Patent Publication Number: US-2021177396-A1

Title: System and method for securing tissue to bone

Description:
RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 15/977,054 filed May 11, 2018, which is a divisional of U.S. application Ser. No. 14/111,523 filed on Oct. 11, 2013, which is a national stage entry of PCT/US2012/033392, filed on Apr. 12, 2012, and claims the benefit of and priority to U.S. Provisional Application No. 61/475,210, filed on Apr. 13, 2011, each of which is incorporated herein by reference in its respective entirety. 
    
    
     BACKGROUND OF THE INVENTION 
     Field of the Invention 
     The present invention relates to medical devices and procedures. More particularly, the present invention relates to devices and methods for securing soft tissue to a rigid material such as bone. 
     Description of the Related Art 
     There are several medical procedures where a surgeon needs to attach soft tissue such as tendons or other soft connective tissue to bone. One common example is a biceps tenodesis, a surgical procedure usually performed for the treatment of biceps tendonitis of the shoulder. A biceps tenodesis may be performed as an isolated procedure, but more often is part of a larger shoulder surgery such as a rotator cuff repair. 
     The biceps tendon connects the biceps muscle to the bone. The tendon passes from the muscle to the shoulder joint. Patients with biceps tendon problems may have a detachment of the biceps tendon from the radial tuberosity, for example, or they may have inflammation and irritation of the biceps tendon itself. Biceps tendon problems can also occur in conjunction with a rotator cuff tear. 
     A biceps tenodesis is a procedure that cuts the normal attachment of the biceps tendon on the shoulder socket and reattaches the tendon to the bone of the humerus (arm bone). By performing a biceps tenodesis, the pressure of the biceps attachment is taken off the cartilage rim of the shoulder socket (the labrum), and a portion of the biceps tendon can be surgically removed. Essentially a biceps tenodesis moves the attachment of the biceps tendon to a position that is out of the way of the shoulder joint. 
     To perform a biceps tenodesis repair, typically a surgical procedure is used and requires the multiple steps of externalizing the tendon, whip stitching it, threading suture through a tenodesis screw, drilling the necessary bone hole and anchor insertion via screwing it in. This is a difficult procedure arthroscopically. Systems recently brought to market still require multiple steps and tools. 
     Another common example is an anterior cruciate ligament repair, a surgical procedure usually performed for the treatment of the ligament of the knee. An ACL repair may be performed as an isolated procedure, but is often part of multiple-repair surgery. 
     SUMMARY OF THE INVENTION 
     Some embodiments relate to a tissue capture anchor for attaching tissue to bone. In some embodiments, the anchor can include, for example, an expandable anchor body and a spreader. In some embodiments, the spreader can be displaceable along an axis of the anchor body between a first position and a second position. The spreader can include, for example, a plurality of spikes that can engage with tissue and an angled portion that can expand the anchor body as the spreader is advanced from the first position to the second position. 
     In some aspects, the anchor body can further include, for example, an expandable tine and/or a plurality of expandable tines. In some embodiments, the spreader can expand the anchor body by deploying the plurality of expandable tines. 
     In some aspects, an outside surface of each tine can include at least two teeth, and in some aspects, an outside surface of the tines can include ridges or teeth which secure the anchor body within bone. In some aspects, the anchor body defines a central hole that can receive the proximal end of the spreader. In some aspects, an outside surface of the spreader can include, for example, a lateral protrusion, and the central hole of the anchor body can include indentations that can engage the lateral protrusion to inhibit movement of the proximal end of the spreader relative to the central hole. In some aspects, the inside surface of the central hole in the anchor body can include a groove and the proximal end of the spreader can include a ridge that can fixedly snap within the anchor body&#39;s groove. 
     In some embodiments, the anchor can be, for example, made of polyether-ether-ketone (PEEK). 
     In some aspects, one of the spikes can have a pointed end, can have a flat end, and/or can have a rounded end. In some aspects, the plurality of spikes can be, for example, four spikes, six spikes, twelve spikes, or any other desired number of spikes. 
     Some embodiments relate to a tissue capture anchor and inserter combination. In some embodiments, this combination can include, for example, an anchor, a handle, an outer tube coupled to the handle, an inner rod or tube positioned within the outer tube and coupled to the spreader, an actuator shaft positioned within the handle and coupled to the inner rod, and/or a deployment knob coupled to the handle and the actuator shaft and that can move the actuator shaft relative to the handle and the inner rod or tube relative to the outer tube. In some embodiments, the anchor can include, for example, an expandable anchor body and a spreader. In some embodiments, the spreader can be displaceable along an axis of the anchor body between a first position and a second position. The spreader can include, for example, a plurality of spikes that can engage with tissue and an angled portion that can expand the anchor body as the spreader is advanced from the first position to the second position. In some embodiments, the inserter tool can draw the spreader into the bone anchor to fully deploy the tissue capture anchor and secure tissue to the bone. 
     Some embodiments relate to a method of attaching soft tissue to bone. In some embodiments, the method can include, for example, engaging the soft tissue with a bone anchor, the anchor including, for example, a spreader having a tissue engaging element that can include a plurality of spikes, and an anchor body that can include expandable tines. In some embodiments, the method can include, for example, inserting the anchor and engaged tissue into the bone and deploying the anchor to secure it and the soft tissue in the bone. 
     In some aspects, the method can include, for example, making a clearance hole for the tissue capture anchor, which hole can be made, for example, in the bicipital groove and/or made inferior to the bicipital groove. In some aspects, the clearance hole can be sized to receive the anchor. 
     In some aspects, the method can include, for example, making a bone hole for the tissue capture anchor. In some embodiments, for example, the bone hole is made with a drill, with a reamer, and/or with the tip of the spreader. In some aspects, the method can include, for example, clearing the bone of any soft tissue in the region of the bone hole. In some aspects, the tendon can be, for example, folded around the anchor longitudinally. 
     In some aspects, deploying the anchor additionally can include, for example, expanding the anchor body to secure the tissue to the bone. In some aspects, the expandable tines can include teeth configured to engage the bone and/or the tissue can be secured without the use of sutures or knots. In some embodiments, the method can be arthroscopically conducted, and/or can be a sub-pectoral procedure. 
     In some aspects, engaging the tissue and inserting the anchor can include, for example, moving the anchor into the bone so as to capture the soft tissue into the bone. In some aspects, the soft tissue can be secured within the bone by forcing the anchor within the bone after the tissue has been engaged by the anchor and/or the tissue becomes secured within the tissue capture anchor once the anchor is deployed. 
     Some embodiments relate to a method of attaching soft tissue to bone in a sub-pectoral procedure. In some embodiments the method can include, for example, creating an incision on an inferior border of the pectoralis major muscle, engaging the soft tissue with a bone anchor through the incision, inserting the anchor and engaged tissue into the bone, and/or deploying the anchor to secure it and the soft tissue in the bone. In some embodiments, the anchor can include, for example, a spreader including a tissue engaging element and/or an anchor body including expandable tines. 
     In some aspects, the method can include, for example, making a clearance hole for the tissue capture anchor, which hole can be made, for example, inferior to the bicipital groove. In some aspects, the clearance hole can be sized to receive the anchor. 
     In some aspects, the method can include, for example, making a bone hole for the tissue capture anchor. In some embodiments, for example, the bone hole is made with a drill, with a reamer, and/or with the tip of the spreader. In some aspects, the method can include, for example, clearing the bone of any soft tissue in the region of the bone hole. In some aspects, the tendon can be, for example, folded around the anchor longitudinally. 
     In some aspects, deploying the anchor additionally can include, for example, expanding the anchor body to secure the tissue to the bone. In some aspects, the expandable tines can include teeth configured to engage the bone and/or the tissue can be secured without the use of sutures or knots. 
     In some aspects, engaging the tissue and inserting the anchor can include, for example, moving the anchor into the bone so as to capture the soft tissue into the bone. In some aspects, the soft tissue can be secured within the bone by forcing the anchor within the bone after the tissue has been engaged by the anchor and/or the tissue becomes secured within the tissue capture anchor once the anchor is deployed. 
     In some aspects, the tissue engaging element can include a single pointed tip, a suture loop, and/or a plurality of spikes. 
     The foregoing is a summary and thus contains, by necessity, simplifications, generalization, and omissions of detail; consequently, those skilled in the art will appreciate that the summary is illustrative only and is not intended to be in any way limiting. Other aspects, features, and advantages of the devices and/or processes and/or other subject matter described herein will become apparent in the teachings set forth herein. The summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1A  shows a side view of one embodiment of a tissue capture anchor in an undeployed or unexpanded state. 
         FIG. 1B  shows a perspective view of one embodiment of an undeployed tissue capture anchor. 
         FIG. 1C  shows a side view of one embodiment of a tissue capture anchor in the deployed or expanded state. 
         FIG. 1D  shows a perspective view of one embodiment of a tissue capture anchor in the deployed or expanded state. 
         FIG. 1E  shows another perspective view of one embodiment of a tissue capture anchor in the deployed or expanded state. 
         FIG. 1F  shows a side view of one embodiment of a tissue capture anchor in an undeployed or unexpanded state. 
         FIG. 1G  shows a perspective view of one embodiment of an undeployed tissue capture anchor. 
         FIG. 1H  shows a side view of one embodiment of a tissue capture anchor in the deployed or expanded state. 
         FIG. 1I  shows a perspective view of one embodiment of a tissue capture anchor in the deployed or expanded state. 
         FIG. 1J  shows another perspective view of one embodiment of a tissue capture anchor in the deployed or expanded state. 
         FIG. 2A  depicts a side view of one embodiment of an anchor body. 
         FIG. 2B  depicts a perspective view of one embodiment of an anchor body. 
         FIG. 2C  depicts another perspective proximal view of one embodiment of an anchor body. 
         FIG. 2D  depicts a perspective distal view of one embodiment of an anchor body. 
         FIGS. 2E and 2F  depict an alternate embodiment of an anchor body. 
         FIG. 3A  depicts a side view of one embodiment of a spreader. 
         FIG. 3B  depicts a perspective view of one embodiment of a spreader. 
         FIG. 3C  depicts a side view of an alternative embodiment of a spreader comprising a through-hole. 
         FIG. 3D  depicts a side view of one embodiment of a spreader. 
         FIG. 3E  depicts a perspective view of one embodiment of a spreader. 
         FIG. 3F  depicts another perspective view of one embodiment of a spreader. 
         FIG. 3G  illustrates a view of the distal face of one embodiment of a twelve-spike spreader. 
         FIG. 3H  illustrates a side perspective view of one embodiment of a four-spike spreader. 
         FIG. 3I  illustrates a perspective distal view of one embodiment of a six-spike spreader. 
         FIG. 3J  illustrates a side view of one embodiment of a six spike spreader. 
         FIG. 3K  illustrates a perspective proximal view of one embodiment of a six spike spreader. 
         FIG. 3L  shows a perspective view of one embodiment of a tissue capture anchor in the undeployed or unexpanded state. 
         FIG. 4  shows an exploded view of one embodiment of an inserter tool. 
         FIG. 5  shows a perspective view of one embodiment of an inner rod component of an insertion tool. 
         FIG. 6  shows a side view of one embodiment of an outer tube component of an insertion tool. 
         FIG. 7A  shows a side view of one embodiment of a handle component of an insertion tool. 
         FIG. 7B  shows a perspective view of one embodiment of a handle component of an insertion tool. 
         FIG. 8  shows one embodiment of an actuator shaft component of an insertion tool. 
         FIG. 9  shows one embodiment of a deployment knob component of an insertion tool. 
         FIG. 10  shows the coupled inserter tool and tissue capture anchor devices in an unexpanded or undeployed state. 
         FIG. 11  shows the coupled inserter tool and tissue capture anchor devices in an unexpanded or undeployed state. 
         FIG. 12  shows the coupled inserter tool and tissue capture anchor devices in an unexpanded or undeployed state. 
         FIG. 13A  shows a side view of one embodiment of a tissue capture anchor in an undeployed or unexpanded state. 
         FIG. 13B  shows a perspective view of one embodiment of an undeployed tissue capture anchor. 
         FIG. 13C  shows a side view of one embodiment of a tissue capture anchor in the deployed or expanded state. 
         FIG. 13D  shows a perspective view of one embodiment of a tissue capture anchor in the deployed or expanded state. 
         FIG. 13E  shows another perspective view of one embodiment of a tissue capture anchor in the deployed or expanded state. 
         FIG. 14A  depicts a side view of one embodiment of an anchor body. 
         FIG. 14B  depicts a perspective view of one embodiment of an anchor body. 
         FIG. 14C  depicts another perspective proximal view of one embodiment of an anchor body. 
         FIG. 14D  depicts a perspective distal view of one embodiment of an anchor body. 
         FIG. 15A  depicts a side view of one embodiment of a spreader. 
         FIG. 15B  depicts a perspective view of one embodiment of a spreader. 
         FIG. 15C  depicts a side view of an alternative embodiment of a spreader comprising a through-hole. 
         FIGS. 16A and 16B  show exploded views of one embodiment of an inserter tool. 
         FIG. 17A  is an anatomical illustration of an arm. 
         FIG. 17B  is an anatomical illustration of a shoulder. 
         FIG. 18A  shows the bicipital groove of the shoulder. 
         FIG. 18B  illustrates another example of the bicipital groove of the shoulder. 
         FIG. 19  illustrates one embodiment of an undeployed anchor inserted in a bone hole. 
         FIG. 20  illustrates one embodiment of a deployed anchor inserted in a bone hole. 
         FIG. 21  illustrates one embodiment of a deployed bone anchor. 
         FIG. 22A  illustrates a sub-pectoral method of attaching tendon to bone using the anchor described herein. 
         FIG. 22B  illustrates a sub-pectoral method of attaching tendon to bone using the anchor described herein. 
         FIG. 22C  illustrates a sub-pectoral method of attaching tendon to bone using the anchor described herein. 
         FIG. 22D  illustrates a sub-pectoral method of attaching tendon to bone using the anchor described herein. 
         FIG. 22E  illustrates a sub-pectoral method of attaching tendon to bone using the anchor described herein. 
         FIG. 22F  illustrates a sub-pectoral method of attaching tendon to bone using the anchor described herein. 
         FIG. 22G  illustrates a sub-pectoral method of attaching tendon to bone using the anchor described herein. 
         FIG. 22H  illustrates a sub-pectoral method of attaching tendon to bone using the anchor described herein. 
         FIG. 23A  illustrates an arthroscopic method of attaching tendon to bone using the anchor described herein. 
         FIG. 23B  illustrates an arthroscopic method of attaching tendon to bone using the anchor described herein. 
         FIG. 23C  illustrates an arthroscopic method of attaching tendon to bone using the anchor described herein. 
         FIG. 23D  illustrates an arthroscopic method of attaching tendon to bone using the anchor described herein. 
         FIG. 23E  illustrates an arthroscopic method of attaching tendon to bone using the anchor described herein. 
         FIG. 23F  illustrates an arthroscopic method of attaching tendon to bone using the anchor described herein. 
         FIG. 23G  illustrates an arthroscopic method of attaching tendon to bone using the anchor described herein. 
         FIG. 23H  illustrates an arthroscopic method of attaching tendon to bone using the anchor described herein. 
         FIG. 23I  illustrates an arthroscopic method of attaching tendon to bone using the anchor described herein. 
     
    
    
     DETAILED DESCRIPTION OF THE CERTAIN EMBODIMENTS 
     In various embodiments, soft tissue may be attached to bone utilizing one or more tissue capture anchors. In the following non-limiting examples elements  100   a  and  100   b  illustrate two embodiments of a bone anchor, and likewise elements  300   a  and  300   b  illustrate a spreader element of the bone anchors. In the following paragraphs, where element  100  is used, it is assumed that elements  100   a  and  100   b  are contemplated. Where element  300  is used, it is assumed that elements  300   a  and  300   b  are contemplated. The elements  300   a  and  300   b  or their corresponding anchor embodiments  100   a  and  100   b  are referenced specifically when pertinent. 
     In one non-limiting example illustrated in  FIGS. 1A-1E , a pointed tip is used to capture tissue. In another non-limiting example illustrated in  FIGS. 1F-1J , suture loop is used to capture tissue.  FIGS. 1A and 1F  depict a side view of a tissue capture anchor  100  comprising an anchor body  200  and a spreader  300 .  FIG. 1F  additionally comprises a suture loop  390 . The anchor body  200  is comprised of tines  220 . In some embodiments, the anchor body  200  may include teeth  230 , and in some embodiments, the anchor body  200  may not include teeth  230 .  FIGS. 1A-1E  depict embodiments of an anchor body including teeth  230 , and specifically including teeth  230  located on the tines  220 . The tines  220  expand from the distal end  210  of the anchor body  200  when the spreader  300  is engaged with the anchor body  200 . The proximal end of the spreader  300  is configured to fit into the distal end  202  of the anchor body  200 . In  FIGS. 1A and 1F , the tissue capture anchor  100  is in the undeployed, or unexpanded position. 
       FIGS. 1B and 1G  show a perspective view of the unexpanded tissue capture anchor  100 . In this embodiment, the spreader  300  is slightly inserted in the central hole  215  at the distal end of the anchor body  200 . 
       FIGS. 1C and 1H  show a side view of the tissue capture anchor  100  in the deployed or expanded position. In the deployed or expanded position, the spreader  300  has been drawn up into the anchor body  200  causing the tines  220  to expand from the distal end of the anchor body  200 . When deployed, the teeth  230  engage with the bone surface trapping tissue between the bone and the bone anchor  100 . 
     The inside surface of the anchor body  200  may comprise a grooved surface  225  to engage with the ridge  315  of the spreader  300  to lock the spreader  300  into place when the anchor body  200  is fully deployed. The grooved surface  225  is oriented such that the distal end of the spreader  300  can be easily moved in the proximal direction in central hole  215  of the anchor body  200  with the ridge  315  snapping into the groove  225  as the distal end is moved proximally. However, when the ridge  315  is snapped into groove  225 , proximal movement of distal end is inhibited. In some embodiments, the groove  225  can exist at different locations of the surface of the central hole or else even along substantially the entire surface of the central hole  215 . In some embodiments the anchor body  200  may be coupled to the spreader  300  in several positions. In other words, in one embodiment the spreader  300  need not be inserted into the anchor body  200  as far as it will go for it to be secured to the anchor body  200 . 
     Although a grooved surface is illustrated, it will be appreciated that other shapes are also contemplated, including multiple concentric grooves, a series of protruding ridges, or any other suitable structure that permits a spreader  300  to be securely locked within the central hole of the anchor body  200 . 
     With reference to  FIGS. 1D and 1I , which are each a perspective view of the top and side of anchor body  200  engaged with the spreader  300 , the top (proximal end) comprises a hole  215  in the center for receiving the spreader  200 . In some embodiments, the top surface  218  of the anchor body  200  may be textured such as with a scallop shape or grooves so as to inhibit movement of an insertion tool against the surface of the anchor body. 
     During deployment, the spreader  300  is drawn into the anchor body  200  causing the tines  220  to expand from the distal end of the anchor body  200 . Also during deployment, the spreader  300  is drawn into the anchor body  200  until the ridge  315  of the spreader  300  passes a groove  225  in the anchor body  200 . When the spreader passes this point, the ridge  330  and groove  225  engage or click and the spreader  300  is locked into place and the anchor body  200  cannot undeploy or reverse and the spreader  300  cannot reverse direction. 
       FIGS. 1E and 1J  each show a distal end view of the tissue capture anchor  100 . In this view the anchor body  200  is fully deployed. The spreader  300  is securedly fixed into the anchor body  200  and the ridge  315  and groove  225  of the anchor body  200  will keep the spreader  300  from being uninserted or reversed from the anchor body  200 . The tines  220  are fully expanded. Since the teeth  230  are facing the opposite direction from the view of  FIGS. 1E and 1J , only their edges are visible along the edges of the tines  220 . 
       FIGS. 2A-2D  depict an embodiment of an undeployed anchor body  200 .  FIG. 2A  depicts a side view of the anchor body  200 .  FIG. 2B  depicts a perspective view of an embodiment of the anchor body  200 .  FIG. 2C  depicts a view from the proximal end of the anchor body  200 , and  FIG. 2D  depicts a perspective view from the distal end of the anchor body  200 . The proximal end  210  of the undeployed anchor body  200  is generally cylindrical in shape with a diameter larger than distal end  202 . With reference to  FIGS. 2B-2D , a hole  215  may advantageously be provided in the center of proximal end  210 . With reference to  FIG. 2B , the bottom of distal end  202  also contains a hole  215 . Hole  215  comprises a central opening that extends through the anchor body  200 . In some embodiments the anchor body  200  comprises a groove  225  in its inner surface, as shown in  FIGS. 2C-2D . Thus, the inner surface of the anchor body  200  is not flat. In some embodiments, some or all of these surfaces may be textured such as with a scallop shape or grooves so as to inhibit movement of spreader  300  once it is withdrawn into the anchor body. In some embodiments, texturing in the inner surfaces of anchor body  200  matches texturing in the outer surfaces of the spreader  300 . It will be appreciated that the illustrated embodiments represent only one possibility; thus, other shapes for the surface of proximal end  210  may also be used. 
     The distal end  202  of the anchor body  200  is configured to receive the spreader  300 . Hole  215  in anchor body  200  is an opening into a central (“axial”) bore into and through the anchor body  200 . The sides of the opening preferably include a groove for engaging with the spreader  300 . It will be appreciated that other methods of securing the spreader  300  within the anchor body  200  may be used, such as a frictional fit or threading. 
     The anchor body  200  is comprised of tines  220  which spread outwardly when engaged with the spreader  200 . The tines  220  engage with the bone fixedly securing the anchor body  200  in the bone. The tines comprise a number of teeth  230  which further engage with the tissue and bone in the deployed tissue capture anchor  100 . The number of tines  220  and teeth  230  can vary. In one embodiment, there are four tines  200  with five teeth  230  per tine  220 . The proximal end  210  of the anchor body  200  is configured to receive an inserter component, which is inserted through the hole  215  in the center of the anchor body  200  and is coupled with a spreader  300 . 
     The distal end  202  of the anchor body  200  may advantageously be tapered to facilitate insertion of the anchor body  200  into bone. The anchor body  200  has at its widest point, a diameter not larger than the widest point of the spreader  300 . 
       FIGS. 2E and 2F  depict an alternate embodiment of an anchor body  200 . In this embodiment, the anchor body also comprises webbed portions  250  across the distal ends of the tines  230 . These webs  250  are easily broken when the spreader  300  is engaged with the anchor body  200 . The webs  250  protect against premature deployment of the anchor upon insertion into the bone by keeping the tines  220  intact until they are expanded via the spreader  300 . 
       FIGS. 3A-3C  depict one embodiment of a spreader  300   a  with a pointed tip.  FIGS. 3D-3F  depict another embodiment of a spreader  300   b  with a flat face and comprising a suture loop.  FIGS. 3G-3L  depict yet another embodiment of a spreader  300   b  with a flat face comprising spikes protruding from the face. 
       FIG. 3A  shows a side view of an embodiment of the spreader  300   a .  FIG. 3B  shows a perspective view of the spreader  300   a . The spreader  300   a  comprises a generally cone-shaped  320  pointed distal end  302  and a proximal end  307  with a means for receiving an insertion tool  325 , a central body  310 , a ridge  315  and a narrow section  318 . The distal end  302  further comprises a tip  305  for engaging the tissue. The proximal end  307  is configured for coupling with an inserter. For instance, in this embodiment, the proximal end  307  of the spreader  300   a  comprises a hole  325  that receives the inserter tool for coupling. 
     The spreader  300   a  further comprises central body  310  which gradually widens from the proximal end and forms a ridge  315  before it narrows again  318  and joins with proximal end of the tip  305 . The distal end  302  is generally cone shaped  320 , meaning that it gradually widens in a conical shape until it fits with the central body  310  at the site of the ridge  318 . In some embodiments, the ridge  315  may be slightly undercut  322  which may result in a stronger lock in the bone when then the anchor is fully deployed. 
     The tip  305  of the spreader  300   a  can be sharp and configured to spear or stab tissue and drag it into a bone hole before the tissue capture anchor  100  is deployed. 
     The spreader  300   a  is configured to be drawn into the distal end of the anchor body  200  via all insertion tool. As the tissue capture anchor  100  is deployed, the spreader  300  is further advanced into the anchor body  200 , spreading the tines  220  of the anchor body  200  until the ridge  315  of the spreader  300   a  engages the groove  225  in the inside of the anchor body  200  at which point it locks into place. In one embodiment, the ridge  315  is undercut  322  providing even more security for reversing. 
     In another embodiment, the spreader  300   a  further comprises a hole  325  that extends longitudinally through the spreader  300   a  to the distal end. In this embodiment, the tip of the spreader  305  is open to allow the insertion tool to extend through the spreader  300   a . In some embodiments, the tip of the insertion tool will be pointed and/or sharp to assist in spearing tissue. 
     In one alternative embodiment, the spreader  300   a  comprises a transverse through-hole configured to receive soft tissue.  FIG. 3C  depicts a side view of a spreader  300   a  having the through-hole  395 . In this embodiment, tissue is captured by the anchor by threading one or more tissue bundles (for example, single or double bundles of tendon) through the through-hole  395 . When the anchor with threaded tissue bundles is inserted into bone, the tissue will follow a serpentine path along the sides of the anchor, through the through-hole  395 , and back out of the bone. In these embodiments, tissue may be captured by only threading through the through-hole  395  or also by piercing with the tip  305  of the spreader  300  (for example, piercing of other bundles of soft tissue). 
     In some embodiments, the entire anchor may be enlarged to accommodate a suitably sized through-hole  395  in the spreader  300   a . In one non-limiting embodiment, an 8 mm diameter anchor with a 4 mm diameter through-hole  395  is used. In one embodiment, the through-hole is approximately 6 mm in diameter. Other sizes of through hole are contemplated. 
       FIG. 3D  shows a side view of an embodiment of the spreader  300   b .  FIG. 3E  shows a perspective distal view of the spreader  300   b , and  FIG. 3F  shows a perspective proximal view. The spreader  300   b  comprises a generally flat face at distal end  17  and a proximal end  307  with a means for receiving an insertion tool  325 , a central body  310 , and a ridge  315 . The distal end  302  further comprises two holes  305   a  and  305   b  for receiving the limbs of a suture loop  390 . The proximal end  307  is configured for coupling with an inserter. For instance, in this embodiment, the proximal end  307  of the spreader  300   b  comprises a hole  325  that receives the inserter tool. 
     The spreader  300   b  further comprises central body  310  which gradually widens from the proximal end and forms a ridge  315  around the face  317 . The spreader  300   b  comprises a tube shaped base  310  at the proximal end  307  with a axial bore  325  for receiving sutures  390  and an insertion tool, a generally conical shaped spreader at the distal end which is wider than the proximal end, and an optional ridge  315  at the tip of the distal end. The distal end can further comprise a flat area around the axial bore  325 . The proximal end  307  is configured for receiving sutures and coupling with an inserter. For instance, in this embodiment, the proximal end  307  of the spreader  300   b  comprises a hole  325  that receives the inserter tool for coupling and sutures  390 . 
     The spreader  300   b  comprises the base section which joins with the gradually expanding distal spreader end  302 . The distal end is generally  310 , meaning that it gradually widens in a conical shape from the base section to the distal end of the spreader  300   b , which comprises a flat area  317  and through which the axial bore  325  extends into two openings  305   a ,  305   b . In one embodiment, the distal end may also comprise a ridge  315 , which may optionally be slightly undercut  322  to result in a stronger lock in the bone anchor when the anchor is fully deployed. 
     The axial bore  325  may be used to receive sutures (see  FIGS. 1 f   - 1 J). In one embodiment, a loop of suture is secured through the axial bore  325  such that a loop of suture extends from the spreader for use in a surgical procedure. The distal end of the spreader  300   b  comprises two openings  305   a ,  305   b  to the axial bore  325  through which the suture loop  390  extends. The resulting length of suture extends from the proximal end of the spreader through the axial bore  325  and through to the distal end where it is threaded through hole  305   a  and then back through  305   b  and back through the proximal end, forming a loop. The suture loop  390  extending through the distal end of the spreader  300   b  is freely slidable, for example, such that it can be moved or adjusted back through the axial bore  325 . 
     The spreader  300   b  is configured to be drawn into the distal end of the anchor body  200  via an insertion tool. As the tissue capture anchor  100  is deployed, the spreader  300   b  is further advanced into the anchor body  200 , spreading the tines  220  of the anchor body  200  until the ridge  315  of the spreader  300   b  engages the groove  225  in the inside of the anchor body  200  at which point it locks into place. In one embodiment, the ridge  315  is undercut  322  providing even more security against reversing. 
     As discussed above, the tines  220  in the anchor may be in a low-profile streamlined position prior to insertion into bone. A spreader  300   b  is used after insertion to expand the tines  220  such that their teeth  225  engage bone. The spreader  300   b  may comprise any suitable shape configured to be inserted through the axial bore  215  in the anchor body  200  and make contact with the tines  225 . The spreader  300   b  may be at least partially positioned within the axial bore of the anchor prior to tine expansion as depicted in  FIG. 1G . As the spreader  300   b  is moved from a first lower position to a second upper position, the proximal end of the spreader  300   b  is designed to spread or force the tines  220  from a first low-profile position (for example, an internal lateral position) to a second external lateral position. In one embodiment, the proximal end of the spreader  300   b  may have ridges to assist in preventing slippage or mis-alignment. 
     The spreader  300   b  will remain in the anchor with the tines  220  in their fully spread position. The force provided by the tines&#39;  220  interaction with the bone keeps the spreader  300   b  tightly engaged. Further protection against slipping or tilting of the spreader  300   b  is provided by the optionally ridged sides of the spreader  300   b . In one embodiment, the spreader  300   b  may have ridges or indentations to assist in a tight fit such that accidental slipping or adjustments are minimized. In one embodiment, one or more of the tines  220  have an indentation on a side facing the central axis of the anchor. A ridge on the spreader can then engage the indentation, thereby stabilizing the spreader  300   b  and preventing the spreader  300   b  from being advanced too far into the anchor. In an alternative embodiment, the spreader comprises an indentation (for example, an indentation in a ridge on the spreader  300   b ) that can engage with a protrusion on a side of a tine facing the central axis of the anchor. In addition to stabilizing the spreader  300   b  and preventing over insertion, this feature also prevents rotation of the spreader  300   b  relative to the anchor. 
     In this embodiment, tissue is captured by the anchor by threading one or more tissue bundles (for example, single or double bundles of tendon) through the suture loop  390 . The suture loop is tightened around the tendon such that the tendon is secured to the face  317  of the spreader  300   b . Securing the tissue can be accomplished by pulling or advancing the suture loop so that it secured the tissue to the anchor  100 . When the anchor with threaded tissue bundles is inserted into bone, the tissue is held in place at the distal end of the spreader and will be held secure against the sides of the bone hole and further secured by the expanded tines, as described herein, along the sides of the anchor, and back out of the bone. In these embodiments, tissue may be captured by only threading through the suture loop  390 . In some embodiments, the suture loop may additionally comprise a knot on the end. 
       FIGS. 3G and 3H  show perspective views of the twelve and four spike embodiments of the spreader  300   c . As shown, outside surface of the spreader can include, for example, a lateral protrusion  310 ′, and the central hole  215  of the anchor body can include indentations  215 ′ (see  FIG. 2D ) that can engage the lateral protrusion to inhibit movement of the proximal end of the spreader relative to the central hole  215 .  FIG. 3I  shows a perspective view of a six-spike spreader and  FIG. 3J  shows a side view of a six-spike spreader. In these embodiments, and as specifically seen in  FIG. 3J , the spreader  300   c  comprises a generally flat-shaped face  317  at the distal end  302  and a proximal end  307  with a means for receiving an insertion tool  325 , a central body  310  and a ridge  315 . The distal end  302  further comprises spikes  319  for engaging the tissue. In this embodiment, the distal end comprises six spikes. In other embodiments, the tip can comprise from two to twelve spikes, as is practicable. The proximal end  307  is configured for coupling with an inserter. For instance, in this embodiment, the proximal end  307  of the spreader  300   c  comprises a hole  325  that receives the inserter tool for coupling. 
     The spreader  300   c  further comprises central body  310  which gradually widens from the proximal end to the distal end of the spreader  300   c , which comprises a flat area  317  and spikes  319 . In one embodiment, the distal end may also comprise a ridge  315 , which may optionally be slightly undercut  322  to result in a stronger lock in the bone anchor when the anchor is fully deployed. 
     The spikes  319  of the spreader  300   c  can be sharp and configured to spear or stab tissue and drag it into a bone hole before the tissue capture anchor  100  is deployed. In other embodiments, the distal end of the spikes can be flat or rounded. 
     The spreader  300   c  is configured to be drawn into the distal end of the anchor body  200  via an insertion tool. As the tissue capture anchor  100  is deployed, the spreader  300   c  is further advanced into the anchor body  200 , spreading the tines  220  of the anchor body  200  until the ridge  315  of the spreader  300   c  engages the groove  225  in the inside of the anchor body  200  at which point it locks into place. In one embodiment, the ridge  315  is undercut  322  providing even more security against reversing. 
     As discussed above with regard to embodiments  300   a  and  300   b , the tines  220  in the anchor may be in a low-profile streamlined position prior to insertion into bone. A spreader  300   c  is used after insertion to expand the tines  220  such that their teeth  225  engage bone. The spreader  300   c  may comprise any suitable shape configured to be inserted through the axial bore  215  in the anchor body  200  and make contact with the tines  225 . The spreader  300   c  may be at least partially positioned within the axial bore of the anchor prior to tine expansion as depicted in  FIG. 3K . As the spreader  300   c  is moved from a first lower position to a second upper position, the proximal end of the spreader  300   c  is designed to spread or force the tines  220  from a first low-profile position (for example, an internal lateral position) to a second external lateral position. In one embodiment, the proximal end of the spreader  300   c  may have ridges to assist in preventing slippage or mis-alignment. 
     As in the afore-mentioned embodiments, the spreader  300   c  will remain in the anchor with the tines  220  in their fully spread position. The force provided by the tines&#39;  220  interaction with the bone keeps the spreader  300   c  tightly engaged. Further protection against slipping or tilting of the spreader  300   c  is provided by the optionally ridged sides of the spreader  300   c . In one embodiment, the spreader  300   c  may have ridges or indentations to assist in a tight fit such that accidental slipping or adjustments are minimized. In one embodiment, one or more of the tines  220  have an indentation on a side facing the central axis of the anchor. A ridge on the spreader can then engage the indentation, thereby stabilizing the spreader  300   c  and preventing the spreader  300   c  from being advanced too far into the anchor. In an alternative embodiment, the spreader comprises an indentation (for example, an indentation in a ridge on the spreader  300   c ) that can engage with a protrusion on a side of a tine facing the central axis of the anchor. In addition to stabilizing the spreader  300   c  and preventing over insertion, this feature also prevents rotation of the spreader  300   c  relative to the anchor. 
     In this embodiment, tissue is captured by the anchor by capturing tissue (for example, single or double bundles of tendon) via the spikes on the face of the spreader. Securing the tissue can be accomplished by a spearing, stabbing, pushing or other method of securing the tissue to the anchor  100  and within the bone hole. When the tissue is engaged with the spikes  319  of the spreader and the anchor, the tissue bundles are inserted into bone and the tissue is held in place at the distal end of the spreader and will be held secure against the sides of the bone hole and further secured by the expanded tines, as described herein, along the sides of the anchor, and back out of the bone. 
     In one embodiment, the tissue capture anchor  100  is made entirely of a biocompatible engineering plastic such as polyether-ether-ketone (PEEK). Other embodiments include a tissue capture anchor entirely or in part of a non-metallic substance that is biocompatible. Biocompatible materials such as poly ether ketone (PEK), polyetherimide (ULTEM), ultrahigh molecular weight polyethylene (UHMPE), polyphenylene, or some other engineering polymer materials known to those of skill in the art may be used. A non-metallic anchor system may provide certain advantages such as, for example, eliminating MRI artifacts. 
       FIG. 4  depicts individual components of an inserter tool. The inserter tool comprises an inner rod or tube  500 , an outer tube  600 , a handle body  700 , a threaded actuator shaft  800 , and a deployment knob  900 . In some embodiments, the inserter  400  is coupled to the tissue capture anchor  100  during manufacturing. In one embodiment, the inserter tool is disposable. 
     The inserter tool  400  is designed to insert and manipulate a tissue capture anchor such the tissue capture anchor  100  described in  FIGS. 1A, 1B , IF and  1 G. In some embodiments, the tissue capture anchor  100  is manufactured to be attached to inserter tool before packaging. In other embodiments, the tissue capture anchor is coupled to the inserter tool prior to insertion. In a basic configuration, the inserter tool is assembled as follows: the inserter tool  400  is configured such that the inner rod  500  is disposed within the outer tube  600 . The outer tube is configured to fit against the proximal end of the stabilizer. The inner rod  500  extends through outer tube  600  and is configured to attach to the spreader  300  via threading on both the proximal hole in the spreader  300  and threading on the distal end of the inner rod  500 . The proximal end of the outer tube  600  is connected to a handle  700  and the inner rod  500  extends through the proximal end of the outer tube  600  and screws into the threaded actuator shaft  800 . The actuator shaft  800  extends just past the proximal end of the handle  700  where it is configured to secure with a deployment knob  900 . 
     The individual components of the inserter tool are further described in detail below. 
       FIG. 5  shows a perspective view and a side view of an embodiment of the inner rod  500 , respectively. In some embodiments, the inner rod is an inner tube. The inner rod comprises a distal end configured to secure to the spreader  300 , a proximal end which is configured to interact with the other components of the inserter, for instance the actuator shaft  800 . The inner rod  500  is configured that a proximal end is advanced through the outer tube  600  and into the handle  700  where it is further secured within the actuator shaft  800  via threading. The distal end of the inner rod  500  is configured to be advanced through the central hole in the anchor body  200  and then secured to the spreader  300  until the tissue capture anchor  100  is fully deployed and the inner rod  500  is separated from the anchor  200 . 
     The inner rod  500  extends through the central hole  225  in the anchor body  200  before coupling with the spreader  300 . In one embodiment, the inner rod  500  couples with the spreader  300  through threads on the end of the inner rod  500  and within the proximal end of the spreader  300 . In other embodiments, the inner rod  500  may couple to the spreader  300  through other securing mechanisms such as adhesives, welding or frictional fit. 
       FIG. 6  shows an embodiment of the outer tube  600 . The outer tube  600  is attached at its proximal end  605  to the distal end of handle  700  via threading  625 . The distal end  610  of the outer tube  600  is configured such that the inner rod  500  is drawn into the outer tube  600  and through the distal end  610  of outer tube  600  where it is secured to the spreader  300 . When the inner tube  500  is advanced far enough that the spreader  300  locks into place or cannot advance anymore, the outer tube  600  distal surface is surface-to-surface with the proximal surface of the anchor body  200 . When the inner rod  500  withdraws further into the outer tube upon the continued rotation of the deployment knob and advancement of the actuator shaft, the inner rod  500  strips the threading from the spreader  300  and the inserter tool  400  detaches from the anchor. 
       FIGS. 7A and 7B  show embodiments of a handle body  700 .  FIG. 7A  is a cut-away view of the handle body  700 . The proximal end of the handle  700  is configured to receive the deployment knob  900  via the ridges  730  which hold the knob  900  secure. The actuator shaft  800  is housed within the handle body  700 . A set of flat brackets or braces  710  secure the actuator shaft  800  within the handle  700 . The distal end of the handle is configured to receive the outer tube  600  via threads  625  at opening  750 . The outer tube  600  is permanently affixed to the handle  700  at its distal end. 
       FIG. 7B  depicts a cross-sectional view of one embodiment of a handle  700 . In  FIG. 7B  the flat surface  715  of the bracket  710  is shown. 
       FIG. 8  depicts the threaded actuator shaft  800 . The actuator shaft  800  is comprised of a distal end  805  comprising a threaded hole  810  which is configured to receive the inner rod  500 , a second threaded portion  825  on the body of the shaft configured to advance the inner rod  500 , and a proximal end  820  configured to secure within the deployment knob  900 . The threading  825  of the actuator  800  has two flat areas  830 , one on each side, where there is no threading. These flat areas  830  fit within the flat brackets  710  of the handle such that the actuator  800  cannot rotate within the handle. 
     The body of the actuator shaft  800  is configured with threading  825  to permit the shaft  800  to advance the inner tube  500 . In some embodiments, the body of the actuator shaft  800  can comprise a variety of shapes and sizes. In some embodiments, the body of the actuator shaft  800  can have a round, ovular, rectangular, triangular, octagonal, or any other desired cross-section. In some embodiments, the body of the actuator shaft can comprise a variety of cross-sectional shapes. In some embodiments, the actuator shaft  800  can be round with flat portions.  FIG. 8  depicts an embodiment in which the body of the actuator shaft  800  is round with flat sides  830  that are fit into the handle body  700  in such a way that the actuator shaft  800  cannot itself rotate when the deployment knob  900  is turned and the shaft  800  advances via knob  900 . Thus, the threads do not go all the way around the shaft but rather flatten out on the flattened sides of the shaft. The actuator shaft is configured as a coaxial system. That is, the spreader  300 , inner tube  500  and actuator  800  are configured to operate as one piece. The flat brackets  710  in the handle make the actuator shaft  800  stay on plane such that the actuator shaft  800  itself cannot rotate within the handle  700 . The proximal end of the inner tube  500  couples with the distal end of the actuator shaft  800  via threading. 
     Moving to  FIG. 9 , a deployment knob  900  is shown. The deployment knob  900  comprises a central hole  910  which is configured with threading  905 , and a groove  930  configured to be received by a corresponding ridge  730  of the handle  700 . The threading  905  in the central hole  910  is configured to receive the actuator shaft  800 . The deployment knob  900  is configured to advance, relative to the deployment knob  900 , the inner rod  500  via the actuator shaft  800 . The actuator shaft  800  is joined at its proximal end to the distal end of the deployment knob  900  via threading  905  in the central hole  910 . The actuator shaft  800  is attached to the inner rod  500  by way of the proximal end of the inner rod  500  advancing into the distal end of the actuator shaft via threading so that when the deployment knob  900  is rotated, the mechanism of the shaft  800  advances the inner rod  500  proximally such that the spreader  300  is then advanced into the anchor body  200  to expand the anchor body  200  into bone and secure the tissue capture anchor  100 . 
     In one embodiment, the deployment knob  900  is threaded  905  to receive the actuator shaft via the groove  930  of knob  900  fitting with the proximal end ridge  730  of the handle body  700 . As the deployment handle is turned, the actuator shaft  800  is advanced in a proximal direction until the anchor body  200  is deployed and locked into place. 
       FIGS. 10-11  show a tissue capture anchor  100  coupled to the inserter tool  400 . The tissue capture anchor  100  comprises the anchor body  200  and the spreader  300 . The inserter tool  400 , as shown, includes the outer tube  600 , the handle  800  and the deployment knob  900 . The inner rod  500  is positioned within the outer tube  600 , and the outer tube is flush with the anchor body  200 . The outer tube  600  may hold the anchor body  200  steady during insertion and deployment. The inner rod  500  extends through the anchor body  200  and couples with the spreader  300  via threading. The spreader  300  is configured to be advanced through the distal end of the anchor body  200  by the inner rod  500  via a rotating the deployment knob  900 . 
     In another embodiment, the inner rod  500  extends through the spreader  300  which is configured such that the central hole  325  extends through the spreader tip  305 . The inner rod  500  is configured with a sharp, pointed tip such that the tip of the inner rod  500  spears or captures tissue to secure into the bone hole before the anchor body  200  is fully deployed. 
     The inner rod  500  provides the mechanism to draw the spreader  300  into the central hole  225  in the anchor body  200  to fully expand the anchor body  200 . During deployment of the tissue capture anchor  100 , the inner rod  500  is continually advanced via a screwing motion until the spreader locks with the anchor body. As the deployment knob  900  continues to turn and the inner rod  500  continues to pull on the threads of the spreader  300 , the inner rod  500  strips the threads from the inside of the spreader  300  and the insertion tool  400  releases from the anchor body  200 . Any thread shavings are contained within the outer tube  600 . 
       FIG. 12  illustrates an exploded view of the anchor  100  and the inserter  400 . The tissue capture anchor  100  comprises the anchor body  200  and the spreader  300 . The inserter tool  400 , as shown, includes the outer tube  600 , the handle  800  and the deployment knob  900 . The inner rod  500  is positioned within the outer tube  600 , and the outer tube is flush with the anchor body  200 . The outer tube  600  may hold the anchor body  200  steady during insertion and deployment. The inner rod  500  extends through the anchor body  200  and couples with the spreader  300  via threading. The spreader  300  is configured to be advanced through the distal end of the anchor body  200  by the inner rod  500  via a rotating the deployment knob  900 . 
     The inner rod  500  provides the mechanism to draw the spreader  300  into the central hole  225  in the anchor body  200  to fully expand the anchor body  200 . During deployment of the tissue capture anchor  100 , the inner rod  500  is continually advanced via a screwing motion until the spreader locks with the anchor body. As the deployment knob  900  continues to turn and the inner rod  500  continues to pull on the threads of the spreader  300 , the inner rod  500  strips the threads from the inside of the spreader  300  and the insertion tool  400  releases from the anchor body  200 . Any thread shavings are contained within the outer tube  600 . Once the anchor is deployed, the sutures are then removed via pulling them free or else cut at the top of the anchor. 
     In some embodiments, a pre-attached delivery handle is provided. In some embodiments, the insertion tool or delivery handle is disposable. In other embodiments, the insertion tool can be sterilized, reloaded and reused. 
     Those of skill in the art will appreciate other inserters and mechanisms that may be used to insert and deploy the tissue capture anchor  100  described herein. 
     Although a particular inserter device for inserting and manipulating tissue capture anchor  100  has been described, it should be understood that other inserter designs may be used for manipulating the parts of tissue capture anchor  100  described above to insert the anchor into bone and tissue to the bone. For example, it may be possible to use separate tools for inserting the anchor and deploying the anchor. 
     It will be appreciated that there are numerous combinations of anchors and their placement that may be used to secure soft tissue to bone by the methods and devices described herein. These variations as well as variations in the design of the above described anchor devices and inserter devices are within the scope of the present disclosure. 
     Tissue Capture Anchor with Flat Sides and Suture Loop 
     In another embodiment, anchors as described herein are used for anterior cruciate ligament (ACL) repair. In one embodiment, a femoral tunnel is drilled in the femur. One or two bundles of tendon are then fed through the suture loop  1390  of the spreader  1300 . The anchor  1000  is then inserted into the bone and deployed as discussed below. 
     In various embodiments, soft tissue may be attached to bone utilizing one or more tissue capture anchors. In one non-limiting example, depicted in  FIGS. 13A-13E , a suture loop is coupled to the distal end of the anchor.  FIG. 13A  depicts a side view of a tissue capture anchor  1000  comprising an anchor body  1200 , a spreader  1300 , and a suture loop  1390 . The anchor body  1200  is comprised of tines  1220  and one or more teeth  1230 . The tines  1220  expand from the distal end of the anchor body  1200  when the spreader  1300  is engaged with the anchor body  1200 . The proximal end of the spreader  1300  is configured to fit around the outside of the proximal end  1202  of the anchor body  1200 . In  FIG. 13A , the tissue capture anchor  1000  is in the undeployed, or unexpanded position. 
       FIG. 13B  shows a perspective view of the unexpanded tissue capture anchor  1000 . In this embodiment, the anchor body  1200  is slightly inserted in the central hole  1215  at the proximal end of the spreader  1300 . 
       FIG. 13C  shows a side view of the tissue capture anchor  1000  in the deployed or expanded position. In the deployed or expanded position, the spreader  1300  has been drawn up in between the tine  1220  causing them to expand from the distal end of the anchor body  1200  through openings in the spreader  1300 . When deployed, the one or more teeth  1230  engage with the bone surface trapping tissue between the bone and the bone anchor  1000 . 
     The distal end of the anchor body  1200  may comprise a grooved surface  1225  to engage with the ridge  1325  of the spreader  1300  to lock the spreader  1300  into place when the anchor body  1200  is fully deployed. The grooved surface  1225  is oriented such that the distal end of the spreader  1300  can be easily moved in the proximal direction in between the tines  1230 . The spreader  1300  fits over the proximal end of the anchor body  1200 , via the central hole  1315  of the spreader  1300  with the ridge  1325  snapping into the groove  1225  as the distal end of the spreader  1300  is moved proximally. However, when the ridge  1325  is snapped into groove  1225 , proximal movement of distal end is inhibited. In some embodiments, the groove  1225  can exist at different locations of the surface of the central hole or else even along substantially the entire surface of the central hole  1215 . In some embodiments the anchor body  1200  may be coupled to the spreader  1300  in several positions. In other words, in one embodiment the spreader  300  need not be inserted over the anchor body  1200  as far as it will go for it to be secured to the anchor body  1200 . 
     It will be appreciated that other shapes are also contemplated, including multiple concentric grooves, a series of protruding ridges, or any other suitable structure that permits an anchor  1200  to be securely locked within the central hole of the spreader  1300 . 
     With reference to  FIG. 13D , which is a perspective view of the top and side of anchor body  1200  engaged with the spreader  1300 , the top (proximal end) of the spreader  1300  comprises a hole  1315  in the center for receiving the anchor body  1200 . In some embodiments, the top surface  1318  of the spreader  1300  may be textured such as with a scallop shape or grooves so as to inhibit movement of an insertion tool against the surface of the spreader. 
     During deployment, the spreader  1300  is drawn proximally in between the tines  1230  causing them to expand from the distal end of the anchor body  1200 . Also during deployment, the spreader  1300  is drawn proximally until the ridge  1325  of the spreader  1300  passes a groove  1225  in the anchor body  1200 . When the spreader passes this point, the ridge  1325  and groove  1225  engage or click and the spreader  1300  is locked into place and the anchor body  1200  cannot undeploy or reverse and the spreader  1300  cannot reverse direction. 
       FIG. 13E  shows a distal end view of the tissue capture anchor  1000 . In this view the anchor body  1200  is fully deployed. The spreader  1300  is securedly fixed between the tines  1230  and the ridge  1325  and groove  1225  of the anchor body  1200  will keep the spreader  1300  from being uninserted or reversed from the anchor body  1200 . The tines  1220  are fully expanded. Since the teeth  1230  are facing the opposite direction from the view of  FIG. 13E , only their edges are visible along the edges of the tines  1220 . 
       FIGS. 14A-14D  depict an embodiment of an undeployed anchor body  1200 .  FIG. 14A  depicts a side view of the anchor body  1200 .  FIG. 14B  depicts a perspective view of an embodiment of the anchor body  1200 .  FIG. 14C  depicts a view from the proximal end, or base, of the anchor body  1200 , and  FIG. 14D  depicts a perspective view from the distal end, or tines, of the anchor body  1200 . The proximal end of the undeployed anchor body  1200  is generally comprised of a slightly rectangular shaped structure which is flat on at least two sides. The anchor body  1200  tapers distally into at least two tines. The anchor body  1200  generally comprises a shape complementary with the spreader, with flat sides and with a diameter larger than distal end  1202 . In some embodiments, the proximal end of the anchor body is rounded. In other embodiments, the proximal end of the anchor body is rectangular. With reference to  FIGS. 14B-14D , a hole  1215  may advantageously be provided in the center of proximal end  1210 . With reference to  FIG. 14B , the bottom of distal end  1202  includes two tines  1200 , or projections which originate from about half to a third of the way distally from the proximal end of the bone anchor  1200 . At the point where the tines begin to project from the proximal end of the anchor body, is the other end of hole  1215 . Central hole  1215  comprises a central opening that extends through the anchor body  1200 . In some embodiments the anchor body  1200  comprises a groove  1225  in its inner surface, as shown in  FIGS. 14C-14D . Thus, the inner surface of the anchor body  1200  is not flat. In some embodiments, some or all of these surfaces may be textured such as with a scallop shape or grooves so as to inhibit movement of the wedge portion  1399  of spreader  1300  once it is withdrawn into the anchor body. In some embodiments, texturing in the outer surfaces of anchor body  1200  matches texturing in the inner surfaces of the spreader  1300 . It will be appreciated that the illustrated embodiments represent only one possibility; thus, other shapes for the surface of proximal end  1210  may also be used. 
     During assembly, the distal end  1202  of the anchor body  1200  is configured to be received within the proximal end of spreader  1300 . Hole  1215  in anchor body  1200  is an opening into a central (“axial”) bore into and through the proximal end of the anchor body  1200 . 
     The sides of the tines  1220  preferably include a groove for engaging with the spreader  1300 . It will be appreciated that other methods of securing the wedge portion  1399  of the spreader  1300  within the anchor body  1200  may be used, such as a frictional fit or threading. 
     The anchor body  1200  is comprised of one or more tines  1220  which spread outwardly when engaged with the spreader  1200 . In one embodiment shown in these figures, there are two tines. The tines  1220  engage with the bone, fixedly securing the anchor body  1200  in the bone. The tines comprise a number of teeth  1230  which further engage with the tissue and bone in the deployed tissue capture anchor  1000 . The number of tines  1220  and teeth  1230  can vary. In one embodiment, there are two tines  1200  with one tooth  1230  per tine  1220 . The proximal end  1210  of the anchor body  1200  is configured to receive an inserter component, which is inserted through the hole  1215  in the center of the anchor body  1200  and is coupled with a spreader  1300 . In one embodiment, the spreader is attached and deployed as disclosed above. 
       FIG. 15A  shows a side view of an embodiment of the spreader  1300 .  FIG. 15B  shows a perspective view of the spreader  1300 . The spreader  1300  comprises a generally inwardly curved face at distal end  1317  and a proximal end  1307  comprising an axial bore  1315  for receiving an insertion tool  400 , a central body  1310 , a triangular-shaped expander portion  1399 , and a ridge  1325 . The distal end  1302  further comprises two holes  1305   a  and  1305   b  for receiving a suture loop  1390 . The proximal end of the wedge  1399  is configured for coupling with an inserter. In one embodiment, the inserter used is as described above. For instance, in this embodiment, the proximal end  1307  of the spreader  1300  comprises a hole  1315  that receives the inserter tool for coupling. 
     The distal end  1302  of the spreader  1300  may advantageously be tapered to facilitate insertion of the spreader  1300  into bone. 
     The spreader  1300  further comprises central body  1310  which gradually narrows from the proximal end. The distal portion of the spreader forms a ridge (or groove)  1325  just proximal to the curved face at distal end  1317 . The distal end  1302  of spreader  1300  comprises axial bores  1305   a  and  1305   b  for receiving sutures  1390  and axial bore  1315  which optionally receives an insertion tool. The distal end comprises a rounded area  1317  for securing tissue in place. The proximal end  1307  is configured for coupling with an anchor body  1200  and optionally receives an inserter. For instance, in this embodiment, the proximal end  1307  of the spreader  1300  comprises a hole  1315  that receives the anchor body  1200 . In one embodiment, sutures  1390  are received into one of holes  1305   a  and  1305   b  from a location exterior to the inserter, looped, threaded into the other of holes  1305   a  and  1305   b  and returned along the exterior of the insertion tool to the proximal end of the insertion tool where the surgeon can secure the sutures  1390 . 
     The spreader  1300  comprises a proximal section comprising a hole for receiving the bone anchor  1200 . The spreader  1300  comprises a distal section which further comprises a wedge  1399  at the interior distal end of the spreader. This distal portion of the spreader including the wedge-shaped portion  1399  is configured to fit between the tines  1220  of the anchor and advance the tines outward as the insertion tool deploys the anchor  1000 . 
     In one embodiment, a loop of suture is secured through the axial bores  1305   a  and  1305   b  from a location exterior to the insertion tool such that a loop of suture extends from the spreader for use in a surgical procedure. The distal end of the spreader  1300  comprises two openings  1305   a ,  1305   b  through which the suture loop  1390  extends. The resulting length of suture extends from the proximal end of the inserter tool  400  to the distal end where the suture  1390  is threaded through hole  1305   a  forms a loop, and then back through  1305   b  and extending once again to the proximal end of the insertion tool. The suture loop  1390  extending through the distal end of the spreader  1300  is freely slidable, for example, such that it can be moved or adjusted back through the holes  1305   a  and  1305   b . In one alternate embodiment, the axial bore  1315  may be used to receive sutures. 
     The spreader  1300  is configured to be drawn in between the tines  1220  via an insertion tool. As the tissue capture anchor  1000  is deployed, the spreader  1300  is advanced, such that the wedge shaped portion  1399  of spreader  1300  is advanced between the tines  1220  of the distal end of anchor body  1200 , spreading the tines  1220  of the anchor body  1200  until the ridge  1325  of the spreader  1300  engages the groove  1225  in the inside of the anchor body  1200  at which point it locks into place. In one embodiment, the ridge  1325  is undercut  1322  providing even more security for reversing. 
     As discussed above, the tines  1220  in the anchor may be in a low-profile streamlined position prior to insertion into bone. A spreader  1300  is used after insertion to expand the tines  1220  such that their one or more teeth  1225  engage bone. The wedge portion  1399  of the spreader  1300  may comprise any suitable shape configured to be inserted through the axial bore  1215  in the anchor body  1200  and make contact with the tines  1220 . The wedge portion  1399  of the spreader  1300  may be at least partially positioned within the axial bore of the bone anchor prior to tine expansion as depicted in  FIG. 13B . As the spreader  1300  is moved from a first lower position to a second upper position, the proximal end of the wedge  1399  of spreader  1300  is designed to spread or force the tines  1220  from a first low-profile position (for example, an internal lateral position) to a second external lateral position. In one embodiment, the proximal end of the spreader  1300  may have ridges to assist in preventing slippage or mis-alignment. 
     The spreader  1300  will remain in a locked position with the anchor body  1200  with the tines  1220  in their fully spread position. The force provided by the tines&#39;  1220  expansion and compression interaction with the bone walls keeps the spreader  1300  tightly engaged. Further protection against slipping or tilting of the spreader  1300  is provided by the optionally ridged sides of the spreader  1300 . In one embodiment, the spreader  1300  may have ridges or indentations to assist in a tight fit such that accidental slipping or adjustments are minimized. In one embodiment, one or more of the tines  1220  have an indentation on a side facing the central axis of the anchor. A ridge on the spreader can then engage the indentation, thereby stabilizing the spreader  1300  and preventing the spreader  1300  from being advanced too far into the anchor. In an alternative embodiment, the spreader comprises an indentation (for example, an indentation in a ridge on the spreader  1300 ) that can engage with a protrusion on a side of a tine facing the central axis of the anchor. In addition, to stabilizing the spreader  1300  and preventing over insertion, this feature also prevents rotation of the spreader  1300  relative to the anchor. 
     In this embodiment, tissue is captured by the anchor by threading one or more tissue bundles (for example, single or double bundles of tendon) through the suture loop  1390 . The suture loop is secured around the tendon such that the tendon is secured to or within the curved portion  1317  of the spreader  1300 . When the anchor with threaded tissue bundles is inserted into bone, the tissue is held into place at the distal end of the spreader and will be held secure against the sides of the bone hole and further secured by the expanded tines, as described herein, along the sides of the anchor, and back out of the bone. In these embodiments, tissue may be captured by only threading through the suture loop  1390 . 
     In the embodiment, the tissue capture anchor  1000  is made entirely of a biocompatible engineering plastic such as polyether-ether-ketone (PEEK). Other embodiments include a tissue capture anchor entirely or in part of a non-metallic substance that is biocompatible. Biocompatible materials such as poly ether ketone (PEK), polyetherimide (ULTEM), ultrahigh molecular weight polyethylene (UHMPE), polyphenylene, or some other engineering polymer materials known to those of skill in the art may be used. A non-metallic anchor system may provide certain advantages such as, for example, eliminating MRI artifacts. 
     The inserter tool shown in  FIG. 4  depicts individual components of an inserter tool used in conjunction with the anchor  1000 . The inserter tool comprises an inner rod or tube  500 , an outer tube  600 , a handle body  700 , a threaded actuator shaft  800 , and a deployment knob  900 . In some embodiments, the inserter  400  is coupled to the tissue capture anchor  1000  during manufacturing. In one embodiment, the inserter tool is disposable. 
     The inserter tool  400  is designed to insert and manipulate a tissue capture anchor such the tissue capture anchor  1000  described in  FIG. 13A  and  FIG. 13B . In some embodiments, the tissue capture anchor  1000  is manufactured to be attached to the inserter tool before packaging. In other embodiments, the tissue capture anchor is coupled to the inserter tool prior to insertion. In a basic configuration, the inserter tool is assembled as follows: the inserter tool  400  is configured such that the inner rod  500  is disposed within the outer tube  600 . The outer tube is configured to fit against the proximal end of the anchor body  1300 . The inner rod  500  extends through outer tube  600  and is configured to attach to the spreader  300  via threading within the hole in the spreader  300  and threading on the distal end of the inner rod  500 . The proximal end of the outer tube  600  is connected to a handle  700  and the inner rod  500  extends through the proximal end of the outer tube  600  and screws into the threaded actuator shaft  800 . The actuator shaft  800  extends just past the proximal end of the handle  700  where it is configured to secure with a deployment knob  900 . Suture  390  is threaded through the around the cleat in the handle and is permitted to freely extend down the exterior of the outer tube to the distal end of the spreader where it is threaded through holes  1305   a  and  1305   b  forming a loop and extending back up the length of the outer tube to the proximal end of the inserter tool. In some embodiments, the suture  1390  is wound around the cleat on the handle. 
     The individual components of the inserter tool are described above, and illustrated in  FIGS. 5-9 . 
       FIG. 16A  shows an exploded view of the tissue capture anchor and the inserter.  FIG. 16B  shows a tissue capture anchor  1000  coupled to the inserter tool  400 . The tissue capture anchor  1000  comprises the anchor body  1200  and the spreader  1300 . The inserter tool  400 , as shown, includes the outer tube  600 , the handle  800  and the deployment knob  900 . The inner rod  500  is positioned within the outer tube  600 , and the outer tube is flush with the anchor body  1200 . The outer tube  600  may hold the anchor body  1200  steady during insertion and deployment. The inner rod  500  extends through the anchor body  1200  and couples with the spreader  1300  via threading. The spreader  1300  is configured to be advanced through the distal end of the anchor body  1200  by the inner rod  500  via rotating the deployment knob  900 . 
     The inner rod  500  provides the mechanism to draw the spreader  1300  into the central hole  1225  in the anchor body  1200  to fully expand the anchor body  1200 . During deployment of the tissue capture anchor  1000 , the inner rod  500  is continually advanced via a screwing motion until the spreader locks with the anchor body. As the deployment knob  900  continues to turn and the inner rod  500  continues to pull on the threads of the spreader  1300 , the inner rod  500  strips the threads from the inside of the spreader  1300  and the insertion tool  400  releases from the anchor body  1200 . Any thread shavings are contained within the outer tube  600 . 
     In some embodiments, a pre-attached delivery handle is provided. In some embodiments, the insertion tool or delivery handle is disposable. In other embodiments, the insertion tool can be sterilized, reloaded and reused. 
     Those of skill in the art will appreciate other inserters and mechanisms that may be used to insert and deploy the tissue capture anchors  100  and  1000  described herein. 
     Although a particular inserter device for inserting and manipulating tissue capture anchors  100  and  1000  have been described, it should be understood that other inserter designs may be used for manipulating the parts of tissue capture anchors  100  and  1000  described above to insert the anchor into bone and tissue to the bone. For example, it may be possible to use separate tools for inserting the anchor and securing tissue capture anchor. 
     It will be appreciated that there are numerous combinations of anchors and their placement that may be used to secure soft tissue to bone by the methods and devices described herein. These variations as well as variations in the design of the above described anchor devices and inserter devices are within the scope of the present disclosure. 
     Methods of Attaching Soft Tissue to Bone 
     Various embodiments include methods for attaching soft tissue to bone. In some embodiments, the methods include using the tissue capture anchors described above. In one embodiment, a biceps tenodesis procedure is performed arthroscopically. In other embodiments, the biceps tenodesis procedure is performed sub-pectorally. 
       FIGS. 17A and 17B  depict illustrations of the anatomy of the biceps and the anatomy of the shoulder.  FIG. 17A  is an anatomical illustration of an arm  1700 . The arm  1700  includes the shoulder  1702 , the upper arm  1704 , and the lower arm  1706 .  FIG. 17A  further illustrates the biceps  1708  which includes the biceps muscle  1710  and the biceps tendon  1712 . As depicted in  FIG. 17A , the biceps muscle  1710  is in the front of the upper arm  1704  and helps with bending the elbow and rotating the arm  1700 , and also helps keep the shoulder  1702  stable. The biceps  1708  works mostly at the elbow to cause flexion of the elbow, which occurs during a curling motion, for example, during a curl as in weightlifting or when lifting anything upward towards the face. The biceps  1708  is unique because it attaches to the radius bone across the elbow and also attaches through two heads to the humerus and the scapula. Thus, it crosses both the shoulder and the elbow. 
       FIG. 17B  is an illustration of the anatomy of the shoulder  1702 , and illustrates the biceps tendon  1712 . The biceps tendon  1712  has a long head  1714  and a short head  1716 .  FIG. 17B  further illustrates the humerous  1718  and the glenoid socket  1720  of the shoulder  1702 . The long head  1714  of the biceps tendon runs in a groove at the top of the humerus  1718 , and it sits almost 90 degrees over the humeral head before it attaches to the top of the glenoid socket  1720 . It attaches to the glenoid socket  1720  through the labrum, which is anchoring point composed of cartilage. The labrum attachment is analogous to a cleat on a dock around which a rope (biceps tendon  1712 ) would attach. The long head  1714  of the biceps tendon  1712  is more likely to be injured. This is because it is vulnerable as it travels through the shoulder joint to its attachment point in the glenoid socket  1712 . Fortunately, the biceps tendon  1712  has two attachments at the shoulder  1702 . 
     Considerations for a biceps tendon repair include achieving the proper tension, fixation strength and minimal disruption of the tendon. The procedures described in this disclosure advantageously are simple, fast, optimize tendon to bone interface, afford adequate initial fixation strength, maintain the appropriate length tension relationship of the biceps tendon  1712  during rehab until healing occurs and minimize tendon fiber disruption. The methods and procedures described herein also advantageously allow suture to be captured within the surgical site without the tendon having to be removed from the site, or body. Additionally, after the anchor is inserted but not deployed, if the tension needs to be adjusted, the surgeon can remove the anchor and reposition or change the tissue capture location and then reinsert the anchor. In one embodiment, after the anchor is inserted, the tissue is positioned along one side of the anchor, underneath the distal end of the anchor, and then up along the other side of the anchor. (For example, see  FIGS. 21, 23E , F, G, H, I). Thus, in some embodiments, the tissue wraps approximately 180 degrees in an axial direction around the anchor. This can be achieved due to the fact that the anchor does not require rotation to secure it in place. 
     Generally one of two types of surgeries is performed using the anchors disclosed herein, arthroscopic and open surgery. Concerns taken into consideration when choosing a method include a reluctance to exteriorize the tendon, difficulty in whip stitching or securing the stitching, and evidence suggesting that sub pectoral placement is a better location for the repair. 
     Recent studies have favored sub pectoral methods for several reasons: efficient and reproducible method with an easy learning curve, with no violation of muscle tendon units and preservation of soft tissue; the relevant anatomy is clearly identified, and the length-tension of proximal biceps tendon  1712  can be reproduced; this technique removes the tendon from the confines of the intertubercular groove, a region lined with synovium and a (which may be cause of persistent pain) possible source of continued tenosynovitis and pain; and tenodesis in a distal location free from synovium and residual tendon disease. 
     The anchor  100  and inserter tool  400  described herein are intended for the reattachment of ligament, tendon, or soft tissue to bone for at least the following indications or conditions of the shoulder: Bankart lesion repairs, SLAP lesion repairs, acromio-clavicular separation repairs, rotator cuff repairs, capsular shift or capsulolabral reconstructions, biceps tenodesis, deltoid repairs. 
     A biceps tenodesis is a procedure that cuts the normal attachment of the biceps tendon  1712  on the glenoid socket  1720  and reattaches the tendon to the bone of the humerus  1718  (arm bone). By performing a biceps tenodesis, the pressure of the biceps attachment is taken off the cartilage rim of the glenoid socket  1720  (the labrum), and a portion of the biceps tendon  1712  can be surgically removed. Essentially a biceps tenodesis moves the attachment of the biceps tendon  1712  to a position that is out of the way of the shoulder joint. 
     A biceps tenodesis is often, but not always, performed in patients with significant biceps tendon symptoms, and evidence at the time of arthroscopy of biceps tendon inflammation or tears. 
     The procedure using a tissue capture anchor described herein merely requires drilling the bone hole and capturing the tendon with the anchor and dragging the tendon into the bone hole. In some embodiments, a further advantage when using an awl to make the bone hole is that the whole procedure can be percutaneous. The advantages of tenodesis over suture anchors include less time, more accuracy and easy positioning, lower cost, and healing on top of the bone versus healing inside the bone. 
     In one example method, the procedure is performed arthroscopically. In one embodiment, a 6 mm PEEK tissue capture anchor is used, although different sizes and materials may be used. In some instances the hole into which the tissue capture anchor will be inserted is made by making a clearance hole for the anchor in the superior portion of the bicipital groove  1105  using a drill bit or suitably sized awl. In one embodiment, the hole is made by the spreader  300  tip after the spreader  300  captures the tissue to be secured. The hole may also be made in any other suitable position depending on pathology of the tendon, etc.  FIGS. 18A and 18B  show different views of the bicipital groove and surrounding bone of the shoulder and biceps. The bicipital groove is a furrow on the upper part of the humerus occupied by the long head of the biceps and is also called the intertubercular groove. In some embodiments a 7 mm drill bit is used; however in other embodiments, a different sized drill bit can be used. In one embodiment, the clearance hole can range from 5 mm wide to 9 mm wide. In other embodiments, the size of the clearance hole will vary, as the size depends on the size of the anchor. Depending on the softness of the bone and the size of the anchor, the hole can be from 8 mm-22 mm deep. For example, in one embodiment, a 6 mm tissue capture anchor is used, and for soft bone, the hole can be at least 11 mm deep. For average bone, the hole can be approximately 10-12 mm deep. For very soft bone, the hole can be approximately 20 mm. 
       FIGS. 19-21  depict one method of using an anchor to secure a tendon to a bone. In this method, the implantation site is cleared of any soft tissue in the region of the bone hole using a bur or other suitable means. When the hole in the bone is pre-drilled, the hole is advantageously drilled with a diameter smaller than the diameter of anchor body  200  and spreader  300  so that the tines can engage the bone through the sides of the hole. Angled protrusions or teeth may be used that provide greater resistance to removal of the anchor body  200  than to insertion.  FIG. 19  shows one embodiment of the insertion of a tendon  1900  and anchor  100  into a bone  1902 . As shown in  FIG. 19 , the tendon  1900  will then be captured by the anchor  100  and forced into the clearance hole. As shown in  FIG. 20 , the anchor  100  is deployed in the clearance hole in the bone  1902 . As shown in  FIG. 21 , the tendon  1900  is essentially folded around the anchor  100  longitudinally resulting in a double surface contact. As described above, the tendon  1900  may be captured using a variety of methods including spearing with the anchor  100  of  FIG. 1A , threading tissue through the through-hole in the anchor of  FIG. 3C , threading tissue through the suture loop in the anchors of  FIGS. 1G and 13C , and engaging with a plurality of spikes  319  shown in  FIG. 3J . 
     In one nonlimiting embodiment, the shoulder preparation is as that used by Richards and Bruthkhart (“A Biomechanical Analysis of Two Biceps Tenodesis Fixation Techniques” Arthoscopy. The Journal OF Arthroscopic and Related Surgery Vol. 21, No 7 (July), 2005: pp 861-866) which is incorporated by herein by reference in its entirety. The shoulder will undergo soft tissue dissection to the level of the rotator cuff. At this point, the surpraspinatus tendon insertion is reflected by sharp dissection and the long head biceps tendon inspected for any evidence of pathology. The tendon of the LHB is then sharply incised, freeing from its intra-articular origin at the superior aspect of the glenoid as well as dividing it as the musculotendinous junction so that the biceps tendon is a free segment. In other embodiments, other methods of shoulder preparation are used. 
     Repairs are complete by drilling a clearance hole for the anchor in the superior portion of the bicipital groove using a standard drill bit. As shown in  FIGS. 19-21 , the tendon will then be captured by the anchor and forced in to the clearance hole and the anchor placed to capture the tendon. The tendon will be essentially folded around the anchor longitudinally, resulting in a double surface contact. The proximal surface of the anchor will be situated flush with the cortical surface. 
     Sub-Pectoral Method 
     One embodiment is a sub-pectoral approach. In preparation, the patient&#39;s neck can be positioned to avoid extremes of flexion and extension. The patient can be positioned laterally, with either a bean bag or a wedge in the lateral position, or in a beach chair position, as is normally for an arthroscopy procedure. The patient&#39;s arm, shoulder, and axilla should be prepped and draped to allow changes in arm position during the procedure. 
     The incision can be made by performing a tenotomy at the base of the biceps insertion with either a skinny biter or arthroscopic scissors. The biceps tendon does not have to be tagged or marked at this time. 
     At this point, the arthroscopic portion of the procedure is complete, and the patient can be taken out of balanced suspension. The arm can be abducted and externally rotated to allow access to the anterior aspect of the axilla (it is helpful to airplane the bed towards the surgeon). The arm can also be placed on a padded mayo stand. Abducting the arm puts the pectoral major muscle tension to help better determine placement of the incision. An incision cut of approximately 3-4 cm can be made beginning at the superior aspect of the axillary fold and running laterally along the medical edge of the biceps muscle. The incision  2200  can be centered on the inferior border of the pectoralis major muscle through the subcutaneous tissue and exposing the fascia of the inferior muscular border of the pectoralis major muscle and the short head of the biceps. ( FIG. 22A ). 
     The plane between the pectoralis and short head biceps muscle can be bluntly developed. Dissecting scissors can be used to open the fascia of the short head of the biceps on the lateral most aspect of the muscle. Once adequately opened, blunt dissection can be made down to the long head of the biceps tendon  1712  (LHB) and intertubercular groove (bicipital groove) which will lie reliably deep and lateral to the short head muscle belly. A Homan retractor can be placed subperiosteally, laterally and medially around the humerus. 
     Care should be taken to avoid excessive medical retraction which may place the musculocutaneous nerve at risk. The tendon should be at the base of the humerus between retractors. The LHB will have a thin layer of fascial tissue overlying it. Internal and external rotation of the arm to palpate the bicipital groove to assist in identifying the tendon may be helpful. A curved hemostat  2202  can be used to hook the biceps tendon  1712  and remove it from the groove to bring it into the incision  2200 . ( FIG. 22B ). 
     The superior border of the pectoralis major insertion, which marks the level for the tenodesis can be identified at about 1-2 cm distal to the base of the bicipital groove. In one embodiment, electrocautery can be used to remove the soft tissue overlying the humerus in this area. 
     Preparation of the biceps tenodesis site includes drilling a guide pin into the humerus at the appropriate position just inferior to the bicipital groove with a either a 7 or 8 mm reamer over the guide pin and drilling an unicortical socket through the anterior cortex of the humerus to a depth of 20 mm. The size of the reamer will depend on the diameter of the tendon. Penetration of the posterior cortex of the humerus should be avoided. The reamer and guide pin can then be removed. In one embodiment, an electrocautery device or ronguer can be used to remove any soft tissue from the surrounding edge of the socket which will also help facilitate insertion of the implant. 
     Applying tension can have the effect of centering the tendon over the socket and can generally corresponds to a position approximately 1-2 cm proximal to the musculotendinous junction. Appropriate tension can be applied to reproduce normal tendon tension and biceps contour. In one embodiment, fully extending the arm will help to determine the appropriate position at which the tendon will enter the socket. This area can be marked on the tendon  1712  with a marking pen  2204 . ( FIG. 22C ). In other embodiments, the location of the mark can be determined based on a known length of the anchor due to the fact that the tendon will be secured to the distal end of anchor. 
     Insertion and delivery of the anchor/implant can be accomplished by placing the tendon through the loop of suture extending from the anchor and aligning it with the mark previously placed on the tendon. In one embodiment, this should be about 1-2 cm just above the musculotendinous junction. Tension can be applied to the suture loop  390  and/or the suture forming the suture loop  390  can be pulled on and secured in the handle cleat, thereby engaging the tendon  1712 . ( FIG. 22D ). During implant insertion the same axial direction as the previously drilled socket should be maintained. ( FIGS. 22C and 22E ). 
     The implant can be positioned into place until the depth marker  2206  on the delivery handle is flush with the surrounding humeral cortex  2208 . In one embodiment, it may be beneficial to slightly tap on the end of the delivery device with a mallet if the biceps tendon  1712  is large and bulbous. ( FIG. 22E ). 
     To deploy the anchor, the deployment knob  900  is turned clockwise which deploys the anchor (also referred to as an implant) and disengages the delivery shaft from the anchor/implant. As the knob is turning, increased resistance occurs. ( FIG. 22F ). The deployment knob  900  should continue to turn until an audible snap occurs. ( FIG. 22G ). The audible snap indicates the implant has disengaged from the delivery handle. The delivery handle can now be removed and deployment is complete. ( FIG. 22H  showing the incision  220  and the competed deployment). At this time, the sliding suture may be removed by simply pulling on the suture. Alternatively, multiple half-hitches can be tied to back up the tenodesis procedure. 
     Closure may be done by using a knife to remove any excess tendon by cutting the remaining proximal tendon from the superior aspect of the tunnel as it exits the implant tunnel interface. The wound is irrigated and the retractors are removed, allowing the pectoralis major to cover the tenodesis site. The wound is closed by using a standard layered closure of both subcutaneous and skin layers. 
     Arthroscopic Method 
     Another embodiment includes a surgical method for Arthroscopic Biceps Tenodesis. In this method, the patient is placed in either the lateral decubitus or beach chair position. Standard anatomical shoulder landmarks can be outlined. 
     Portals and preparation for arthroscopic repair can then be made. Through standard arthroscopic portals, glenohumeral joint pathology are addressed prior to performing biceps tenodesis. If required, rotator cuff repair can be performed after tenodesis to facilitate biceps tendon visualization. Using a percutaneous device, the biceps tendon  1712  can be tagged with a lasso stitch  2302  and then the biceps tendon  1712  can be detached from its superior labral attachment. ( FIG. 23A .). Using needle localization, an anterior-lateral portal  2304  perpendicular to the intertubercular groove between the anterior supraspinatus and the superior subscapularis tendons is established. ( FIG. 23B ). In some embodiments, a posterior portal  2306  and/or a lateral portal  2308  can also be established. With the arthroscope in the posterior portal  2306  or anterior-lateral portal  2304 , the interval tissue over the intertubercular groove is excised, exposing the biceps tendon. Care should be taken not to damage rotator cuff (if intact) or the suture controlling the biceps tendon  1712 . 
     Preparation of the biceps tenodesis site is done by detaching the biceps tendon  1712  about 1 cm proximal to the tagging suture  2302  and allowing the biceps tendon  1712  to retract slightly to expose the proximal intertubercular groove. Electrocautery can be used to remove the soft tissue overlying the humerus  1718  in this area.  FIG. 23C  shows the biceps tendon  1712  and the tagging suture  2302 . A humeral socket  2310  approximately 30 mm deep ( FIG. 23C ) can be created using a standard 7.0 mm or 8.0 mm cannulated reamer over a guide pin. 
       FIG. 23D  shows the biceps tendon  1712 , the tagging suture  2302 , the anchor  100 , and the humeral socket  2310 . The anchor  100  is inserted through the anterior-lateral cannula. Using the anchor&#39;s  100  conical tip and the tagging suture  2302 , the biceps tendon  1712  is manipulated with the desired tension over the center of the humeral socket  2310 . ( FIG. 23D ). 
     The tension on the biceps tendon  1712  should be released (whether using a grasper or tagging suture  2302 ) when pushing the biceps tendon  1712  into the prepared humeral socket  2310  to allow it to slide into the humeral socket  2310  more easily. The anchor  100  can be driven into place until the surface of humerus cortical bone is even with the black laser marking  2312 .  FIG. 23E , which shows the biceps tendon  1712 , the tagging suture  2302 , the anchor  100 , and the humeral socket  2310 ). Once at the depth of the laser mark  2312 , the anchor  100  is ready for deployment. 
     Deployment/disengagement: of the anchor  100 , or implant, is accomplished by turning the deployment knob of the inserter clockwise to deploy the implant and to disengage the delivery shaft from the implant. ( FIG. 23F , which shows the biceps tendon  1712 , the tagging suture  2302 , the anchor  100 , the humeral socket  2310 , and the marking  2312 ). As the deployment knob is turning, resistance increases. The deployment knob  900  should be turned until an audible snap is heard. ( FIG. 23G ). The audible snap indicates the implant has disengaged from the delivery handle. 
     The delivery handle can now be removed and deployment is complete. ( FIG. 23H , which shows the biceps tendon  1712 , the tagging suture  2302 , the anchor  100 , the humeral socket  2310 , and the marking  2312 ). Once the anchor  100  is completely installed, the elbow is flexed and extended to confirm a stable fixation of the biceps tendon  1712 . Excess tendon, including the tagging suture  2302 , is trimmed. ( FIG. 23I , which shows the biceps tendon  1712 , the anchor  100 , and the humeral socket  2310 ). Standard closing procedures can be used. 
     In another embodiment, anchors as described below are used for anterior cruciate ligament (ACL) repair. In this embodiment, a femoral tunnel is drilled in the bone. One or two bundles of hamstring tendon are captured by the anchor. The anchor is then inserted into the bone and deployed as discussed above. As described above, the tendon may be captured using a variety of methods including spearing with the anchor of  FIG. 1A , threading tissue through the through-hole in the anchor of  FIG. 3C , and threading tissue through the suture loop in the anchors of  FIGS. 1G and 13C . 
     The bone anchor is made of any acceptable material. In one embodiment, the anchor is made of PEEK. The procedure using the PEEK tissue capture anchor merely requires drilling the bone hole and “capturing” the tendon within the suture loop of the anchor, dragging the tendon into the bone hole. In some embodiments, the tendon is captured using a spear tip. In one embodiment, the suture loop is used to capture and secure the tendon. In some embodiments, a further advantage when using an awl to make the bone hole is that the whole procedure can be percutaneous. 
     In one embodiment, a hole is drilled in to the bone at a diameter of about 9 mm. The anchor is positioned such that a grasper tool can be implemented to grasp a tendon through the suture loop and secure the suture around the tendon. The tendon can then be manipulated and moved or positioned. In one embodiment, a double bundle of tendons is inserted into a single bone tunnel in the femur. In one embodiment, a gracilis and a semitendinosus tendon are both doubled over for insertion into the bone hole. The anchor, which, in one embodiment may be about 8 mm or 9 mm in diameter, is inserted into the bone hole with the doubled over tendons. Due to the size of the hole, the anchor, which may be 8 or 9 mm in diameter is inserted with the doubled over tendons draped over its tip into the hole. The anchor is also suited for single bundle single tunnel and single bundle double tunnel procedures. In other embodiments, the bone hole and the anchor can be difference sizes as needed. 
     In one embodiment, the surgeon drills through the tibia and up into the femur and loads the anchor plus tendons through the tibial tunnel. In one embodiment, an anteromedial portal is used to drill the femoral tunnel and a separate tibial tunnel. 
     It will be appreciated by those of skill in the art that the tissue capture anchors  100  and  1000  and inserter tool  400  provide a system for easy attachment of a tendon or tissue to bone. The anchors  100  or  1000  may be inserted into bone with minimal disruption of surrounding tissue. Only an access route having the diameter of the outer tube  704  and the anchor body  200  is required. Furthermore, the anchor can be securely attached to the bone without having to insert additional instrumentation into the site or without performing any cumbersome attachment maneuvers such as knot tying. 
     Although the invention has been described with reference to embodiments and examples, it should be understood that numerous and various modifications can be made without departing from the spirit of the invention. Accordingly, the invention is limited only by the following claims.