method for attaching a soft tissue to a boney structure is also provided. The method can include providing a suture anchor and forming a cavity in the boney structure for receipt of the suture anchor. The method can also include coupling the soft tissue to a suture and coupling the suture to the suture anchor. The method can also include disposing the suture anchor in the cavity and applying a retractive force to the suture anchor. The retractive force can fix the suture in the suture anchor.  
         [0009]     A suture anchor for attaching soft tissue to a pre-selected area of a boney structure is further provided. The suture anchor can include an expanding anchor for engaging the boney structure and an insert slideably coupled to the expanding anchor. The insert can be moveable to cause the expanding anchor to expand and engage the boney structure. An aperture can be defined in the insert, and a suture can be received in the aperture. The suture can be adapted to be coupled to the soft tissue. The movement of the insert can fix the suture to the expanding anchor.  
         [0010]     Further areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure. 
     
    
     DRAWINGS  
       [0011]     The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way.  
         [0012]      FIG. 1  is a perspective view of an expanding suture anchor having an actuator pin according to the present disclosure;  
         [0013]      FIG. 2  is an exploded view of the suture anchor in  FIG. 1 ;  
         [0014]      FIG. 3  is a cross-sectional view taken along line  3 - 3  of  FIG. 1 ;  
         [0015]      FIG. 3A  is a detailed view of  FIG. 3 ;  
         [0016]      FIG. 4A  is an environmental view of a use of the suture anchor shown in  FIG. 1 ;  
         [0017]      FIG. 4B  is an environmental view of the suture anchor as the retractive force is applied to move the suture anchor into the fully expanded position;  
         [0018]      FIG. 4C  is an environmental view illustrating the suture anchor in a fully expanded position;  
         [0019]      FIG. 4D  is an environmental view illustrating an alternate actuator gun for use with the suture anchor shown in  FIG. 1 ;  
         [0020]      FIG. 5A  is an environmental view illustrating an alternate use of the suture anchor of  FIG. 1  after the application of a first retractive force;  
         [0021]      FIG. 5B  is an environmental view of the suture anchor as a second retractive force is applied;  
         [0022]      FIG. 6A  is an alternate environmental view of a use of the suture anchor of  FIG. 1 ;  
         [0023]      FIG. 6B  is an environmental view of the suture anchor of  FIG. 6A  during the application of a retractive force;  
         [0024]      FIG. 7  is a perspective view of a first alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0025]      FIG. 8  is an environmental view of a first procedure associated with the suture anchor shown in  FIG. 7 ;  
         [0026]      FIG. 9  is an environmental view of a second procedure associated with the suture anchor shown in  FIG. 7 ;  
         [0027]      FIG. 10  is an environmental view of the suture anchor of  FIG. 7  as the retractive force is applied to move the suture anchor into the fully expanded position;  
         [0028]      FIG. 11  is an environmental view illustrating the suture anchor of  FIG. 7  in a fully expanded position;  
         [0029]      FIG. 11A  is an alternative environmental partial view illustrating the suture anchor of  FIG. 7  in a fully expanded position;  
         [0030]      FIG. 12  is detailed front view of the suture anchor of  FIG. 7  illustrating a suture fixed to the suture anchor;  
         [0031]      FIG. 13  is a perspective view of a second alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0032]      FIG. 14  is an environmental view of a first procedure associated with the suture anchor shown in  FIG. 13 ;  
         [0033]      FIG. 15  is an environmental view of a second procedure associated with the suture anchor shown in  FIG. 13 ;  
         [0034]      FIG. 16  is detailed front view of the suture anchor of  FIG. 13  illustrating a suture fixed to the suture anchor;  
         [0035]      FIG. 17  is a perspective view of a third alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0036]      FIG. 18  is detailed front view of the suture anchor of  FIG. 17  illustrating a suture fixed to the suture anchor;  
         [0037]      FIG. 19  is a perspective view of a fourth alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0038]      FIG. 20  is detailed front view of the suture anchor of  FIG. 19  illustrating a suture fixed to the suture anchor;  
         [0039]      FIG. 21  is a perspective view of a fifth alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0040]      FIG. 22  is a cross-sectional view taken along line  22 - 22  of  FIG. 21 ;  
         [0041]      FIG. 23  is an environmental view of a first procedure associated with the suture anchor shown in  FIG. 21 ;  
         [0042]      FIG. 24  is an environmental view of a second procedure associated with the suture anchor shown in  FIG. 21 ;  
         [0043]      FIG. 25  is an environmental view of the suture anchor of  FIG. 21  as the retractive force is applied to move the suture anchor into the fully expanded position;  
         [0044]      FIG. 26  is an environmental view illustrating the suture anchor of  FIG. 21  in a fully expanded position;  
         [0045]      FIG. 27  is detailed front view of the suture anchor of  FIG. 21  illustrating a suture fixed to the suture anchor;  
         [0046]      FIG. 28  is a perspective view of a sixth alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0047]      FIG. 29  is an environmental view of a first procedure associated with the suture anchor shown in  FIG. 28 ;  
         [0048]      FIG. 30  is an environmental view of a second procedure associated with the suture anchor shown in  FIG. 28 ;  
         [0049]      FIG. 31  is detailed front view of the suture anchor of  FIG. 28  illustrating a suture fixed to the suture anchor;  
         [0050]      FIG. 32  is a perspective view of a seventh alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0051]      FIG. 33  is detailed front view of the suture anchor of  FIG. 32  illustrating a suture fixed to the suture anchor;  
         [0052]      FIG. 34  is a perspective view of a eighth alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0053]      FIG. 35  is detailed front view of the suture anchor of  FIG. 34  illustrating a suture fixed to the suture anchor;  
         [0054]      FIG. 36  is a perspective view of a ninth alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0055]      FIG. 37  is detailed front view of the suture anchor of  FIG. 36  illustrating a suture fixed to the suture anchor;  
         [0056]      FIG. 38  is a perspective view of a tenth alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0057]      FIG. 39  is detailed front view of the suture anchor of  FIG. 38  illustrating a suture fixed to the suture anchor;  
         [0058]      FIG. 40  is a perspective view of a eleventh alternative expanding suture anchor having an actuator pin according to the present disclosure;  
         [0059]      FIG. 41  is an environmental view of a procedure associated with the suture anchor shown in  FIG. 40 ; and  
         [0060]      FIG. 42  is detailed front view of the suture anchor of  FIG. 40  illustrating a suture fixed to the suture anchor. 
     
    
     DETAILED DESCRIPTION  
       [0061]     The following description of various embodiments is merely exemplary in nature and is in no way intended to limit the present teachings, their application, or uses. Although the following description is related generally to a suture anchor that can be positioned in a pre-drilled hole, that is a hole provided in a boney structure for acceptance of the suture anchor, it will be understood that a suture anchor including an impacting tip or self-drilling thread may be provided as well. Moreover, it will be understood that the suture anchor, as described and claimed herein, can be used with any appropriate surgical procedure. Therefore, it will be understood that the following discussions is not intended to limit the scope of the appended claims.  
         [0062]     With reference to  FIG. 1 , an expanding suture anchor  10  having an actuator pin  12  is illustrated. The suture anchor  10  is operable in a first configuration for insertion into a pre-drilled hole  14  in a boney structure  16  (as shown in  FIG. 4A ) and operable in a second configuration to secure the suture anchor  10  in the pre-drilled hole  14  (as shown in  FIG. 4C ). The suture anchor  10  generally includes an insert  18  molded to the actuator pin  12  and partially disposed in a sleeve  20 .  
         [0063]     With continuing reference to  FIG. 1  and additional reference to  FIGS. 2 and 3 , the insert  18  includes a suture receiving portion  22  and an end section  24  displaced from the suture receiving portion  22  by a breakaway section  26 . The suture receiving portion  22  and end section  24  have a tensile and a torsion strength that are greater than the tensile and torsion strength of the breakaway section  26  such that the suture receiving portion  22  and end section  24  will be severed by the breakaway section  26  without damage to the structural integrity of either section. The insert  18  is generally insert molded from a resorbable material (such as, for example, Lactosorb®, available from Biomet Inc. of Warsaw, Ind.); however, it will be understood that other types of biocompatible materials and other methods of forming could be used.  
         [0064]     At least one groove  28  extends throughout a length L 1  of the suture receiving portion  22  and the end section  24  for receipt of strands from a suture  30  therein. The suture receiving portion  22  further has a tip  32  and a cylindrical body  34 . The tip  32  is generally conical in shape; however, any other desired shape may be used. The cylindrical body  34  has a diameter D 1 , which is sized to ensure a slip fit with the sleeve  20  such that the cylindrical body  34  can slide within the sleeve  20 . The cylindrical body  34  includes a formed eyelet  36  extending through the cylindrical body  34  to provide an attachment point for the suture  30 , as shown in  FIG. 3A . The diameter D 1  of the cylindrical body can provide an interference fit with regard to the suture  30  fitting between the cylindrical body  34  and the sleeve  20 . Referring back to  FIG. 3 , the cylindrical body  34  may further include a tapered section  40  leading to the breakaway section  26 .  
         [0065]     The breakaway section  26  has a diameter D 2 , which is generally one-half the size of the diameter D 1  of the cylindrical body  34 . The breakaway section  26  may include two necked portions  42 ,  44 , which facilitate the fracturing of the breakaway section  26  by reducing the fracture strength of the breakaway section  26  in torsion and tension as compared to the suture receiving portion  22  and the end section  24 . The diameter of the necked portions  42 ,  44  may vary to enable different fracture loads for various applications; however, generally the force required to fracture the necked portions  42 ,  44  will be between 10-12 foot-pounds. The fracturing of the breakaway section  26  detaches the suture receiving portion  22  from the end section  24  of the insert  18  (as illustrated in  FIG. 4C ).  
         [0066]     With continued reference to  FIG. 3  and additional reference to  FIG. 2 , the end section  24  has a tapered portion  46  coupled to an annular body  48 . The tapered portion  46  includes a first diameter D 3  at a first end  50 , which tapers to a second diameter D 4  at a second end  52 . In general, the first diameter D 3  of the tapered portion  46  is approximately equal to the diameter D 1  of the suture receiving portion  22 . The tapered portion  46  operates to place the suture anchor  10  in the second position to engage the boney structure  16  as will be described in greater detail below. The second end  52  of the tapered portion  46  is coupled to the annular body  48 . The annular body  48  is generally cylindrical and has a constant diameter D 5 . The diameter D 5  of the annular body  48  may be larger than or equal to the second diameter D 4  of the tapered portion  46 , yet smaller than the first diameter D 3  of the tapered portion  46 . The annular body  48  can extend beyond the sleeve  20  when the suture anchor  10  is assembled to provide a locator  54  for an actuator gun  56  (as shown in  FIG. 4A ) for the application of a retractive force F 1 ; however, this is not necessary, as will be discussed further below. The annular body  48  and tapered portion  46  each further include a formed central bore  58  for receipt of the actuator pin  12  therein.  
         [0067]     The actuator pin  12  is fixedly attached to the annular body  48  and tapered portion  46  via insert molding. In particular, the insert  18  is formed around the actuator pin  12 , ensuring secure and precise attachment. The actuator pin  12  is positioned in the formed central bore  58  of the annular body  48  and tapered portion  46  such that the actuator pin  12  is removed from the suture anchor  10  when the breakaway section  26  is fractured. The actuator pin  12  can be made of any suitable biocompatible corrosive resistance material such as, for example, surgical steel. In this regard, the actuator pin  12  need not be made of the same material as the sleeve  20 .  
         [0068]     The actuator pin  12  further includes a formed cavity  60  that retains the actuator pin  12  in the insert  18  through out the application of the retractive force F 1 . More specifically, as best shown in  FIG. 3 , as the insert  18  is formed around the actuator pin  12 , material M is formed under the cavity  60 . Thus, this material M must be displaced in order to remove the actuator pin  12  from the insert  18 . Accordingly, the retractive force F 1  must be less than the fracture strength of the material M to ensure the actuator pin  12  is retained in the insert  18 . Similarly, the size of the cavity  60  can be modified to allow the accumulation of varying amounts of material M depending on the amount of retractive force F 1  required to secure the suture anchor  10  in a given boney structure.  
         [0069]     With continuing reference to  FIGS. 2 and 3  and additional reference to  FIG. 1 , the sleeve  20  is disposed about a substantial portion of the insert  18 . More specifically, the sleeve  20  includes a throughbore  62  for receipt of the insert  18  therein. The sleeve  20  has a length L, which may be configured such that the suture receiving portion  22  and locator  54  are exposed when the suture anchor  10  is in the first position. For example, a first end  64  of sleeve  20  is shown covering the breakaway section  26  and approximately one half of the cylindrical body  34  of the suture receiving portion  22  and a second end  66  of the sleeve  20  covers the tapered portion  46  and approximately one half of the annular body  48  of the end section  24 . The sleeve  20  is typically made from a resorbable material (such as, for example, Lactosorb®, available from Biomet Inc. of Warsaw, Ind.); however, other suitable materials could be employed.  
         [0070]     The sleeve  20  is generally cylindrical in nature, and may include at least one ring or securement device  68  on an external surface  70  of the sleeve  20 . Although the sleeve  20  is shown having a ring  68 , it is to be understood various other external features could be disposed on the sleeve  20  (such as, for example, barbs or threads). The at least one ring  68  further aids in the engagement of the suture anchor  10  in the pre-drilled hole  14 . The sleeve  20  also includes at least one expanding member  72  hingably coupled to the sleeve  20  to engage the pre-drilled hole  14 . Specifically, the expanding member  72  is defined by a slot  74  formed in the sleeve  20  and includes a hinge  76 . In one embodiment, the sleeve  20  includes two expanding members  72  located approximately 180 degrees apart. It shall be noted, however, that the expanding members  72  could be located at any position on the sleeve  20  that would engage the boney structure  16 . The expanding members  72  are located at a midsection  78  of the sleeve  20 . The expanding members  72  expand to lock into the boney structure  16  when the retractive force F 1  is applied to the actuator pin  12  and, in turn, to a tapered interior bearing surface  80  on the expanding members  72 .  
         [0071]     With reference now to  FIG. 4A , after the pre-drilled hole  14  has been drilled into the boney structure  16  and the eyelet  36  of the insert  18  has been threaded with the suture  30 , the suture anchor  10  can be inserted into the pre-drilled hole  14  as shown. The suture anchor  10  is generally configured such that only the locator  54  of the end section  24  extends beyond a top surface  82  of the boney structure  16 .  
         [0072]     Next, the actuator gun  56  is applied to the suture anchor  10  as shown in  FIGS. 4A and 4B . When a trigger  84  on the actuator gun  56  is pulled, the actuator gun  56  applies the retractive force F 1  to the actuator pin  12 . It should be noted, however, that the actuator gun  56  may not be the only actuating device capable of applying the retractive force F 1  to the suture anchor  10 . In particular, numerous other devices may be employed (such as, for example, a syringe-type actuator  88 , as shown in  FIG. 4D ). In  FIG. 4D , the syringe-type actuator  88  includes a cannula  90  that engages the actuator pin  12 . A lever  92  can be used to retract the cannula  90  by the application of a force F to the lever  92 . More specifically, the lever  92  operates to retract the cannula  90  once it is engaged with the actuator pin  12  to provide the retractive force F 1  to the suture anchor  10 . A stop  94  can also be provided to prevent the lever  92  from prematurely applying the retractive force F 1 .  
         [0073]     The application of the retractive force F 1  causes the insert  18  to displace rearwardly with respect to the sleeve  20 , as illustrated in  FIG. 4B . This rearward displacement causes the tapered portion  46  to apply a force F 3  to the tapered interior bearing surface  80  of the expanding members  72  of the sleeve  20 . As the insert  18  continues to move rearward, the tapered portion  46  applies an increasingly greater force F 3  to the tapered interior bearing surface  80  of the expanding members  72  until the expanding members  72  are engaged with the boney structure  16 .  
         [0074]     In a soft boney structure  16 , when the expanding members  72  are fully engaged, the tip  32  of the suture receiving portion  22  is pressed against the first end  64  of the sleeve  20 , and thus the insert  18  is not able to further retract. Hence, the continued application of the retractive force F 1  causes the breakaway section  26  to fracture, as shown in  FIG. 4C . With reference now to  FIG. 5A , in a hard boney structure  16 ′, however, the breakaway section  26  may fracture prior to the tip  32  of the suture receiving portion  22  contacting the first end  64  of the sleeve  20 . In this situation, the suture  30  can be pulled by a hand  86  of an operator, as illustrated in  FIG. 5B , such that the tip  32  of the suture receiving portion  22  abuts the first end  64  of the sleeve  20 . The pulling of the suture  30  by the hand  86  of the operator causes the expanding members  72  to expand further due to the force applied to the tapered interior bearing surface  80  of the expanding members  72  by the cylindrical body  34  of the suture receiving portion  22 . In either hard or soft boney structures  16 ,  16 ′ once the breakaway section  26  fractures, the sleeve  20  and suture receiving portion  22  remain in the pre-drilled hole  14  to couple a selected soft tissue to the boney structures  16 ,  16 ′ via the suture  30 .  
         [0075]     In addition, the suture anchor  10  is also adaptable for use in a curved pre-drilled hole  14 ′, as shown in  FIG. 6A . In this exemplary embodiment, the suture anchor  10  may be positioned in the curved pre-drilled hole  14 ′ via the actuator pin  12 . Next, as shown in  FIG. 6B , the retractive force F 1  may be applied to the actuator pin  12  by an actuating device, such as the actuator gun  56 , to cause the expanding members  72  to engage the boney structure  16 ′″, as discussed previously.  
         [0076]     With reference to  FIG. 7 , a first alternative insert  18   a  is shown. The first alternative insert  18   a  can include a suture receiving portion  22   a,  the breakaway section  26  and the end section  24  for use with a suture anchor  10   a  substantially similar to that described with regard to  FIGS. 1-6B . As will be appreciated, the remainder of the suture anchor  10   a  can be generally similar to the suture anchor  10  that is illustrated in and described in conjunction with  FIGS. 1-6B . In addition, as the breakaway section  26  and end section  24  of the first alternative insert  18   a  are substantially similar to the breakaway section  26  and end section  24  of the insert  18  of the suture anchor  10 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the first alternative insert  18   a.  Further, the same reference numerals will be used to denote the same or similar components.  
         [0077]     The suture receiving portion  22   a  and end section  24  can have a tensile and a torsion strength that are greater than the tensile and torsion strength of the breakaway section  26  such that the suture receiving portion  22   a  and end section  24  will be severed by the breakaway section  26  without damage to the structural integrity of either section. The first alternative insert  18   a  is generally insert molded from a resorbable material (such as, for example, Lactosorb® available from Biomet Inc. of Warsaw, Ind.); however, it will be understood that other types of biocompatible materials and other methods of forming could be used.  
         [0078]     As shown in  FIG. 7 , the suture receiving portion  22   a  can include the tip  32 , a cylindrical body  34   a,  and a suture  30   a.  The tip  32  can be generally conical in shape; however, any other desired shape may be used, such as rectangular. The cylindrical body  34   a  can have a diameter D 1   a,  which is sized to ensure a slip fit with the sleeve  20  such that the cylindrical body  34   a  can slide within the sleeve  20 . The cylindrical body  34   a  can define an aperture, which can be an eyelet  36   a,  extending through the cylindrical body  34   a  to provide an attachment point for the suture  30   a.  The diameter D 1   a  of the cylindrical body  34   a  can also provide an interference fit between the cylindrical body  34   a,  the suture  30   a  and the sleeve  20 . The cylindrical body  34   a  can further include the tapered section  40  leading to the breakaway section  26 . The suture  30   a  can have a first end  200 , a midsection  201  and a second end  202 . The eyelet  36   a  can be sized to receive both the first end  200  and the second end  202  of the suture  30   a.  The suture  30   a  can be fixed to the cylindrical body  34   a  without the use of a knot by the sleeve  20 , as will be discussed herein. The midsection  201  of the suture  30   a  can be coupled to a section of soft tissue  204 , as shown in  FIG. 8 . The midsection  201  of the suture  30   a  can be coupled to the soft tissue  204  through any appropriate technique, such as a mattress stitch  206  or by using a suture punch (not shown).  
         [0079]     In order to employ the suture anchor  10   a,  with the pre-drilled hole  14  drilled into the boney structure  16 , the suture  30   a  can be coupled to the soft tissue  204 . Then, the hand  86  of the operator can thread or insert the first end  200  and the second end  202  of the suture  30   a  through the eyelet  36   a.  With additional reference to  FIG. 9 , once the first end  200  and the second end  202  of the suture  30   a  are threaded through the eyelet  36   a,  the suture anchor  10   a  can be inserted into the pre-drilled hole  14 . Generally, the first end  200  and the second end  202  of the suture  30   a  can extend beyond the pre-drilled hole  14  to enable the hand  86  of the operator to grasp either or both the first end  200  and the second end  202 . The hand  86  of the operator can be used to tighten the suture  30   a,  and thus the soft tissue  204 , to the pre-drilled hole  14  by pulling the first end  200  and second end  202  of the suture  30   a  that extends from the pre-drilled hole  14 . This further removes any slack from the suture  30   a.  After the suture  30   a  is tightened, the expanding members  72  of the suture anchor  10   a  can be expanded to engage the pre-drilled hole  14 .  
         [0080]     For example, in order to expand the expanding members  72 , an alternative syringe-type actuator  88 ′ can be coupled to the actuator pin  12  of the suture anchor  10   a  as shown in  FIGS. 9 and 10 . The alternative syringe-type actuator  88 ′ can include a cannula  90 ′ that engages the actuator pin  12 . A lever  92 ′ can be used to retract the cannula  90 ′ by the application of a force F to the lever  92 ′. Generally, the lever  92 ′ can operate to retract the cannula  90 ′ once it is engaged with the actuator pin  12  to provide the retractive force F 1  to the suture anchor  10   a.  A safety or stop  94 ′ can also be provided to prevent the operator from prematurely applying the retractive force F 1 .  
         [0081]     In order to deploy the suture anchor  10   a  in the pre-drilled hole  14 , the stop  94 ′ can be pushed in and then the force F can be applied to the lever  92 ′ on the syringe-type actuator  88 ′, as shown in  FIG. 10 . When the lever  92 ′ on the alternative syringe-type actuator  88 ′ is pulled, the alternative syringe-type actuator  88 ′ can apply the retractive force F 1  to the actuator pin  12  via the cannula  90 ′. It should be noted, however, that the alternative syringe-type actuator  88 ′ is not the only actuating device capable of applying the retractive force F 1  to the suture anchor  10   a.  Numerous other devices can be employed, such as, a syringe-type actuator  88 , as discussed with regard to  FIG. 4D , or the actuator gun  56  discussed with regard to  FIGS. 4A and 4B .  
         [0082]     The application of the retractive force F 1  can cause the first alternative insert  18   a  to be displaced or moved rearwardly with respect to the sleeve  20 , as illustrated in  FIG. 10 . This rearward movement can cause the tapered portion  46  of the first alternative insert  18   a  to apply a force F 3  to the tapered interior bearing surface  80  of the expanding members  72  of the sleeve  20 . The first alternative insert  18   a  can continue to move rearward, which can cause the tapered portion  46  to apply an increasingly greater force F 3  to the tapered interior bearing surface  80  of the expanding members  72  until the expanding members  72  are engaged with the boney structure  16 .  
         [0083]     When the expanding members  72  are fully engaged, the tip  32  of the suture receiving portion  22   a  can be adjacent to the suture  30   a,  while the suture  30   a  is adjacent to the first end  64  of the sleeve  20  (as best shown in  FIG. 12 ). The compression of the suture  30   a  between the suture receiving portion  22   a  and the tip  32  can fix or lock the suture  30   a  to the suture anchor  10   a,  while preventing the first alternative insert  18   a  from retracting further. The continued application of the retractive force F 1  to the first alternative insert  18   a  can cause the breakaway section  26  to fracture, as shown in  FIG. 11 .  
         [0084]     It should be noted, as shown in  FIG. 11A , the pre-drilled hole  14  can be sized with a depth D substantially equivalent to a length L of the suture anchor  10   a,  if desired. If the pre-drilled hole  14  has the depth D substantially equivalent to the length L of the suture anchor  10   a,  then the expanding members  72  can be deployed or expanded by the contact of the tip  32  of the suture receiving portion  22   a  against a bottom  213  of the pre-drilled hole  14 . Generally, as the suture anchor  10   a  is inserted, the tip  32  can be pushed against the bottom  213  of the pre-drilled hole  14 , forcing the first alternative insert  18   a  to be displaced or moved rearwardly with respect to the sleeve  20 . This rearward movement can cause the tapered portion  46  of the first alternative insert  18   a  to apply a force F 3  to the tapered interior bearing surface  80  of the expanding members  72  of the sleeve  20 . Then, the lever  92 ′ on the syringe-type actuator  88 ′ can be pulled (with the stop  94 ′ pushed in) to apply the retractive force F 1  to the actuator pin  12  to fully engage the expanding members  72  in the pre-drilled hole  14 . The continued application of the retractive force F 1  to the first alternative insert  18   a  can cause the breakaway section  26  to fracture, as shown in  FIG. 11 .  
         [0085]     Once the breakaway section  26  fractures, as shown in either  FIG. 11  or  11  A, the sleeve  20  and suture receiving portion  22   a  remain in the pre-drilled hole  14  to couple the soft tissue  204  to the boney structure  16  via the suture  30   a.  The first end  200  and second end  202  of the suture  30   a  that extends from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0086]     As shown in  FIG. 12 , the suture anchor  10   a  can fix the suture  30   a  to the suture anchor  10   a  without the use of a knot. Generally, as the first end  200  and second end  202  of the suture  30   a  extend from the eyelet  36   a  of the first alternative insert  18   a  prior to the deployment of the expanding members  72  of the sleeve  20 , the application of the retractive force F 1  causes the first alternative insert  18   a,  and thus suture  30   a,  to be withdrawn into the sleeve  20 . Thus, the movement of the first alternative insert  18   a  within the sleeve  20  can fix or lock the suture  30   a  to the suture anchor  10   a  due to the interference fit between the first alternative insert  18   a,  the suture  30   a  and the sleeve  20 . Further, the interference fit between the first alternative insert  18   a,  the suture  30   a  and the sleeve  20  can prevent the first alternative insert  18   a  from moving after the deployment of the expanding members  72  due to the frictional lock created between the suture  30   a,  the first alternative insert  18   a  and the sleeve  20 .  
         [0087]     With reference to  FIG. 13 , a second alternative insert  18   b  is shown. The second alternative insert  18   b  can include a suture receiving portion  22   b,  the breakaway section  26 , and the end section  24  for use with a suture anchor  10   b  substantially similar to that described with regard to  FIGS. 7-12 . As the breakaway section  26  and end section  24  of the second alternative insert  18   b  are substantially similar to the breakaway section  26  and end section  24  of the insert  18 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the second alternative insert  18   b.  In addition, as the suture receiving portion  22   b  is substantially similar to the suture receiving portion  22   a  of the first alternative insert  18   a,  as discussed with  FIGS. 7-12 , only the modifications to the suture receiving portion  22   b  will be discussed herein.  
         [0088]     As shown in  FIG. 13 , the suture receiving portion  22   b  can include an aperture, for example, a groove or slot  250 , which can be for receipt of the suture  30   a.  Generally, the slot  250  can be formed longitudinally in a cylindrical body  34   b  of the second alternative insert  18   b;  however, the slot  250  can be formed in any desired position, such as vertically or diagonally. As will be appreciated, the remainder of the cylindrical body  34   b  can be generally similar to the cylindrical body  34   a  that is illustrated in and described in conjunction with  FIG. 7 .  
         [0089]     The slot  250  can extend for a length L and can have a height H configured to enable an operator to insert the first end  200  and second end  202  of the suture  30   a  through the slot  250 , as shown in  FIG. 14 . Generally, once the midsection  201  of the suture  30   a  is coupled to the soft tissue  204  via the mattress stitch  206  or any other technique, such as a suture punch (not shown), the hand  86  of the operator can thread or insert the first end  200  and second end  202  of the suture  30   a  into the slot  250 . Then, with reference to  FIG. 15 , the suture anchor  10   b  can be inserted into the pre-drilled hole  14 . As discussed previously, the hand  86  of the operator can be used to tighten the suture  30   a,  and thus the soft tissue  204 , to the pre-drilled hole  14  by pulling the first end  200  and second end  202  of the suture  30   a  that extends from the pre-drilled hole  14 . After the suture  30   a  is tightened, the suture anchor  10   b  can be deployed to engage the pre-drilled hole  14  through the use of the actuator gun  56 , syringe-type actuator  88  or syringe-type actuator  88 ′, for example, as discussed previously with reference to  FIGS. 4A and 4B ,  4 D and  9 - 12 , respectively.  
         [0090]     When the suture anchor  10   b  is fully engaged to the pre-drilled hole  14 , the tip  32  of the suture receiving portion  22   b  can be adjacent to the suture  30   a,  while the suture  30   a  is adjacent to the first end  64  of the sleeve  20  (as best shown in  FIG. 16 ). The compression of the suture  30   a  between the suture receiving portion  22   b  and the tip  32  can fix or lock the suture  30   a  to the suture anchor  10   b.  Thus, the suture anchor  10   b  can also fix the suture  30   a  to the suture anchor  10   b  without the use of a knot, while providing greater access for the hand  86  of the operator to couple the first end  200  and the second end  202  to the second alternative insert  18   b  prior to the placement of the suture anchor  10   b  into the pre-drilled hole  14 . The first end  200  and second end  202  of the suture  30   a  that extends from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0091]     With reference to  FIG. 17 , a third alternative insert  18   c  is shown. The third alternative insert  18   c  can include a suture receiving portion  22   c,  the breakaway section  26 , and the end section  24  for use with a suture anchor  10   c  substantially similar to that described with regard to  FIGS. 7-12 . As the breakaway section  26  and end section  24  of the third alternative insert  18   c  are substantially similar to the breakaway section  26  and end section  24  of the insert  18 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the third alternative insert  18   c.  In addition, as the suture receiving portion  22   c  is substantially similar to the suture receiving portion  22   a  of the first alternative insert  18   a,  as discussed with  FIGS. 7-12 , only the modifications to the suture receiving portion  22   c  will be discussed herein.  
         [0092]     As shown in  FIG. 17 , the suture receiving portion  22   c  can include a slot, for example, a C-shaped slot  260 , which can be for receipt of the suture  30   a.  Generally, the slot  260  can be defined in a cylindrical body  34   c  of the third alternative insert  18   c.  As will be appreciated, the remainder of the cylindrical body  34   c  can be generally similar to the cylindrical body  34   a  that is illustrated in and described in conjunction with  FIG. 7 . The slot  260  can define a throughbore  262  and a necked portion  264  as shown in  FIGS. 17 and 18 . The necked portion  264  can define an aperture  266  for receipt of the first end  200  and second end  202  of the suture  30   a.  Generally, the necked portion  264  can be configured such that the first end  200  and second end  202  of the suture  30   a  can be hooked behind and retained by the necked portion  264 .  
         [0093]     As the assembly and deployment of the suture anchor  10   c  can be substantially similar to the assembly and deployment of the suture anchor  10   a  discussed with regard to  FIGS. 8-12  and the suture anchor  10   b  discussed with regard to  FIGS. 15 and 16 , the assembly and deployment of the suture anchor  10   c  will not be discussed in detail herein. Briefly, however, once the midsection  201  of the suture  30   a  is coupled to the soft tissue  204  via the mattress stitch  206  or any other technique, such as a suture punch (not shown), the hand  86  of the operator can thread or insert the first end  200  and second end  202  of the suture  30   a  through the aperture  266  of the necked portion  264  and into the throughbore  262  (not shown). Then, the suture anchor  10   c  can be inserted into the pre-drilled hole  14 . The hand  86  of the operator can be used to tighten the suture  30   a,  and thus the soft tissue  204 , to the pre-drilled hole  14  by pulling the first end  200  and second end  202  of the suture  30   a  that extends from the pre-drilled hole  14  (not shown). This further removes any slack from the suture  30   a.  After the suture  30   a  is tightened, the expanding members  72  of the suture anchor  10   c  can be deployed or expanded to engage the pre-drilled hole  14 .  
         [0094]     When the suture anchor  10   c  is fully engaged to the pre-drilled hole  14 , the tip  32  of the suture receiving portion  22   c  can be adjacent to the suture  30   a,  while the suture  30   a  is adjacent to the first end  64  of the sleeve  20  (as best shown in  FIG. 18 ). The compression of the suture  30   a  between the suture receiving portion  22   c  and the tip  32  can fix or lock the suture  30   a  to the suture anchor  10   c.  Thus, the suture anchor  10   c  can also fix the suture  30   a  to the suture anchor  10   c  without the use of a knot. The first end  200  and second end  202  of the suture  30   a  that extends from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0095]     With reference to  FIG. 19 , a fourth alternative insert  18   d  is shown. The fourth alternative insert  18   d  can include a suture receiving portion  22   d,  the breakaway section  26 , and the end section  24  for use with a suture anchor  10   d  substantially similar to that described with regard to  FIGS. 7-12 . As the breakaway section  26  and end section  24  of the fourth alternative insert  18   d  are substantially similar to the breakaway section  26  and end section  24  of the insert  18 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the fourth alternative insert  18   d.  In addition, as the suture receiving portion  22   d  is substantially similar to the suture receiving portion  22   a  of the first alternative insert  18   a,  as discussed with  FIGS. 7-12 , only the modifications to the suture receiving portion  22   d  will be discussed herein.  
         [0096]     As shown in  FIG. 19 , the suture receiving portion  22   d  can include a hinged slot  270  which can be for receipt of the suture  30   a.  Generally, the hinged slot  270  can be defined in a cylindrical body  34   d  of the fourth alternative insert  18   d.  As will be appreciated, the remainder of the cylindrical body  34   d  can be generally similar to the cylindrical body  34   a  that is illustrated in and described in conjunction with  FIG. 7 .  
         [0097]     The hinged slot  270  can define a throughbore  272  and can include a hinged portion  274 . The hinged portion  274  can optionally include at least one or a plurality of barbs or projections  276 . The throughbore  272  can be configured to retain the first end  200  and second end  202  of the suture  30   a.  The hinged portion  274  can be pivotably coupled to the cylindrical body  34   d  and can rotate from an opened position to a closed position. In the opened position, as shown in  FIG. 19 , the hinged portion  274  can define an aperture  278  for receipt of the first end  200  and second end  202  of the suture  30   a  to enable the suture  30   a  to enter the throughbore  272  of the hinged slot  270 . In the closed position, the hinged portion  274  can seal or enclose the aperture  278  to retain the suture  30   a  within the throughbore  272 , as shown in  FIG. 20 . Thus, generally, the hinged portion  274  can be sized such that in the closed position the hinged portion  274  can substantially enclose the aperture  278 . The projections  276  of the hinged portion  274  are optional and can be coupled to or formed with the hinged portion  274  if desired. The projections  276  can extend into the throughbore  272  when the hinged portion  274  is in the closed position to further retain the suture  30   a  within the throughbore  272 . The projections  276  are illustrated as triangular, however, any appropriate shape, such as annular or hooked, could be employed.  
         [0098]     As the assembly and deployment of the suture anchor  10   d  in the pre-drilled hole  14  is substantially similar to the assembly and deployment of the suture anchor  10   a  discussed with regard to  FIGS. 8-12  and the suture anchor  10   b  discussed with regard to  FIGS. 15 and 16 , the assembly and deployment of the suture anchor  10   d  will not be discussed in detail herein. Briefly, however, once the midsection  201  of the suture  30   a  is coupled to the soft tissue  204  via the mattress stitch  206  or any other technique, such as a suture punch, the hand  86  of the operator can thread or insert the first end  200  and second end  202  of the suture  30   a  through the aperture  278  of the hinged portion  274  and into the throughbore  272  (not shown). Then, the suture anchor  10   d  can be inserted into the pre-drilled hole  14  (not shown). The hand  86  of the operator can be used to tighten the suture  30   a,  and thus the soft tissue  204 , to the pre-drilled hole  14  by pulling the first end  200  and second end  202  of the suture  30   a  that extends from the pre-drilled hole  14  (not shown). This further removes any slack from the suture  30   a.  After the suture  30   a  is tightened, the expanding members  72  of the suture anchor  10   d  can be deployed to engage the pre-drilled hole  14 . During the deployment of the suture anchor  10   d,  as the fourth alternative insert  18   d  moves rearwardly in the sleeve  20 , the hinged portion  274  can be pushed closed by the sleeve  20  to lock the suture  30   a  within the throughbore  272  of the suture receiving portion  22   d.    
         [0099]     When the suture anchor  10   d  is fully engaged to the pre-drilled hole  14 , the tip  32  of the suture receiving portion  22   d  can be adjacent to the suture  30   a,  while the suture  30   a  is adjacent to the first end  64  of the sleeve  20  (as best shown in  FIG. 20 ). The compression of the suture  30   a  between the suture receiving portion  22   d  and the tip  32  can fix or lock the suture  30   a  to the suture anchor  10   d.  Thus, the suture anchor  10   d  can also fix the suture  30   a  to the suture anchor  10   d  without the use of a knot. The first end  200  and second end  202  of the suture  30   a  that extends from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0100]     With reference to  FIG. 21 , a fifth alternative insert  18   e  is shown. The fifth alternative insert  18   e  can include a suture receiving portion  22   e,  the breakaway section  26 , and the end section  24  for use with a suture anchor  10   e  substantially similar to that described with regard to  FIGS. 1-6B . As will be appreciated, the remainder of the suture anchor  10   e  can be generally similar to the suture anchor  10  that is illustrated in and described in conjunction with  FIGS. 1-6B . As the breakaway section  26  and end section  24  of the fifth alternative insert  18   e  are substantially similar to the breakaway section  26  and end section  24  of the insert  18 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the fifth alternative insert  18   e.    
         [0101]     The suture receiving portion  22   e  and end section  24  can have a tensile and a torsion strength that are greater than the tensile and torsion strength of the breakaway section  26  such that the suture receiving portion  22   e  and end section  24  will be severed by the breakaway section  26  without damage to the structural integrity of either section. The fifth alternative insert  18   e  is generally insert molded from a resorbable material (such as, for example, Lactosorb® available from Biomet Inc. of Warsaw, Ind.); however, it will be understood that other types of biocompatible materials and other methods of forming could be used.  
         [0102]     As shown in  FIG. 21 , the suture receiving portion  22   e  can include the tip  32 , a cylindrical body  34   e  and a suture  30   e.  The tip  32  can be generally conical in shape; however, any other desired shape may be used, such as rectangular. The cylindrical body  34   e  can have a diameter D 1   e,  which is sized to ensure a slip fit with the sleeve  20  such that the cylindrical body  34   e  can slide within the sleeve  20 . The cylindrical body  34   e  can define an aperture or eyelet  36   e  extending through the cylindrical body  34   e  to provide an attachment point for the suture  30   e.  The cylindrical body  34   e  can further include the tapered section  40  leading to the breakaway section  26 .  
         [0103]     With additional reference to  FIGS. 22 and 23 , the suture  30   e  can have a first end  300 , a midsection  302  and a second end  304 . The first end  300  of the suture  30   e  can be coupled to the breakaway section  26  of the fifth alternative insert  18   e.  Generally, the first end  300  can be knotted about the breakaway section  26  at a midpoint  307  of the two necked portions  42 ,  44  ( FIG. 22 ). The midsection  302  of the suture  30   e  can be coupled to a section of soft tissue  306  ( FIG. 23 ). The second end  304  of the suture  30   e  can be received into the eyelet  36   e  of the cylindrical body portion  34   e  of the fifth alternative insert  18   e.  The second end  304  can be coupled to a needle  309  (shown in phantom) to facilitate the threading of the second end  304  into the eyelet  36   e  ( FIG. 22 ). The second end  304 , once threaded, can pass through the eyelet  36   e  to secure the soft tissue  306  to the pre-drilled hole  14 , as will be discussed in greater detail herein.  
         [0104]     With reference to  FIG. 23 , prior to the assembly of the sleeve  20  with the fifth alternative insert  18   e,  the first end  300  of the suture  30   e  can be knotted to the midpoint  307  of the breakaway section  26  of the fifth alternative insert  18   e.  Then, the sleeve  20  can be disposed over the breakaway section  26  of the fifth alternative insert  18   e,  such that the second end  304  of the suture  30   e  can extend out from the sleeve  20 . Then, with the pre-drilled hole  14  drilled into the boney structure  16 , and the first end the suture  30   e  coupled to the breakaway section  26 , the midsection  302  of the suture  30   e  can be coupled to the soft tissue  306 . The suture  30   e  can be coupled to the soft tissue  306  through any appropriate technique, such as a mattress stitch  308  or a suture punch (not shown), for example. Then, the hand  86  of an operator can thread or insert the second end  304  of the suture  30   e  through the eyelet  36   e  with or without the use of the needle  309 .  
         [0105]     With additional reference to  FIG. 24 , once the second end  304  of the suture  30   e  is threaded through the eyelet  36   e,  the suture anchor  10   e  can be inserted into the pre-drilled hole  14 . Generally, the second end  304  of the suture  30   e  can extend beyond the pre-drilled hole  14  to enable the hand  86  of the operator to grasp the second end  304  to tighten the suture  30   e,  and thus the soft tissue  306 , to the pre-drilled hole  14 . Typically, the suture  30   e  can be tightened by pulling the second end  304  of the suture  30   e  that extends beyond the pre-drilled hole  14 . This further removes any slack from the suture  30   e.  After the suture  30   e  is tightened, the expanding members  72  of the suture anchor  10   e  can be deployed to engage the pre-drilled hole  14 .  
         [0106]     As discussed herein, the alternative alternative syringe-type actuator  88 ′ can be used to expand the expanding members  72  of the suture anchor  10   e;  however, any other activating device, such as the actuator gun  56  discussed with regard to  FIGS. 4A and 4B , or the syringe-type actuator  88  discussed with regard to  FIG. 4D , could be used. If the alternative alternative syringe-type actuator  88 ′ is used, then the lever  92 ′ on the alternative syringe-type actuator  88 ′ can be pulled, as shown in  FIG. 25 , to apply the retractive force F 1  to the actuator pin  12 . The application of the retractive force F 1  can cause the fifth alternative insert  18   e  to be displaced or moved rearwardly with respect to the sleeve  20  and can cause the tapered portion  46  of the fifth alternative insert  18   e  to apply a force F 3  to the tapered interior bearing surface  80  of the expanding members  72  of the sleeve  20  until the expanding members  72  are engaged with the boney structure  16 .  
         [0107]     When the expanding members  72  are fully engaged, the tip  32  of the suture receiving portion  22   e  can be adjacent to the suture  30   e,  while the suture  30   e  is adjacent to the first end  64  of the sleeve  20  (as best shown in  FIG. 19 ). The compression of the suture  30   e  between the suture receiving portion  22   e  and the tip  32  can fix or lock the suture  30   e  to the suture anchor  10   e,  while preventing the fifth alternative insert  18   e  from retracting further. The continued application of the retractive force F 1  to the fifth alternative insert  18   e  can cause the breakaway section  26  to fracture, as shown in  FIG. 26 . Once the breakaway section  26  fractures, the sleeve  20  and suture receiving portion  22   e  remain in the pre-drilled hole  14  to couple the soft tissue  306  to the boney structure  16  via the suture  30   e.  The portion of the second end  304  that extends from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0108]     As shown in  FIG. 27 , the suture anchor  10   e  can fix or lock the second end  304  of the suture  30   e  to the suture anchor  10   e  without the use of a knot. In addition, the suture anchor  10   e  can ensure the first end  300  of the suture  30   e  remains fixed to the fifth alternative insert  18   e.  Generally, as a portion of the first end  300  extends from the sleeve  20  and the second end  304  extends from the eyelet  36   e  of the fifth alternative insert  18   e  prior to the deployment of the expanding members  72  of the sleeve  20 , the application of the retractive force F 1  causes the fifth alternative insert  18   e,  and thus the portion of the first end  300  and the second end  304  extending from the eyelet  36   e,  to be withdrawn into the sleeve  20 . Thus, the movement of the fifth alternative insert  18   e  within the sleeve  20  can fix or lock the portion of the first end  300  and the second end  304  to the suture anchor  10   e  due to the interference fit between the fifth alternative insert  18   e,  the suture  30   e,  and the sleeve  20 , as discussed previously. Additionally, the frictional lock created between the suture  30   e,  the fifth alternative insert  18   e  and the sleeve  20  can prevent the fifth alternative insert  18   e  from moving after the deployment of the expanding members.  
         [0109]     With reference to  FIG. 28 , a sixth alternative insert  18   f  is shown. The sixth alternative insert  18   f  can include a suture receiving portion  22   f,  the breakaway section  26 , and the end section  24  for use with a suture anchor  10   f  substantially similar to the suture anchor  10   e  described with regard to  FIGS. 21-27 . As the breakaway section  26  and end section  24  of the sixth alternative insert  18   f  are substantially similar to the breakaway section  26  and end section  24  of the insert  18 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the sixth alternative insert  18   f.  In addition, as the suture receiving portion  22   f  is substantially similar to the suture receiving portion  22   e  of the fifth alternative insert  18   e,  as discussed with reference to  FIGS. 21-27 , only the modifications to the suture receiving portion  22   f  will be discussed herein.  
         [0110]     As shown in  FIG. 28 , the suture receiving portion  22   f  can include an aperture, for example, a groove or slot  350 , which can be for receipt of the suture  30   e.  Generally, the slot  350  can be formed longitudinally in a cylindrical body  34   f  of the sixth alternative insert  18   f;  however, the slot  350  can be formed in any desired position, such as vertically or diagonally. As will be appreciated, the remainder of the cylindrical body  34   f  can be generally similar to the cylindrical body  34   e  that is illustrated in and described in conjunction with  FIG. 21 .  
         [0111]     The slot  350  can extend for a length L and can have a height H configured to enable an operator to insert the second end  304  of the suture  30   e  through the slot  350 , as shown in  FIG. 29 . Generally, once the first end  300  of the suture  30   e  is tied to the breakaway section  26  and the midsection  302  of the suture  30   e  is coupled to the soft tissue  306  via the mattress stitch  308  or any other technique, such as a suture punch (not shown), the hand  86  of the operator can thread or insert the second end  304  of the suture  30   e  into the slot  350 .  
         [0112]     With reference to  FIG. 30 , the suture anchor  10   f  can be inserted into the pre-drilled hole  14  formed in the boney structure  16 . Next, as discussed herein, the hand  86  of the operator can be used to tighten the suture  30   e,  and thus the soft tissue  306 , to the pre-drilled hole  14  by pulling the second end  304  of the suture  30   e  that extends from the pre-drilled hole  14 . After the suture  30   e  is tightened, the expanding members  72  of the suture anchor  10   f  can be expanded to engage the pre-drilled hole  14  through the use of the actuator gun  56 , syringe-type actuator  88  or syringe-type actuator  88 ′, for example, as discussed previously with reference to  FIGS. 4A and 4B ,  4 D and  9 - 12 , respectively.  
         [0113]     When the suture anchor  10   f  is fully engaged to the pre-drilled hole  14 , the tip  32  of the suture receiving portion  22   f  can be adjacent to the suture  30   e,  while the suture  30   e  is adjacent to the first end  64  of the sleeve  20 , as best shown in  FIG. 31 . The compression of the suture  30   e  between the suture receiving portion  22   f  and the tip  32  can fix or lock the suture  30   e  to the suture anchor  10   f.  Thus, the suture anchor  10   f  can fix the second end  304  of the suture  30   e  to the suture anchor  10   f  without the use of a knot, while providing greater access for the operator to couple the second end  304  of the suture  30   e  to the sixth alternative insert  18   f  prior to the insertion of the suture anchor  10   f  into the pre-drilled hole  14 . The portion of the second end  304  that extends from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0114]     With reference to  FIG. 32 , a seventh alternative insert  18   g  is shown. The seventh alternative insert  18   g  can include a suture receiving portion  22   g,  the breakaway section  26 , and the end section  24  for use with a suture anchor  10   g  substantially similar to the suture anchor  10   e  described with regard to  FIGS. 21-27 . As the breakaway section  26  and end section  24  of the seventh alternative insert  18   g  are substantially similar to the breakaway section  26  and end section  24  of the insert  18 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the seventh alternative insert  18   g.  In addition, as the suture receiving portion  22   g  is substantially similar to the suture receiving portion  22   e  of the fifth alternative insert  18   e,  as discussed with  FIGS. 21-27 , only the modifications to the suture receiving portion  22   g  will be discussed herein.  
         [0115]     As shown in  FIG. 32 , the suture receiving portion  22   g  can include a slot, for example, a C-shaped slot  360 , which can be for receipt of the suture  30   e.  Generally, the slot  360  can be defined in a cylindrical body  34   g  of the seventh alternative insert  18   g.  As will be appreciated, the remainder of the cylindrical body  34   g  can be generally similar to the cylindrical body  34   e  that is illustrated in and described in conjunction with  FIG. 21 . The slot  360  can define a throughbore  362  and a necked portion  364 . The necked portion  364  can define an aperture  366  for receipt of the first end  300  and second end  304  of the suture  30   e.  Generally, the necked portion  364  can be configured such that the first end  300  and second end  304  of the suture  30   e  can be hooked behind and retained by the necked portion  364 .  
         [0116]     As the assembly and deployment of the suture anchor  10   g  in the pre-drilled hole  14  is substantially similar to the deployment of the suture anchor  10   e  discussed with regard to  FIGS. 21-27  and the suture anchor  10   f  discussed with regard to  FIGS. 30 and 31 , the assembly and deployment of the suture anchor  10   g  will not be discussed in detail herein. Briefly, however, the first end  300  of the suture  30   e  can be tied to the breakaway section  26  and the midsection  302  of the suture  30   e  can be coupled to the soft tissue  306  via the mattress stitch  308  or any other technique, such as a suture punch (not shown). Then, the hand  86  of the operator can thread or insert the second end  304  of the suture  30   e  into the slot  360  (not shown). Then, the suture anchor  10   g  can be inserted into the pre-drilled hole  14  and the hand  86  of the operator can be used to tighten the suture  30   e,  and thus the soft tissue  306 , to the pre-drilled hole  14  by pulling the second end  304  of the suture  30   e  that extends from the pre-drilled hole  14  (not shown). This further removes any slack from the suture  30   e.  After the suture  30   e  is tightened, the expanding members  72  of the suture anchor  10   g  can be deployed to engage the pre-drilled hole  14 .  
         [0117]     When the suture anchor  10   g  is fully engaged to the pre-drilled hole  14 , the tip  32  of the suture receiving portion  22   g  can be adjacent to the suture  30   e,  while the suture  30   e  is adjacent to the first end  64  of the sleeve  20 , as best shown in  FIG. 33 . The compression of the suture  30   e  between the suture receiving portion  22   g  and the tip  32  can fix or lock the suture  30   e  to the suture anchor  10   g.  Thus, the suture anchor  10   g  can fix the second end  304  of the suture  30   e  to the suture anchor  10   g  without the use of a knot, while providing greater access for the operator to couple the second end  304  of the suture  30   e  to the seventh alternative insert  18   g  prior to the insertion of the suture anchor  10   g  into the pre-drilled hole  14 . The portion of the second end  304  that extends from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0118]     With reference to  FIG. 34 , an eighth alternative insert  18   h  is shown. The eighth alternative insert  18   h  can include a suture receiving portion  22   h,  the breakaway section  26 , and the end section  24  for use with a suture anchor  10   h  substantially similar to the suture anchor  10   e  described with regard to  FIGS. 21-27 . As the breakaway section  26  and end section  24  of the eighth alternative insert  18   h  are substantially similar to the breakaway section  26  and end section  24  of the insert  18 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the eighth alternative insert  18   h.  In addition, as the suture receiving portion  22   h  is substantially similar to the suture receiving portion  22   e  of the fifth alternative insert  18   e,  as discussed with  FIGS. 21-27 , only the modifications to the suture receiving portion  22   h  will be discussed herein.  
         [0119]     As shown in  FIG. 34 , the suture receiving portion  22   h  can include a hinged slot  370  which can be for receipt of the suture  30   e.  Generally, the hinged slot  370  can be defined in a cylindrical body  34   h  of the eighth alternative insert  18   h.  As will be appreciated, the remainder of the cylindrical body  34   h  can be generally similar to the cylindrical body  34   e  that is illustrated in and described in conjunction with  FIG. 21 .  
         [0120]     The hinged slot  370  can define a throughbore  372  and can include a hinged portion  374 . The hinged portion  374  can optionally include at least one or a plurality of barbs or projections  376 . The throughbore  372  can be configured to retain the first end  300  and second end  304  of the suture  30   e.  The hinged portion  374  can be pivotably coupled to the cylindrical body  34   h  and can rotate from an opened position to a closed position. In the opened position, as shown in  FIG. 34 , the hinged portion  374  can define an aperture  378  for receipt of the first end  300  and second end  304  of the suture  30   e  to enable the suture  30   e  to enter the throughbore  372  of the hinged slot  370 . In the closed position, the hinged portion  374  can substantially enclose the aperture  378  to retain the suture  30   e  within the throughbore  372 , as shown in  FIG. 35 . Thus, generally, the hinged portion  374  can be sized such that in the closed position the hinged portion  374  can substantially enclose the aperture  378 . The projections  376  are optional and can be coupled to or formed with the hinged portion  374  if desired. The projections  376  can extend into the throughbore  372  when the hinged portion  374  is in the closed position to further retain the suture  30   e  within the throughbore  372 . The projections  376  are illustrated as triangular, however, any appropriate shape, such as annular or hooked, could be employed.  
         [0121]     As the assembly and deployment of the suture anchor  10   h  in the pre-drilled hole  14  is substantially similar to the assembly and deployment of the suture anchor  10   e  discussed with regard to  FIGS. 21-27  and the suture anchor  10   f  discussed with regard to  FIGS. 30 and 31 , the assembly and deployment of the suture anchor  10   h  will not be discussed in detail herein. Briefly, however, the first end  300  of the suture  30   e  can be tied to the breakaway section  26  and the midsection  302  of the suture  30   e  can be coupled to the soft tissue  306  via the mattress stitch  308  or any other technique, such as a suture punch (not shown). The hand  86  of the operator can thread or insert the second end  304  of the suture  30   e  into the hinged slot  370  (not shown). Then, the suture anchor  10   h  can be inserted into the pre-drilled hole  14  and the hand  86  of the operator can be used to tighten the suture  30   e,  and thus the soft tissue  306 , to the pre-drilled hole  14  by pulling the second end  304  of the suture  30   e  that extends from the pre-drilled hole  14  (not shown). This further removes any slack from the suture  30   e.  After the suture  30   e  is tightened, the expanding members  72  of the suture anchor  10   h  can be deployed to engage the pre-drilled hole  14 . During the deployment of the suture anchor  10   h,  as the eighth alternative insert  18   h  moves rearwardly in the sleeve  20 , the hinged portion  374  can be pushed closed by the sleeve  20  to lock the suture  30   e  within the throughbore  372  of the suture receiving portion  22   h.    
         [0122]     When the suture anchor  10   h  is fully engaged to the pre-drilled hole  14 , the tip  32  of the suture receiving portion  22   h  can be adjacent to the suture  30   e,  while the suture  30   e  is adjacent to the first end  64  of the sleeve  20 , as best shown in  FIG. 35 . The compression of the suture  30   e  between the suture receiving portion  22   h  and the tip  32  can fix or lock the suture  30   e  to the suture anchor  10   h.  Thus, the suture anchor  10   h  can also fix the second end  304  of the suture  30   e  to the suture anchor  10   h  without the use of a knot. The portion of the second end  304  that extends from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0123]     With reference to  FIG. 36 , a ninth alternative insert  18   i  is shown. The ninth alternative insert  18   i  can include a suture receiving portion  22   i,  the breakaway section  26 , and the end section  24  for use with a suture anchor  10   i  substantially similar to the suture anchor  10  described with regard to  FIGS. 1-7 . As the breakaway section  26  and end section  24  of the ninth alternative insert  18   i  are substantially similar to the breakaway section  26  and end section  24  of the insert  18 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the ninth alternative insert  18   i.  In addition, as the suture receiving portion  22   i  is substantially similar to the suture receiving portion  22  of the insert  18 , as discussed with  FIGS. 1-6B , only the modifications to the suture receiving portion  22   i  will be discussed herein.  
         [0124]     As shown in  FIG. 36 , the suture receiving portion  22   i  includes the eyelet  36  and a hinged slot  400 . Generally, the eyelet  36  and hinged slot  400  can each be defined in a cylindrical body  34   i  of the ninth alternative insert  18   i.  As will be appreciated, the remainder of the cylindrical body  34   i  can be generally similar to the cylindrical body  34  that is illustrated in and described in conjunction with  FIGS. 1-6B . The eyelet  36  can be configured for receipt of the suture  30  therein, as discussed herein, while the hinged slot  400  can be configured for receipt of a suture  30   i  therein.  
         [0125]     The hinged slot  400  can include a throughbore  402 , a first hinged portion  404  and a second hinged portion  406 . The throughbore  402  defines a passageway for receipt of the suture  30   i  therethrough and can include a first end  408  and a second end  410 . The first hinged portion  404  can be pivotably coupled to the first end  408  of the throughbore  402  and the second hinged portion  406  can be pivotably coupled to the second end  410  of the throughbore  402 . The first hinged portion  404  and second hinged portion  406  can generally be pivotable from an opened position to a closed position. In the opened position, as shown in  FIG. 36 , the first hinged portion  404  and second hinged portion  406  can enable the suture  30   i  to be received into and through the throughbore  402 . In the closed position, as shown in  FIG. 37 , the first hinged portion  404  and second hinged portion  406  can generally pivot to enclose the first end  408  and second end  410  of the throughbore  402 , respectively, to secure or lock the suture  30   i  within the throughbore  402 . Thus, generally, the first hinged portion  404  and the second hinged portion  406  can be sized to create an interference fit between the suture  30   i,  the first and second hinged portion  404 ,  406  and the throughbore  402  to lock the suture  30   i  to the ninth alternative insert  18   i.    
         [0126]     The suture  30   i  can include a first end  412 , a midsection  414  and a second end  416 . The suture  30   i  can be used to couple multiple suture anchors  10  together, wherein the reference numeral “10” denotes all of the suture anchors  10 . Generally, the first end  412  of the suture  30   i  can be coupled to an adjacent suture anchor  10  (not specifically shown) and the midsection  414  of the suture  30   i  can pass through the throughbore  402  to secure the suture  30   i  to the suture anchor  10   i.  The second end  416  of the suture  30   i  can then be coupled to another suture anchor  10 , or can be trimmed. Alternatively, the midsection  414  of the suture  30   i  can be coupled to additional soft tissue (not shown). If the midsection  414  is coupled to additional soft tissue, then the first end  412  and second end  416  of the suture  30   i  can pass through the throughbore  402  to couple the additional soft tissue to the suture anchor  10 , as shown in  FIG. 36A .  
         [0127]     As the assembly and deployment of the suture anchor  10   i  in the pre-drilled hole  14  is substantially similar to the deployment of the suture anchor  10  discussed with regard to  FIGS. 4A-6B  and the suture anchor  10   a  discussed with regard to  FIGS. 8-12 , the assembly and deployment of the suture anchor  10   i  will not be discussed in detail herein. Briefly, however, in order to employ the suture anchor  10   i,  the suture  30  can be threaded through the eyelet  36  of the ninth alternative insert  18   i  and then the sleeve  20  can be disposed over the ninth alternative insert  18   i  (not specifically shown). The suture  30   i  can then be coupled to an adjacent suture anchor  10  or to the additional soft tissue via a mattress stitch or any other technique, such as a suture punch (not shown). If the suture  30   i  is coupled to an adjacent suture anchor  10 , then the hand  86  of the operator can thread or insert the second end  416  of the suture  30   e  into the throughbore  402  until the midsection  414  is received in the throughbore  402  of hinged slot  400 , and the second end  416  of the suture  30   i  extends beyond the second end  410  of the throughbore  402 . If the suture  30   i  is coupled to the additional soft tissue, then the hand  86  of the operator can thread or insert the first end  412  and the second end  416  of the suture  30   i  into the hinged slot  400  (not shown). Once the suture  30   i  is threaded through the hinged slot  400 , the suture anchor  10   i  can be inserted into the pre-drilled hole  14 .  
         [0128]     The hand  86  of the operator can be used to tighten the suture  30   i  to the pre-drilled hole  14  by pulling the respective first end  414  and/or second end  416  of the suture  30   i  that extends from the pre-drilled hole  14 . This further removes any slack from the suture  30   i  (not shown). After the suture  30   i  is tightened, the expanding members  72  of the suture anchor  10   i  can be deployed to engage the pre-drilled hole  14 . During the deployment of the suture anchor  10   i,  as the ninth alternative insert  18   i  moves rearwardly in the sleeve  20 , the first hinged portion  404  and second hinged portion  406  can be pushed closed by the sleeve  20  to lock the suture  30   i  within the throughbore  402  of the suture receiving portion  22   i  as shown in  FIGS. 37 and 37 A. In addition, if necessary, the suture  30  coupled to the eyelet  36  can be pulled by the hand  86  of the operator to fully expand the expanding members  72  in soft boney tissue, as discussed herein.  
         [0129]     When the suture anchor  10   i  is fully engaged to the pre-drilled hole  14 , the tip  32  of the suture receiving portion  22   i  can be adjacent to the suture  30   i,  while the suture  30   i  is adjacent to the first end  64  of the sleeve  20 , as best shown in  FIGS. 37 and 37 A. The compression of the suture  30   i  between the suture receiving portion  22   i  and the tip  32  can fix or lock the suture  30   i  to the suture anchor  10   i.  Thus, the suture anchor  10   i  can fix the first end  412  ( FIG. 37 ), and the first end  412  and the second end  416  ( FIG. 37A ) of the suture  30   i  to the suture anchor  10   i  without the use of a knot. The portion of the first end  412  and/or second end  416  that extends from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0130]     With reference to  FIG. 38 , a tenth alternative insert  18   j  is shown. The tenth alternative insert  18   j  can include a suture receiving portion  22   j,  the breakaway section  26 , and the end section  24  for use with a suture anchor  10   j  substantially similar to the suture anchor  10  described with regard to  FIGS. 1-6B . As the breakaway section  26  and end section  24  of the tenth alternative insert  18   j  are substantially similar to the breakaway section  26  and end section  24  of the insert  18 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the tenth alternative insert  18   j.  In addition, as the suture receiving portion  22   j  is substantially similar to the suture receiving portion  22  of the insert  18 , as discussed with  FIGS. 1-6B , only the modifications to the suture receiving portion  22   j  will be discussed herein.  
         [0131]     As shown in  FIG. 36 , the suture receiving portion  22   j  includes the eyelet  36  and a second formed eyelet  450 . Generally, the eyelet  36  and second formed eyelet  450  can each be defined in a cylindrical body  34   j  of the tenth alternative insert  18   j.  As will be appreciated, the remainder of the cylindrical body  34   j  can be generally similar to the cylindrical body  34  that is illustrated in and described in conjunction with  FIGS. 1-6B . The eyelet  36  can be configured for receipt of the suture  30  therein, as discussed previously, while the second formed eyelet  450  can be configured for receipt of the suture  30   j  therein.  
         [0132]     The second formed eyelet  450  can generally be formed perpendicular to the eyelet  36 ; however, the second formed eyelet  450  could be formed in any appropriate orientation with regard to the eyelet  36 , such as parallel. The second formed eyelet  450  defines a passageway for receipt of a suture  30   j  therethrough. The suture  30   j  can be used to couple multiple suture anchors  10  together, wherein the reference numeral “10” denotes all of the suture anchors  10 , or the suture  30   j  can be used to couple additional soft tissue to the suture anchor  10   j.  The suture  30   j  can include a first end  418 , a midsection  420  and a second end  422 . The midsection  420  can be coupled to either the suture anchor  10  or additional soft tissue, while the first end  418  and second end  422  can pass through the second formed eyelet  450  to couple the suture  30   j  to the suture anchor  10   j.    
         [0133]     As the assembly and deployment of the suture anchor  10   j  in the pre-drilled hole  14  is substantially similar to the assembly and deployment of the suture anchor  10  discussed with regard to  FIGS. 4A-6B  and the suture anchor  10   a  discussed with regard to  FIGS. 8-12 , the assembly and deployment of the suture anchor  10   j  will not be discussed in detail herein. Briefly, however, in order to employ the suture anchor  10   j,  the suture  30  can be threaded through the eyelet  36  of the tenth alternative insert  18   j  and then the sleeve  20  can be disposed over the tenth alternative insert  18   j  (not specifically shown). The suture  30   j  can then be coupled to an adjacent suture anchor  10  or to additional soft tissue via the mattress stitch or any other technique, such as a suture punch (not shown).  
         [0134]     If the suture  30   j  is coupled to an adjacent suture anchor  10 , then the hand  86  of the operator can thread or insert the second end  416  of the suture  30   j  into the second formed eyelet  450  until the midsection  414  is received in the second formed eyelet  450 , and the second end  416  of the suture  30   j  extends beyond the suture anchor  10   j.  If the suture  30   i  is coupled to the additional soft tissue, then the hand  86  of the operator can thread or insert the first end  412  and the second end  416  of the suture  30   j  into the second formed eyelet  450  (not shown). Once the suture  30   j  is threaded through the second formed eyelet  450 , the suture anchor  10   j  can be inserted into the pre-drilled hole  14 .  
         [0135]     As discussed herein, the hand  86  of the operator can be used to tighten the suture  30   j  to the pre-drilled hole  14  by pulling the first end  418  and second end  416  of the suture  30   j  that extends from the pre-drilled hole  14  (not shown). After the suture  30   j  is tightened, the expanding members  72  of the suture anchor  10   j  can be deployed to engage the pre-drilled hole  14 . It should be noted, however, that if necessary, the suture  30  coupled to the eyelet  36  can be pulled by a hand  86  of an operator to fully expand the expanding members  72 , as discussed herein.  
         [0136]     When the suture anchor  10   j  is fully engaged to the pre-drilled hole  14 , the tip  32  of the suture receiving portion  22   j  can be adjacent to the suture  30   j,  while the suture  30   j  is adjacent to the first end  64  of the sleeve  20 , as best shown in  FIG. 39 . The compression of the suture  30   j  between the suture receiving portion  22   j  and the tip  32  can fix or lock the suture  30   j  to the suture anchor  10   j.  Thus, the suture anchor  10   j  can fix the first end  412  and second end  416  of the suture  30   j  to the suture anchor  10   j  without the use of a knot. The portion of the first end  412  and second end  416  of the suture  30   j  that extends from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0137]     With reference to  FIG. 40 , an eleventh alternative insert  18   k  is shown. The eleventh alternative insert  18   k  can include a suture receiving portion  22   k,  the breakaway section  26 , and the end section  24  for use with a suture anchor  10   k  substantially similar to the suture anchor  10   e  described with regard to  FIGS. 21-27 . As the breakaway section  26  and end section  24  of the eleventh alternative insert  18   k  are substantially similar to the breakaway section  26  and end section  24  of the insert  18 , the breakaway section  26  and end section  24  will not be discussed in detail with regard to the eleventh alternative insert  18   k.  In addition, as the suture receiving portion  22   k  is substantially similar to the suture receiving portion  22   e  of the fifth alternative insert  18   e,  as discussed with  FIGS. 21-27 , only the modifications to the suture receiving portion  22   k  will be discussed herein.  
         [0138]     As shown in  FIG. 40 , the suture receiving portion  22   k  can include the eyelet  36  and a second formed eyelet  460 . Generally, the eyelet  36  and second formed eyelet  460  can each be defined in a cylindrical body  34   k  of the eleventh alternative insert  18   k.  As will be appreciated, the remainder of the cylindrical body  34   k  can be generally similar to the cylindrical body  34  that is illustrated in and described in conjunction with  FIGS. 1-6B . The eyelet  36  can be configured for receipt of a suture  30 ′ therein, while the second formed eyelet  460  can be configured for receipt of the suture  30   k  therein. The suture  30 ′ can include a first end  454 , a midsection  456  and second end  458 . The first end  454  of the suture  30 ′ can be coupled to a suture anchor  10  or additional soft tissue  462  and can pass through the second formed eyelet  460  to couple the suture  30 ′ to the suture anchor  10   k.  The midsection  456  can be received through the eyelet  36  to further retain the suture  30 ′ within the suture anchor  10   k.  The second end  458  can extend from the second end  66  of the sleeve  20 .  
         [0139]     The second formed eyelet  460  can generally be formed perpendicular to the eyelet  36 ; however, the second formed eyelet  460  could be formed in any appropriate orientation with regard to the eyelet  36 , such as parallel. The second formed eyelet  460  defines a passageway for receipt of the suture  30   k  therethrough. The suture  30   k  can be used to couple multiple suture anchors  10  together, wherein the reference numeral “10” denotes all of the suture anchors  10 , or the suture  30   k  can be used to couple additional soft tissue  462  to the suture anchor  10   k.  The suture  30   k  can include a first end  464 , a midsection  466 , and a second end  468 . The first end  464  can be coupled to the breakaway section  26  of the eleventh alternative insert  18   k.  The midsection  466  can be coupled to either the suture anchor  10  or to the additional soft tissue  462 . The second end  468  of the suture  30   k  can pass through the second formed eyelet  460  to couple the suture  30   k  to the suture anchor  10   k.    
         [0140]     Typically, in order to employ the suture anchor  10   k,  with additional reference to  FIG. 41 , the suture  30 ′ can be threaded through the eyelet  36  of the eleventh alternative insert  18   k  and then the first end  412  of the suture  30   k  can be tied to the breakaway section  26 . The sleeve  20  can be disposed over the eleventh alternative insert  18   k  such that the suture  30 ′ and the suture  30   k  extend from the second end  66  of the sleeve  20 . Then, the midsection  466  of the suture  30   k  and a portion  470  of the first end  454  of the suture  30 ′ can then be coupled to an adjacent suture anchor  10  (not shown) or to the additional soft tissue  462  via the mattress stitch  472  or any other technique, such as a suture punch. If the suture  30 ′ and the suture  30   k  are coupled to an adjacent suture anchor  10 , then the hand  86  of the operator can thread or insert the first end  454  of the suture  30 ′ and the second end  468  of the suture  30   k  into the second formed eyelet  460  until the first end  454  of the suture  30 ′ and the second end  468  of the suture  30   k  extend beyond the suture anchor  10   k  (not shown).  
         [0141]     If the midsection  466  of the suture  30   k  and the portion  470  of the first end  454  of the suture  30 ′ are coupled to the additional soft tissue  462 , then the hand  86  of the operator can thread or insert the first end  454  of the suture  30 ′ and the second end  468  of the suture  30   k  into the second formed eyelet  460 , as shown in  FIG. 41 . Once the first end  454  of the suture  30 ′ and the suture  30   k  are threaded through the second formed eyelet  460 , the suture anchor  10   k  can be inserted into the pre-drilled hole  14 .  
         [0142]     The hand  86  of the operator can be used to tighten the additional soft tissue  462  to the pre-drilled hole  14  by pulling the suture  30   k  and the first end  454  of the suture  30 ′ that extends from the pre-drilled hole  14 . After the suture  30 ′ and suture  30   k  are tightened, the expanding members  72  of the suture anchor  10   k  can be deployed to engage the pre-drilled hole  14 . As the deployment of the suture anchor  10   k  in the pre-drilled hole  14  is substantially similar to the deployment of the suture anchor  10  discussed with regard to  FIGS. 4A-6B  and the suture anchor  10   e  discussed with regard to  FIGS. 21-27 , the deployment of the suture anchor  10   k  will not be discussed in detail herein. It should be noted, however, that if necessary, the first end  454  and second end  458  of the suture  30 ′ coupled to the eyelet  36  can be pulled by the hand  86  of the operator to fully expand the expanding members  72  in the case of soft boney tissue, as discussed herein.  
         [0143]     When the suture anchor  10   k  is fully engaged to the pre-drilled hole  14 , the tip  32  of the suture receiving portion  22   k  can be adjacent to the suture  30 ′ and the suture  30   k,  while the suture  30 ′ and suture  30   k  are adjacent to the first end  64  of the sleeve  20 , as best shown in  FIG. 42 . The compression of the suture  30 ′ and the suture  30   k  between the suture receiving portion  22   k  and the tip  32  can fix or lock the suture  30 ′ and the suture  30   k  to the suture anchor  10   k.  Thus, the suture anchor  10   k  can fix the suture  30 ′ and the suture  30   k  to the suture anchor  10   k  without the use of a knot. The portion of the second end  458  of the suture  30 ′ and the suture  30   k  that extend from the pre-drilled hole  14  can then be trimmed if desired (not shown).  
         [0144]     The description of these teachings is merely exemplary in nature and, thus, variations that do not depart from the gist of the teachings are intended to be within the scope of the teachings. Such variations are not to be regarded as a departure from the spirit and scope of the teachings.