Patent Publication Number: US-2010121376-A1

Title: Suture Anchoring System and Method

Description:
BACKGROUND 
     The complete or partial detachment of ligaments, tendons or other soft tissues from their associated bones within the body is a relatively common place injury, particularly among athletes and physically active individuals. These types of injuries generally result from excessive stresses being applied to the soft tissues. For example, a tissue detaching injury may occur as the result of a fall, overexertion during a work-related activity, during the course of an athletic event, and/or in association with other situations or physical activities. 
     In the case of a partial detachment injury, which is commonly referred to under the general term “sprain”, the injury will frequently heal itself if given sufficient time and if care is taken not to expose the injury to any undue or extraordinary stress during the healing process. If, however, the ligament or tendon is completely detached from its associated bone or bones, or if it is severed as a result of a traumatic injury, partial or permanent disability may result. Fortunately, a number of surgical techniques exist for reattaching detached tissues and/or completely replacing severely damaged tissues. One such technique involves reattachment of detached tissue using traditional attachment devices such as metal staples, sutures over buttons and/or cancellous bone screws. These types of traditional attachment techniques and devices may also be used to attach tendon or ligament substitutes (sometimes formed of autogenous tissue harvested from other locations in the body) to the desired bone or bones. 
     Although attempts have been made to provide techniques and devices for forming an attachment to bone or other tissue, there is a general need in the industry to provide an improved suture anchoring system and method. The present invention satisfies this need and provides other benefits and advantages in a novel and unobvious manner. 
     SUMMARY 
     The present invention relates generally to an improved suture anchoring system and method. While the actual nature of the invention covered herein can only be determined with reference to the claims appended hereto, certain forms of the invention that are characteristic of the preferred embodiments disclosed herein are described briefly as follows. 
     In one form of the present invention, a suture anchoring system is provided including at least three anchor members interconnected to form an anchor assembly with a suture extending therefrom. The anchor assembly has an insertion configuration sized for delivery through an aperture in bodily tissue and is transitionable to an expanded configuration sized to prevent passage of the anchor assembly back through the aperture. 
     In another form of the present invention, a suture anchoring system is provided including at least three anchor members interconnected to form an anchor assembly with a suture extending therefrom. The anchor assembly has an insertion configuration wherein the anchor members are aligned in a substantially linear arrangement for delivery through an aperture in bodily tissue and an expanded configuration wherein the anchor members are transitioned to a non-linear arrangement to prevent passage of the anchor assembly back through the aperture. 
     In another form of the present invention, a suture anchoring system is provided including at least three anchor members interconnected to form an anchor assembly with a suture extending therefrom. The anchor assembly includes first and second outer anchor members and at least one intermediate anchor member, and has an insertion configuration wherein the anchor members are aligned in a substantially linear arrangement for delivery through an aperture in bodily tissue and an expanded configuration wherein the outer anchor members are drawn toward one another to define a non-linear arrangement to prevent passage of the anchor assembly back through the aperture. 
     In another form of the present invention, a suture anchoring system is provided including at least three anchor members, means for interconnecting the anchor members to form an anchor assembly with a suture extending therefrom and having an insertion configuration wherein the anchor members are aligned in a substantially linear arrangement for delivery through an aperture in bodily tissue, and means for transitioning the anchor assembly from the insertion configuration to an expanded configuration wherein the anchor members are transitioned to a non-linear arrangement to prevent passage of the anchor assembly back through the aperture. 
     In another form of the present invention, a suture anchoring system is provided including a plurality of anchor members interconnected to form an anchor assembly with a suture extending therefrom. The anchor assembly has an insertion configuration wherein the anchor members are aligned in a substantially linear arrangement for delivery through an aperture in bodily tissue and an expanded configuration wherein first and second ones of the anchor members are drawn toward one another to define a non-linear arrangement to prevent passage of the anchor assembly back through the aperture. The system further includes an actuating element extending through a first loop structure associated with the first anchor member and through a second loop structure associated with the second anchor member, and wherein the first and second anchor members are drawn toward one another by pulling the actuating element in a direction away from the anchor assembly to at least partially transition the anchor assembly toward the expanded configuration. 
     In another form of the present invention, a method for anchoring a suture to bodily tissue is provided including providing at least three anchor members interconnected to form an anchor assembly with a suture extending from the anchor assembly, aligning the anchor members in a substantially linear configuration, inserting the anchor members through an aperture in the bodily tissue while in the linear configuration, and transitioning the anchor members from the linear configuration to a non-linear configuration to prevent passage of the anchor assembly back through the aperture. 
     It is one object of the present invention to provide an improved suture anchoring system and method. Further objects, features, advantages, benefits, and aspects of the present invention will become apparent from the drawings and description contained herein. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view of a suture anchoring system according to one form of the present invention. 
         FIG. 2  is an illustration of the suture anchoring system shown in  FIG. 1 , as loaded within a cannula tube in an insertion configuration for delivery through an aperture in body tissue. 
         FIG. 3  is an illustration of the suture anchoring system shown in  FIG. 2 , with the anchor members delivered through the aperture in the body tissue. 
         FIG. 4  is an illustration of the suture anchoring system shown in  FIG. 3 , with the anchor members transitioned to a first anchoring configuration. 
         FIG. 5  is an illustration of the suture anchoring system shown in  FIG. 4 , with the anchor members transitioned to a second anchoring configuration. 
         FIG. 6  is a perspective view of a suture anchoring system according to another form of the present invention. 
         FIG. 7  is an illustration of the suture anchoring system shown in  FIG. 6 , as loaded within a cannula tube in an insertion configuration for delivery through an aperture in body tissue. 
         FIG. 8  is an illustration of the suture anchoring system shown in  FIG. 7 , with the anchor members delivered through the aperture in the body tissue. 
         FIG. 9  is an illustration of the suture anchoring system shown in  FIG. 8 , with the anchor members transitioned to an anchoring configuration. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is hereby intended, and that alterations and further modifications to the illustrated devices and/or further applications of the principles of the invention as illustrated herein are contemplated as would normally occur to one skilled in the art to which the invention relates. 
     Referring to  FIG. 1 , shown therein is a suture anchoring system  10  according to one form of the present invention. The anchoring system  10  is generally comprised of a plurality of anchor members  12  and a number of suture elements  14 . As will be discussed in greater detail below, in one embodiment of the invention, the anchoring system  10  is configured for anchoring to either hard or soft biological tissue, with the suture elements  14  serving to attach another element or structure (either biological or non-biological) to the biological tissue. As used herein, the term “suture” is broadly defined to include any type of longitudinal element suitable for attachment to biological tissue including, for example, thread, wire, gut or any other type of suture material known to those of skill in the art. 
     In the illustrated embodiment of the invention, the anchor members  12  each have a generally tubular configuration including a cylindrical wall  20  and defining an axial passage or channel  22  extending therethrough. However, it should be understood that other shapes and configurations of the anchor members  12  are also contemplated as falling within the scope of the present invention including, for example, a rectangular, triangular, polygonal or spherical configuration, or any other suitable shape or configuration. The anchor members  12  are preferably formed of a bio-compatible material. In one embodiment, the anchor members  12  are formed of metallic material such as stainless steel or a stainless steel alloy, titanium or a titanium alloy, a shape-memory alloy, or any other suitable metallic material. However, the use of other materials is also contemplated, including polymeric or ceramic materials, resorbable materials, bioabsorbable materials, or bone or bone substitute materials. 
     In the illustrated embodiment of the invention, the suture anchoring system  10  includes four anchor members  12   a ,  12   b ,  12   c  and  12   d  that are coupled together or interconnected to form an anchor assembly. However, it should be understood that the anchoring system  10  may include any number of anchor members  12 , including two, three or five or more anchor members. In one embodiment, the anchor members  12   a - 12   d  are coupled or interconnected to one another via a linking element  30 . In the illustrated embodiment, the linking element  30  comprises a suture extending through the axial passages  22  in each of the anchor members  12   a - 12   d  to link the anchor members  12   a - 12   d  together in series. The linking element  30  provides structural integrity to the anchoring system  10  by controlling the position and/or orientation of the anchor members  12   a - 12   d  relative to one another, the details of which will be discussed below. Additionally, the linking element  30  has a length/such that the anchor members  12   a - 12   d  may be axially separated or spaced from one another in a non-abutting manner, the purpose of which will also become apparent below. 
     In the illustrated embodiment of the invention, the ends  30   a ,  30   b  of the linking element  30  are attached to one another so to define a continuous suture loop having a first end loop  32  extending from the outer anchor member  12   a  and a second end loop  34  extending from the outer anchor member  12   d . In the illustrated embodiment of the invention, the ends  30   a ,  30   b  are tied or knotted together to form the suture loop  30 . However, it should be understood that the ends  30   a ,  30   b  of the suture loop  30  may be attached to one another using other techniques such as, for example, via the use of a crimp or another type of coupling device, by fusing or splicing the ends  30   a ,  30   b  together, or by any other suitable method of attachment. It should also be understood that the linking element  30  need necessarily be configured as a loop, but may alternatively define a non-looped, single strand configuration. It should further be understood that the anchor members  12   a - 12   d  need not necessarily be coupled together or interconnected via a single suture element, but may alternatively be individually coupled together via a number of discrete suture elements. Additionally, it should be understood that the anchor members  12   a - 12   d  need not necessarily be coupled together by suture material, but may alternatively be coupled together using other elements and techniques such as, for example, via a number of pins, hinges, fittings, eyelets or any other suitable coupling device. 
     In the illustrated embodiment of the invention, the anchoring system  10  also includes an actuating element  40  that cooperates with the linking element  30  to selectively manipulate the position and/or orientation of one or more of the anchor members  12   a - 12   d . In the illustrated embodiment, the actuating element  40  comprises a suture that engages the end portions of the linking element  30  to selectively manipulate the position and/or orientation of one or more of the anchor members  12   a - 12   d . In a specific embodiment, the actuating element  40  extends through the end loops  32 ,  34  of the linking element  30  such that pulling the ends  40   a ,  40   b  of the actuating element  40  draws the outer anchor members  12   a ,  12   d  toward one another and transitions one or more of the anchor members  12   a - 12   d  to a different position and/or orientation, the details of which will be discussed below. Although the actuating element  40  is illustrated and described as being engaged with the end loops  32 ,  34  of the linking element  30 , it should be understood that the actuating element  40  may alternatively be coupled to the outer anchor members  12   a ,  12   d  via other suitable techniques for drawing the outer anchor members  12   a ,  12   d  toward one another and for selectively transitioning one or more of the anchor members  12   a - 12   d  to a different position and/or orientation. For example, a full or partial loop element may be attached directly to the outer anchor members  12   a ,  12   d  through which the actuating element  40  extends. 
     In the illustrated embodiment of the invention, the anchoring system  10  further includes a second actuating element  50  that cooperates with the linking element  30  to selectively manipulate the position and/or orientation of one or more of the anchor members  12   a - 12   d . In the illustrated embodiment, the actuating element  50  comprises a suture that engages the linking element  30  at a location between the inner anchor member  12   b ,  12   c  to selectively manipulate the position and/or orientation of one or more of the anchor members  12   a - 12   d . In one embodiment, the actuating element  50  is looped about the linking element  30  such that pulling the ends  50   a ,  50   b  of the actuating element  50  draws the inner anchor members  12   b ,  12   c  to a location between the outer anchor members  12   a ,  12   d . In a specific embodiment, the actuating element  50  is threaded between the strands of the suture loop linking element  30 . Although the actuating element  50  is illustrated and described as being looped about the linking element  30 , it should be understood that the actuating element  50  may be coupled to the linking element  30  via other techniques suitable for drawing the inner anchor members  12   b ,  12   c  between the outer anchor members  12   a ,  12   d . For example, instead of looping the actuating element  50  about the linking element  30 , an end portion of the actuating element  50  may by tied or otherwise secured to the linking element  30 . 
     Having illustrated and described the various elements and features associated with the suture anchoring system  10 , reference will now be made to a technique for engaging the anchoring system  10  to human body tissue. As indicated above, the anchoring system  10  is used to anchor a suture in either hard or soft biological tissue. In the illustrated embodiment of the invention, the anchoring system  10  is used to anchor a suture to bone in a human body. In a specific embodiment, the anchoring system  10  is used to anchor a suture to a portion of one or more vertebrae in the spinal column. However, it should be understood that other applications of the anchoring system  10  are also contemplated, including anchoring to other bones or anatomic structures within the human body. Additionally, it should be understood that use of the anchoring system  10  in other animals is also contemplated as falling within the scope of the present invention. 
     Referring to  FIG. 2 , the anchoring system  10  is illustrated as being used in association with a bone B having a relatively hard and compact outer cortical layer L surrounding a softer and more porous inner cancellous region C. In one embodiment of the invention, an axial tunnel or aperture A having a maximum transverse dimension d may be preformed through the cortical layer L and into the cancellous region C for receiving the anchoring system  10 . However, in an alternative embodiment, the anchoring system  10  may be inserted directly into the body tissue without creating a preformed tunnel or aperture, particularly in applications involving relatively soft body tissue. 
     In the illustrated embodiment of the invention, the anchoring system  10  is delivered to the surgical site via a delivery instrument  200  extending along a longitudinal axis  201  and generally comprising an outer sleeve or cannula member  202  and an inner rod member  204 . The cannula member  202  defines an axial passageway  206  extending therethrough and having an inner cross section sized somewhat larger than the outer transverse cross section of the individual anchor members  12 . The inner rod member  204  is sized and configured to be slidably positioned within the axial passageway  206  of the cannula member  202 . In one embodiment, the inner rod member  204  has a circular outer cross section that corresponds to the inner cross section of the cannula member  202 . However, other configurations of the cannula member  202  and/or the inner rod member  204  are also contemplated as falling within the scope of the present invention. 
     The outer transverse cross section of the individual anchor members  12  is sized somewhat smaller than the inner cross section of the axial passageway  206  in the cannula member  202  to allow the anchor members  12  to freely slide along the axial passageway  206 . Additionally, sufficient clearance exists between the anchor members  12  and the cannula member  202  to provide spacing for the passage of the suture elements  40  and  50 . In the illustrated embodiment, the axial passageway  206  has a circular inner cross section corresponding to the circular outer cross section of the anchor members  12 . However, it should be understood that the axial passageway  206  may be configured to have a different inner cross section such as, for example, a rectangular, triangular or polygonal inner cross section, or any other inner cross section suitable for receiving and conveying the anchor members  12  therethrough. Additionally, in an alternative embodiment of the invention, the outer transverse cross section of the anchor members  12  and the inner cross section of the axial passageway  206  can be configured different from one another to provide a predetermined spacing therebetween for passage of the suture elements  40  and  50 . For example, in one alternative embodiment, the axial passageway  206  can be configured to have a circular inner cross section whereas the anchor members  12  can be configured to have a generally triangular or rectangular outer cross section. 
     The anchor members  12   a - 12   d  are initially positioned within the distal end portion of the cannula member  202  in an axially-aligned or linear configuration, with the axes of the anchor members  12   a - 12   d  generally aligned along the longitudinal axis  201 . The end portions  40   a ,  40   b  and  50   a ,  50   b  of the suture elements  40  and  50  extend from the proximal end (not shown) of the cannula member  202  for subsequent manipulation by the surgeon. The distal end portion  202   a  of the cannula member  202  is positioned proximally adjacent the bone B, with the axial passageway  206  generally aligned with the aperture A. However, in an alternative embodiment of the invention, the distal end portion  202   a  of the cannula member  202  may be positioned within the aperture A formed through the outer cortical layer L and possibly extending partially into the cancellous region C of the bone B. 
     Referring to  FIG. 3 , once the cannula member  202  is properly positioned relative to the aperture A, the inner rod member  204  is axially displaced in the direction of arrow  210  with the distal end  204   a  engaging the anchor member  12   d , which in turn displaces the anchor members  12   a - 12   d  through the axial passageway  206 . The inner rod member  204  is axially advanced in the direction of arrow  210  until the anchor members  12   a - 12   d  are deployed from the cannula member  202  and into the aperture A in the cancellous region C of the bone B. As illustrated in  FIG. 3 , the depth of the aperture A in the cancellous region C is preferably sized to entirely receive the anchor members  12   a - 12   d  therein in the axially-aligned configuration. The rod member  204  may then be removed from the cannula member  202  or can remain in position until the anchoring process is completed to prevent the anchor members  12   a - 12   d  from passing back through the cortical layer L of the bone B. 
     Referring to  FIG. 4 , once the anchor members  12   a - 12   d  are deployed from the cannula member  202  and properly positioned within the aperture A in the cancellous region C of the bone B, the anchor members  12   a - 12   d  are selectively transitioned to a non-linear or expanded configuration. As should be appreciated, transitioning of the anchor members  12   a - 12   d  to the non-linear configuration results in outward compression against the relatively soft cancellous bone tissue, thereby resulting in enlargement of the aperture A in the bone B. However, as should also be appreciated, for applications involving anchoring to denser or harder bone tissue, an enlarged portion of the aperture A may have to be preformed in the bone B to allow for transitioning of the anchor members  12   a - 12   d  to the expanded, non-linear configuration. 
     Transitioning of the anchor members  12   a - 12   d  is effectuated by pulling the ends  40   a ,  40   b  of the actuating suture element  40  in a proximal direction so as to reconfigure the anchor members  12   a - 12   d  from the axially-aligned configuration illustrated in  FIG. 3  to the expanded configuration illustrated in  FIG. 4 . More specifically, since the suture element  40  extends through the end loops  32 ,  34  of the linking element  30 , pulling the suture element  40  in a proximal direction draws the outer anchor members  12   a ,  12   d  toward one another. As a result, the anchor members  12   a - 12   d  are repositioned/reoriented so as to define a generally U-shaped configuration, with the anchor members  12   a ,  12   b  being arranged generally laterally opposite the anchor members  12   c ,  12   d.    
     Once transitioned to the non-linear configuration illustrated in  FIG. 4 , the anchor members  12   a - 12   d  are further transitioned to the expanded configuration illustrated in  FIG. 5  by pulling the ends  50   a ,  50   b  of the actuating suture element  50  in a proximal direction. As should be appreciated, pulling the suture element  50  in a proximal direction reconfigures the anchor members  12   a - 12   d  from the U-shaped expanded configuration illustrated in  FIG. 4  to the denser configuration illustrated in  FIG. 5 . Pulling the actuating element  50  in a proximal direction draws the inner anchor members  12   b ,  12   c  between the outer anchor members  12   a ,  12   d . More specifically, the inner anchor members  12   b ,  12   c  are repositioned and reoriented relative to the outer anchor members  12   a ,  12   d  so as to position the inner anchor members  12   b - 12   c  in a laterally adjacent or side-by-side relationship relative to the outer anchor members  12   a ,  12   d . As should be appreciated, the expanded configuration of the anchor members  12   a - 12   d  illustrated in  FIG. 5  is somewhat larger than the inner cross section of the aperture A extending through the outer cortical layer L of the bone B. Accordingly, the expanded configuration of the anchor members  12   a - 12   d  will not pass through the aperture A in the cortical bone layer L, thereby securely anchoring the anchor members  12   a - 12   d  and the suture elements  40  and  50  to the bone B. The suture elements  40  and  50  may then be attached to other elements/structures so as to secure such elements/structures to the bone B, examples of which will be set forth below. 
     Referring to  FIG. 6 , shown therein is a suture anchoring system  100  according to another form of the present invention. The anchoring system  100  is generally comprised of a plurality of anchor members  112  and a number of suture elements  114 . As will be discussed in greater detail below, in one embodiment of the invention, the anchoring system  100  is configured for anchoring to either hard or soft biological tissue, with the suture elements  114  serving to attach another element or structure (either biological or non-biological) to the biological tissue. 
     In the illustrated embodiment of the invention, the anchor members  112  are configured identical to the anchor members  12  illustrated and described above with regard to the anchoring system  10 , with each anchor member  112  having a generally tubular configuration including a cylindrical wall  120  and defining an axial passage or channel  122  extending therethrough. However, it should be understood that other shapes and configurations of the anchor members  112  are also contemplated as falling within the scope of the present invention including, for example, a rectangular, triangular, polygonal or spherical configuration, or any other suitable shape or configuration. The anchor members  112  are preferably formed of a bio-compatible material. In one embodiment, the anchor members  112  are formed of metallic material such as stainless steel or a stainless steel alloy, titanium or a titanium alloy, a shape-memory alloy, or any other suitable metallic material. However, the use of other materials is also contemplated, including polymeric or ceramic materials, resorbable materials, bioabsorbable materials, or bone or bone substitute materials. 
     In the illustrated embodiment of the invention, the suture anchoring system  100  includes three anchor members  112   a ,  112   b  and  112   c  that are coupled together or interconnected to form an anchor assembly. However, it should be understood that the anchoring system  100  may include any number of anchor members  112 , including two or four or more anchor members. In one embodiment, the anchor members  112   a - 112   c  are coupled or interconnected to one another via a linking element  130 . In the illustrated embodiment, the linking element  130  comprises a suture extending through the axial passages  122  in each of the anchor members  112   a - 112   c  to link the anchor members  112   a - 112   c  together in series. The linking element  130  provides structural integrity to the anchoring system  100  by controlling the position and/or orientation of the anchor members  112   a - 112   c  relative to one another, the details of which will be discussed below. Additionally, the linking element  130  has a length l′ such that the anchor members  112   a - 112   c  may be axially separated or spaced from one another in a non-abutting manner, the purpose of which will become apparent below. 
     In the illustrated embodiment of the invention, the ends  130   a ,  130   b  of the linking element  130  are attached to one another so to define a continuous suture loop having a first end loop  132  extending from the outer anchor member  112   a  and a second end loop  134  extending from the outer anchor member  112   c . In the illustrated embodiment of the invention, the ends  130   a ,  130   b  are tied or knotted together to form the suture loop  130 . However, it should be understood that the ends  130   a ,  130   b  of the suture loop  130  may be attached to one another using other techniques such as, for example, via the use of a crimp or another type of coupling device, by fusing or splicing the ends  130   a ,  130   b  together, or by any other suitable method of attachment. It should also be understood that the linking element  130  need necessarily be configured as a loop, but may alternatively define a non-looped, single strand configuration. It should further be understood that the anchor members  112   a - 112   c  need not necessarily be coupled together or interconnected via a single suture element, but may alternatively be individually coupled together via a number of discrete suture elements. Additionally, it should be understood that the anchor members  112   a - 112   c  need not necessarily be coupled together by suture material, but may alternatively be coupled together using other elements and techniques such as, for example, via a number of pins, hinges, fittings, eyelets or any other suitable coupling device. 
     In the illustrated embodiment of the invention, the anchoring system  100  also includes an actuating element  140  that cooperates with the linking element  130  to selectively manipulate the position and/or orientation of one or more of the anchor members  112   a - 112   c . In the illustrated embodiment, the actuating element  140  comprises a suture that engages the end portions of the linking element  130  to selectively manipulate the position and/or orientation of one or more of the anchor members  112   a - 112   c . In a specific embodiment, the actuating element  140  extends through the end loops  132 ,  134  of the linking element  130  such that pulling the ends  140   a ,  140   b  of the actuating element  140  draws the outer anchor members  112   a ,  112   c  toward one another and transitions one or more of the anchor members  112   a - 112   c  to a different position and/or orientation, the details of which will be discussed below. Although the actuating element  140  is illustrated and described as being connected to the end loops of the linking element  130 , it should be understood that the actuating element  140  may be coupled to the outer anchor members  112   a ,  112   c  via other suitable techniques for drawing the outer anchor members  112   a ,  112   c  toward one another and for selectively transitioning one or more of the anchor members  112   a - 112   c  to a different position and/or orientation. For example, a full or partial loop element may be attached directly to the outer anchor members  112   a ,  112   c  through which the actuating element  140  extends. 
     Having illustrated and described the various elements and features associated with the suture anchoring system  100 , reference will now be made to a technique for engaging the anchoring system  100  to biological tissue such as, for example, to the bone B. However, as discussed above with regard to the anchoring system  10 , it should be understood that other applications of the anchoring system  100  are also contemplated, including anchoring to other bones or anatomic structures. Referring to  FIG. 7 , in one embodiment of the invention, the anchoring system  100  is delivered to the surgical site via the delivery instrument  200  illustrated and described above. The anchor members  112   a - 112   c  are initially positioned within the distal end portion of the cannula member  202  in an axially-aligned or linear configuration, with the axes of the anchor members  112   a - 112   c  generally aligned along the longitudinal axis  201 . The end portions  140   a ,  140   b  of the suture element  40  extend from the proximal end (not shown) of the cannula member  202  for subsequent manipulation by the surgeon. The distal end portion  202   a  of the cannula member  202  is positioned proximally adjacent the bone B, with the axial passageway  206  generally aligned with the aperture A extending into the cortical layer L. 
     Referring to  FIG. 8 , once the cannula member  202  is properly positioned relative to the aperture A, the inner rod member  204  is axially displaced in the direction of arrow  210  with the distal end  204   a  engaging the anchor member  112   c , which in turn displaces the anchor members  112   a - 112   c  through the axial passageway  206 . The inner rod member  204  is axially advanced in the direction of arrow  210  until the anchor members  112   a - 112   c  are deployed from the distal end  202   a  of cannula member  202  and into the cancellous region C of the bone B. As illustrated in  FIG. 8 , the depth of the aperture A in the cancellous region C is preferably sized so as to receive the axially-aligned anchor members  112   a - 112   c  therein. The rod member  204  may then be removed from the cannula member  202  or can remain in position until the anchoring process is completed to prevent the anchor members  112   a - 112   c  from passing back through the cortical layer L of the bone B. 
     Referring to  FIG. 9 , once the anchor members  112   a - 112   c  are deployed from the distal end of the cannula member  202  and properly positioned within the aperture A in the cancellous region C of the bone B, the anchor members  112   a - 112   c  are transitioned to a non-linear or expanded configuration. Such transitioning is effectuated by pulling the ends  140   a ,  140   b  of the actuating suture element  140  in a proximal direction to reconfigure the anchor members  112   a - 112   c  from the axially-aligned configuration illustrated in  FIG. 8  to the expanded configuration illustrated in  FIG. 9 . More specifically, since the suture element  140  extends through the end loops  132 ,  134  of the linking element  130 , pulling the suture element  140  in a proximal direction draws the outer anchor members  112   a ,  112   c  toward one another. As a result, the anchor members  112   a - 112   c  are repositioned/reoriented so as to define a generally triangular-shaped configuration, with the outer anchor members  112   a ,  112   c  being angled toward one another and with the inner anchor member  112   b  extending laterally between the outer anchor members  112   a ,  112   c.    
     As should be appreciated, the expanded configuration of the anchor members  112   a - 112   c  illustrated in  FIG. 9  is larger than the inner cross section of the aperture A extending through the outer cortical bone layer L. Accordingly, the expanded configuration of the anchor members  112   a - 112   c  will not pass through the aperture A in the cortical bone layer L, thereby securely anchoring the anchor members  112   a - 112   c  and the suture element  140  to the bone B. The suture element  140  may be attached to other elements/structures so as to secure such elements/structures to the bone B. 
     As should now be appreciated, the anchoring systems  10 ,  100  illustrated and described above may be anchored to either hard or soft biological tissue, with the suture elements  40 ,  50  and  140  being used to attach another element or structure to the biological tissue. In one embodiment of the invention, the anchoring systems  10 ,  100  may be used to provide a surgical anchor useful in the repair and/or replacement of ligaments, tendons or other types of tissues. In another embodiment of the invention, the anchoring systems  10 ,  100  may be used to provide a surgical anchor for holding a bone block in place in a tunnel formed in bone such that a piece of soft tissue attached to the bone block can be connected to the bone under tension. In yet another embodiment of the invention, the anchoring systems  10 ,  100  may be used to provide a surgical anchor that avoids or reduces the risks associated with severing, twisting or otherwise damaging material associated with soft tissue repair or replacement. In still another embodiment of the invention, the anchoring systems  10 ,  100  may be used to provide a surgical anchor that may be inserted into a tunnel formed in bone that avoids or reduces the likelihood of seriously damaging the surrounding bone material. In a further embodiment of the invention, the anchoring systems  10 ,  100  may be used to provide a surgical anchor that is adapted to secure material used in association with tissue repair or replacement in close proximity to bone in such a manner as to promote the formation or growth of a permanent attachment therebetween. In another embodiment of the invention, the anchoring systems  10 ,  100  may be used in association with a method for repairing and/or replacing ligaments, tendons or other types of tissues by coupling an end portion of such tissue (or its replacement) to a tunnel extending into or through a bone or a bone-like structure. 
     While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiments have been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected.