Patent Publication Number: US-2023136876-A1

Title: Anchor insertion systems for a winged bone anchor having a driving core

Description:
PRIORITY CLAIM 
     This application claims priority to U.S. Provisional Pat. Application No. 63/272,970 filed on Oct. 28, 2021, the entire contents of which are hereby incorporated by reference and relied upon. 
    
    
     BACKGROUND 
     Bone anchors are used extensively in open and minimally invasive surgery to reattach tissue to bone. The bone anchor is secured to the bone and one or more sutures attached to the bone anchor are used to secure the tissue to the bone. The tissue can be soft tissue anywhere in the body, for example, a torn rotator cuff in a shoulder or a torn ligament. Typically, in a first step to reattach tissue to bone, a hole is drilled into the bone under arthroscopic visualization. The bone anchor may be inserted through the hole and may be configured to lock itself within the hole in the bone upon deployment therein. Once the bone anchor is secured within the hole in the bone, one or both ends of suture attached to the bone anchor may be tensioned to approximate the positioning of the tissue with respect to the bone. Once the tissue is positioned as desired, the suture may be locked in place to maintain the tension in the suture. The free end or ends of the suture may be clipped under arthroscopic visualization to complete the procedure. 
     The bone hole size that is drilled when inserting the bone anchor can correlate with a patient’s recovery time. Accordingly, the smallest bone hole that enables achieving fixation needs is desired to reduce recovery times for patients. It is therefore preferred that a bone anchor can be inserted through as small a bone hole as possible while still providing sufficient pull-out strength once installed. 
     One way to provide such bone anchor properties is a bone anchor having wings constructed with a shape-memory material. The bone anchor may be shape-set in an expanded state with the wings splayed outward, though may be compressed to a smaller size with the wings bent inward as it is translated through a bone hole. Once the bone anchor reaches softer bone (e.g., cancellous bone), the bone anchor returns to its expanded state. In its expanded state, the bone anchor cannot translate back through the bone hole (e.g., cortical bone) because the wings are splayed outward wider than the bone hole. 
     Typical shape-memory material bone anchors, however, must be inserted through a bone hole with the use of an inserter having a cannula, or may otherwise not have a drive feature to be used with an inserter. For instances with an inserter having a cannula, the bone anchor is positioned within the cannula so that the cannula maintains the bone anchor in a compressed state as it is translated through the bone hole. The bone anchor can then be deployed from the cannula into its expanded state once a desired depth into the bone is reached. The cannula, however, necessitates a larger bone hole than if the bone anchor was inserted into the bone hole on its own, since the cannula surrounds the bone anchor. The larger bone hole may contribute to increased patient recovery times. 
     Additionally, it is desired to keep suture away from a bone anchor’s shape-memory material wings. For example, the wings may potentially damage the suture by cutting or fraying the suture. Typical bone anchors having shape-memory material wings, however, are not constructed to maintain suture away from its wings. 
     Accordingly, there is a need for a bone anchor having shape-memory material wings that solves the above drawbacks. 
     SUMMARY 
     The present disclosure provides a new and innovative bone anchor and bone anchor insertion system that enable smaller bone holes in part due to a drive feature of the bone anchor that may be engaged with an inserter. 
     An example bone anchor includes a core portion including a head and a rod, wherein at least a portion of the core portion is hollow; and a securement portion including a plurality of wings, the securement portion positioned around at least a portion of the rod. The plurality of wings curve away from a central axis of the rod in a rest position and are configured to bend towards and away from the central axis of the rod. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the securement portion includes four wings. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the securement portion is constructed of a shape memory material. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the shape memory material is nitinol. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the plurality of wings are configured to bend towards the central axis of the rod such that the plurality of wings are substantially parallel to the central axis of the rod. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, when the plurality of wings are substantially parallel to the central axis of the rod, the securement portion surrounds the entire length of the rod. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the hollow portion of the core portion is a notch in an end of the rod opposite the head. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the rod includes an opening with a central axis perpendicular to the central axis of the rod. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the core portion and the securement portion are separate components. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the core portion and the securement portion are press fit together. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the core portion and the securement portion are integrally formed as a single component. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the securement portion further includes a base from which the plurality of wings extend, and wherein the base contacts the head. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the base contacts the head on a first side of the base and the plurality of wings extend from a second side of the base, the first side being opposite the second side. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, each of the plurality of wings is equally dispersed around the central axis of the rod. 
     In some examples, an example bone anchor insertion system includes: an inserter including an insertion end having a key; suture material; and a bone anchor including: a core portion having a head and a rod, wherein the rod includes an opening perpendicular to a central axis of the rod and a drive notch parallel with the central axis of the rod; and a securement portion including a plurality of wings, the securement portion positioned around at least a portion of the rod. The plurality of wings curve away from the rod’s central axis in a rest position and are configured to bend towards and away from the rod’s central axis. The suture material is positioned through the opening in the rod. The key of the inserter is configured to be positioned within the drive notch of the rod so that the inserter drives the bone anchor through a bone canal. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the inserter and the bone anchor are configured such that the bone anchor is driven through a bone canal via the inserter without a cannula. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the key and the drive notch are correspondingly configured such that the inserter and the bone anchor are prevented from rotating with respect to one another when the key is positioned within the drive notch. 
     In some examples, an example bone anchor insertion system includes an inserter having an insertion end with a tapered groove; suture material; and a bone anchor including: a core portion including a head and a rod, wherein at least a portion of the core portion is hollow; and a securement portion including a plurality of wings, the securement portion positioned around at least a portion of the rod. The plurality of wings curve away from the rod’s central axis in a rest position and are configured to bend towards and away from the rod’s central axis. The inserter’s insertion end is configured to be positioned within the rod so that the bone anchor is driven through a bone canal via the inserter. The suture material is positioned through the rod and within the tapered groove. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the head includes two separate components joined by a bar. 
     In an aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the rod is configured to maintain the suture material within the plurality of wings as the bone anchor is driven through the bone canal via the inserter. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    illustrates a perspective view of a bone anchor having a hollow core portion, according to an aspect of the present disclosure. 
         FIG.  2    illustrates a perspective view of a securement portion, according to an aspect of the present disclosure. 
         FIG.  3 A  illustrates a perspective view of a core portion, according to an aspect of the present disclosure. 
         FIG.  3 B  illustrates a perspective view of a core portion having a head with a bar, according to an aspect of the present disclosure. 
         FIG.  4    illustrates a portion of a bone anchor insertion system having a hollow core portion and an inserter with a tapered groove, according to an aspect of the present disclosure. 
         FIG.  5    illustrates a portion of a bone anchor insertion system having a core portion with a drive notch and an inserter with a key, according to an aspect of the present disclosure. 
         FIG.  6    illustrates a perspective view of a bone anchor insertion system, according to an aspect of the present disclosure. 
         FIGS.  7 A to  7 C  illustrate perspective views of a method for inserting a bone anchor with a bone anchor insertion system, according to an aspect of the present disclosure. 
         FIG.  8    illustrates a perspective view of a securement portion including a base with a reduced section, according to an aspect of the present disclosure. 
         FIG.  9    illustrates a side view of the securement portion of  FIG.  8   , according to an aspect of the present disclosure. 
         FIG.  10    illustrates a cross-sectional view of the securement portion of  FIG.  9   , according to an aspect of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     The present disclosure provides new and innovative bone anchors and bone anchor insertion systems that enable smaller bone holes by providing a bone anchor having a drive feature that may be engaged with an inserter. The provided bone anchors and insertion systems also help prevent damage to suture used in a bone anchor insertion procedure. The presently disclosed bone anchor includes a core portion and a securement portion that surrounds the core portion. The securement portion includes multiple wings. The wings are curved or splayed outward from the core portion at rest, though may be bent towards or away from the core portion in response to an applied force. For instance, as the bone anchor is driven into a bone hole that is narrower than the outward perimeter of the splayed wings, the bone hole walls force the splayed wings to bend towards the core portion to a compressed state to fit within the bone hole. Once the force is insufficient to maintain the wings in the compressed state (e.g., softer bone), the wings return to their initial, splayed outward state. 
     The core portion includes a rod extending from a head. The securement portion is positioned around the core portion’s rod. The rod extends between the multiple wings such that the wings are dispersed about the rod’s central axis. The core portion’s rod is configured such that it may be used as a drive feature with an insertion instrument (e.g., inserter). Stated differently, a surgeon may engage an inserter with the rod to drive the bone anchor through a bone hole. A cannula is not needed to transport the bone anchor. Moreover, a cannula is not needed to maintain the bone anchor in a compressed state. Rather, while the surgeon drives the bone anchor through the bone hole, the bone anchor is maintained in a compressed state by the bone hole itself. Accordingly, smaller bone holes may be drilled by eliminating the need for an inserter with a cannula to deploy a bone anchor, which may help contribute to decreased patient recovery times. 
     In some examples, the core portion may include a notch on its end opposite the head. The notch shape matches the shape of an inserter tip such that the tip may be positioned within the notch. This enables the bone anchor to be driven head first via the inserter. The notch may have at least one flat side to prevent rotation with respect to the inserter. In such notch examples, the core portion may include an opening perpendicular to its central axis. Suture may be positioned through the opening. The suture may be secured to the inserter while transporting the bone anchor, which couples the bone anchor to the inserter. The opening may be positioned on the rod near the notch end (e.g., as close as possible) to prevent the suture from contacting the wings as much as possible. This configuration may help protect the suture from potential damage by the wings. 
     In other examples, instead of a notch, at least the core portion’s rod may be hollow along its entire length. The core portion’s head may be hollow and/or may include a suture securing structure. A tip of an inserter may be positioned within the end of the rod opposite the head. This enables the bone anchor to be driven head first via the inserter. In such examples, suture may be secured at the core portion’s head (e.g., a knot or other structure in the core’s head) and positioned through the rod. The suture may be secured to the inserter while transporting the bone anchor, which couples the bone anchor to the inserter. Positioning the suture through the rod helps maintain the suture away from the wings and therefore helps protect the suture from potential damage by the wings. Additionally, in such examples, the inserter’s tip may have a tapered groove that enables the tip to be inserted within the rod while also enabling the suture to exit the rod. 
       FIGS.  1 ,  2 , and  3 A  illustrate perspective views of a securement portion  110  and a core portion  120  of an example bone anchor  100 . The bone anchor  100  includes the securement portion  110  and the core portion  120 . The securement portion  110  is positioned around the core portion  120 . In various instances, such as the illustrated example, the securement portion  110  and the core portion  120  are separate components. The securement portion  110  may be press fit (e.g.,  FIGS.  8 - 10   ) or laser welded to the core portion  120 . In other instances, the securement portion  110  and the core portion  120  may be machined as a single component. 
     The securement portion  110  includes wings  112 A,  112 B,  112 C,  112 D that extend from a base  114 . The base  114  is in contact with the head  124  of the core portion  120 . The wings  112 A,  112 B,  112 C,  112 D are dispersed about a central axis  102  of the rod  122  of the core portion  120 . In some aspects, the wings  112 A,  112 B,  112 C,  112 D may be equally dispersed about the central axis  102 . In some instances, the securement portion  110  may include four wings  112 A,  112 B,  112 C,  112 D as illustrated. In other instances, the securement portion  110  may include more or less than four (e.g., two, three, five, six) wings  112 A,  112 B,  112 C,  112 D. 
     The securement portion  110  may be constructed of any suitable medical-grade material that enables the flexibility of the wings  112 A,  112 B,  112 C,  112 D described herein. For instance, the wings  112 A,  112 B,  112 C,  112 D or the securement portion  110  as a whole may be constructed of a shape-memory material, such as nitinol. In such instances, the wings  112 A,  112 B,  112 C,  112 D may be shape-set to splay or curve away from the central axis  102 . 
     As illustrated, the wings  112 A,  112 B,  112 C,  112 D splay or curve away from the central axis  102  while at rest. The wings  112 A,  112 B,  112 C,  112 D are flexible and may bend towards and away from the central axis  102  in response to an applied force. For example, the wings  112 A,  112 B,  112 C,  112 D may bend towards the central axis  102  such that the wings  112 A,  112 B,  112 C,  112 D are substantially parallel with the central axis  102  when the bone anchor  100  is driven into a bone hole. When the wings  112 A,  112 B,  112 C,  112 D are substantially parallel to the central axis  102 , the wings  112 A,  112 B,  112 C,  112 D may extend past the end of the rod  120 . In other instances, the wings  112 A,  112 B,  112 C,  112 D may be shorter such that they terminate at the end of the rod  120  or terminate along the rod  120  prior to its end. The wings  112 A,  112 B,  112 C,  112 D may also bend away from the central axis  102  in response to an applied force, further splaying away from the central axis  102 . In either instance, when the applied force is removed, the wings  112 A,  112 B,  112 C,  112 D return to the illustrated example rest position. The wings  112 A,  112 B,  112 C,  112 D may be splayed a greater or lesser amount from the central axis  102  in the rest position in other examples. 
     In some aspects of the present disclosure, each of the wings  112 A,  112 B,  112 C,  112 D is configured the same as the other wings  112 A,  112 B,  112 C,  112 D. In such aspects, each of the wings  112 A,  112 B,  112 C,  112 D has the same shape, an equal length, is splayed the same amount from the central axis  102 , and requires the same amount of applied force to bend towards or away from the central axis  102 . 
     In other aspects of the present disclosure, one or more of the wings  112 A,  112 B,  112 C,  112 D may be different than the other wings  112 A,  112 B,  112 C,  112 D. For example, one or more wings  112 A,  112 B,  112 C,  112 D may have a different length. In another example, one or more wings  112 A,  112 B,  112 C,  112 D may be shaped differently. In another examples, one or more wings  112 A,  112 B,  112 C,  112 D may be splayed a greater or lesser amount from the central axis  102 . In another example, one or more wings  112 A,  112 B,  112 C,  112 D may be stronger than the others such that a greater applied force is needed to bend the one or more stronger wings  112 A,  112 B,  112 C,  112 D toward or away from the central axis  102 . In another example, one or more wings  112 A,  112 B,  112 C,  112 D may be weaker than the others such that less applied force is needed to bend the one or more stronger wings  112 A,  112 B,  112 C,  112 D toward or away from the central axis  102 . For instance, the width of a particular wing  112 A,  112 B,  112 C,  112 D contributes to its strength such that a greater width corresponds to greater strength. 
     The one or more different wings  112 A,  112 B,  112 C,  112 D may cause the bone anchor  100  to apply unequal or asymmetric force on a bone. Since many bone surfaces are not flat, the unequal or asymmetric force may be beneficial in certain instances because it may enable the bone anchor  100  to better conform to an uneven surface as compared to a bone anchor that applies symmetric force. 
     In some aspects, as mentioned above, the securement portion  110  and the core portion  120  may be press fit together.  FIGS.  8  to  10    illustrate an example securement portion  110  having a base  114  formed with a reduced section  802  that is used to press fit the securement portion  110  to the core portion  120 . As shown in the cross-section of  FIG.  10   , a width W of the interior of the base  114  at the reduced section  802  is smaller than a width Y of the interior of the base  114  outside of the reduced section  802 . In this way, the base  114  may press against the rod  122  of the core portion  120  at the reduced section  802  when the rod  122  is positioned through the securement portion  110  to thereby press fit the securement portion  110  and the core portion  120  together. In an example, the securement portion  110  may be heat-treated and/or crimped to form the reduced section  802 . In some instances, the rod  122  of the core portion  120  may be positioned through the securement portion  110  when the securement portion  110  is heat-treated and/or crimped. In other instances, the securement portion  110  may be heat-treated and/or crimped prior to positioning the rod  122  through the securement portion  110 . 
     The core portion  120  of the example bone anchor  100  includes a rod  122  and a head  124 . The rod  122  and the head  124  may be formed integrally with one another or may be separate components that are connected. The core portion  120  may be constructed of any suitable medical-grade material, such as titanium, stainless steel or a medical-grade plastic (e.g., polyether ether ketone). 
     At least a portion of the core portion  120  is hollow. In some aspects, such as the ones illustrated in  FIGS.  1  to  4   , the core portion  120  includes a channel  126  that opens on one end of the rod  122 . The channel  126  extends the length of the rod  122 . In some instances, the channel  126  extends all the way through the head  124  such that it opens at the outermost end of the head  124 . In such instances, suture may be positioned through the channel  126  of the core portion  120  and secured (e.g., knotted) to the core portion  120  outside of the head  124 . 
     In other instances, the channel  126  connects to a different opening in the head  124 . In such other instances, the head  124  may be configured to secure suture to the core portion  120  within the head  124 . For example,  FIG.  3 B  illustrates an example core portion  300  that includes a head that is split into a first head part  304 A and a second head part  304 B. A rod  122  having a channel  126  extends from the first and second head parts  304 A and  304 B. A bar  306  connects the first head part  304 A to the second head part  304 B. Suture positioned through the channel  126  may be positioned around the bar  306  and back through the channel  126  to secure the suture to the core portion  300 . 
     The channel  126  of the core portion  120  may act as a drive feature in connection with an inserter.  FIG.  4    illustrates a portion of an example bone anchor insertion system  400  including an inserter  402  and the core portion  120  of the example bone anchor  100 . It should be appreciated that the securement portion  110  is not shown around the core portion  120  merely for illustrative purposes. The inserter  402  includes an insertion tip  404 . The inserter  402  may also include a shaft (not illustrated) and handle (not illustrated). The insertion tip  404  is configured such that it may be inserted within the channel  126  of the bone anchor  120 . The insertion tip  404  may be tapered, with its end being the most narrow portion, so that the insertion tip  404  may only be positioned within the channel  126  a certain amount (e.g., the end does not reach the head  124 ). The insertion tip  404  may also include a tapered groove  406 . The tapered groove  406  enables suture to exit the channel  126  while the insertion tip  404  is inserted within the channel  126 . When the insertion tip  404  is positioned within the channel  126 , at least a portion of the tapered groove  406  remains outside of the channel  126  to that the suture may exit the channel  126 . 
     When the insertion tip  404  is inserted within the channel  126 , the suture may be secured to the inserter  402 , which couples the bone anchor  120  to the inserter  402 . A surgeon may drive the coupled bone anchor  120  through a bone hole via the inserter  402 . The surgeon may deploy the suture from the inserter  402  and remove the insertion tip  404  from the channel  126  to decouple the inserter  402  from the bone anchor  120 . Additionally, the rod  122  of the core portion  120  helps protect the suture from accidental damage by the wings (not illustrated) since the suture is positioned within the rod  122 . 
     In some aspects of the present disclosure, the hollow part of the core portion may be a notch instead of a channel. For example,  FIG.  5    illustrates a portion of a bone anchor insertion system  500  having a core portion  510  with a notch  516 . It should be appreciated that a securement portion (e.g., the securement portion  110 ) is not shown around the core portion  510  merely for illustrative purposes. The bone anchor insertion system  500  may also include suture (not illustrated). In this example, the core portion  510  includes a rod  122  extending from a head  124 . The notch  516  is an absence of material that extends into the end of the rod  122  as illustrated. The core portion  510  may include an opening  518  through the rod  122 . The notch  516  may end prior to reaching the opening  518  in various instances. Due to the absence of a channel in the example core portion  510 , suture may instead be positioned through the opening  518  to secure the suture to the core portion  510 . 
     The bone anchor insertion system  500  also includes an example inserter  520 . The inserter  520  includes a key  522  on its insertion end. The inserter  520  also includes a shaft  524  and may include a handle (not illustrated). The notch  516  acts as a drive feature for use with the inserter  520 . The key  522  and the notch  516  are configured to correspond to one another such that the key  522  may be inserted within the notch  516 . In some instances, the key  522  and the notch  516  may include at least one corresponding flat side in order to prevent rotation of the core portion  510  with respect to the inserter  520  or vice versa. 
       FIG.  6    illustrates a perspective view of the bone anchor insertion system  500  showing a bone anchor  602  that includes a securement portion  110  surrounding the core portion  510 . The suture  606  of the bone anchor system  500  is also illustrated. The inserter  520  is shown engaged with the bone anchor  602  such that the key  522  is positioned within the notch  516 . In this position, the suture  606  placed through the opening  518  may be secured to the inserter  520 , which couples the bone anchor  602  to the inserter  520 . In the example bone anchor insertion system  500 , the suture  606  is not positioned within the rod  122 . Nevertheless, the opening  518  may be positioned near the end of the rod  122  closest the inserter  520  to help maintain the suture  606  away from the wings  112 A,  112 B,  112 C,  112 D. This configuration helps prevent the wings  112 A,  112 B,  112 C,  112 D from accidentally damaging the suture  606 . 
     When the key  522  is inserted within the notch  516  and the suture  606  couples the bone anchor  602  to the inserter  520  as illustrated, a surgeon may drive the coupled bone anchor  602  through a bone hole via the inserter  520 . The surgeon may thereafter deploy the suture  606  from the inserter  520  and translate the inserter  520  away from the bone anchor  602  to decouple the inserter  520  from the bone anchor  602 . 
       FIGS.  7 A to  7 C  illustrate perspective views of example processes for inserting the bone anchor  602  through a bone hole  702  using the inserter  520 . The example process  700  of  FIG.  7 A  illustrates the inserter  520  coupled to the bone anchor  602  as a surgeon drives the bone anchor  602  through a bone hole  702  in the direction of the arrow  704 . The bone hole  702  may be created by drilling into cortical bone to a length that is longer than the length of the bone anchor  602 . A gap is illustrated between the walls of the bone hole  702  and the bone anchor  602  solely for the sake of clarity. As the surgeon drives the bone anchor  602  into and through the bone hole  702 , the outer surface of the bone anchor  602  contacts the walls of the bone hole  702 , which causes the wings  112 A- 112 D of the securement portion  110  to fold up or bend towards the central axis  706  as illustrated. The hardness of cortical bone is sufficient to effect an opposing force that maintains the wings  112 A- 112 D of the securement portion  110  in this folded up or compressed state. 
     Once the surgeon drives the bone anchor  602  into softer bone, such as cancellous bone, however, the hardness of the cancellous bone is insufficient to effect such an opposing force. The wings  112 A- 112 D of the securement portion  110  accordingly splay away from the central axis  706 , into the cancellous bone, to return to their resting position, as illustrated in the example process  710  of  FIG.  7 B . In some instances, once the surgeon detects that the wings  112 A- 112 D of the securement portion  110  have returned to their resting position, the surgeon may deploy the suture  606  from the inserter  520 . The surgeon may then decouple the inserter  520  from the bone anchor  602  by translating the inserter  520  out of the bone hole  702 . 
     Once the inerter  520  is removed, the surgeon may tension the suture  606  in the direction of the arrow  722 , as illustrated in the example process  720  of  FIG.  7 C . As the surgeon tensions the suture  606  in the direction of the arrow  722  from the positioning illustrated in  FIG.  7 B , the suture  606  pulls the bone anchor  602  in the direction of the arrow  722 . The wings  112 A- 112 D of the securement portion  110 , however, are prevented from translating in the direction of the arrow  722  by the cortical bone. Instead, the cortical bone causes the wings  112 A- 112 D of the securement portion  110  to splay or bend further away from the central axis  706 . Once the wings  112 A- 112 D of the securement portion  110  splay or bend apart a sufficient amount to provide an amount of pull-out strength that the surgeon desires, the surgeon may lock the suture  606  in place. The surgeon may then clip the free ends of the suture  606  and complete the procedure. 
     In other instances, the surgeon may position the bone anchor  602 , causing the wings  112 A- 112 D of the securement portion  110  to splay outward, prior to deploying the suture  606  from the inserter  520 . In such other instances, the inserter  520  remains coupled to the bone anchor  602  prior to deploying the suture  606  so translating the inserter  520  in the direction of the arrow  722  has the same effect as tensioning the suture  606  in the direction of the arrow  722  as described above. Once the bone anchor  602  is positioned to the surgeon’s liking, the surgeon may deploy the suture  606  while maintaining tension in the suture  606 . The surgeon may then lock the suture  606  in place and clip its free ends. 
     The presently disclosed bone anchor insertion system therefore enables smaller bone holes as compared to typical bone anchor insertion systems by eliminating the need for a cannula to transport a bone anchor. Rather than a cannula, the presently disclosed bone anchor insertion system includes a bone anchor with a drive feature that enables a surgeon to engage an inserter to the bone anchor to drive the bone anchor through a bone hole, which maintains the bone anchor in a folded up or compressed state (e.g.,  FIG.  7 A ). The provided bone anchor is also configured to help prevent accidental damage to the suture. 
     In the present disclosure, the terms “including” and “comprising” are used in an open-ended fashion, and thus should be interpreted to mean “including, but not limited to....” As used herein, “about,” “approximately” and “substantially” are understood to refer to numbers in a range of numerals, for example the range of -10% to +10% of the referenced number, preferably -5% to +5% of the referenced number, more preferably -1% to +1% of the referenced number, most preferably -0.1% to +0.1% of the referenced number. Moreover, these numerical ranges should be construed as providing support for a claim directed to any number or subset of numbers in that range. For example, a disclosure of from 1 to 10 should be construed as supporting a range of from 1 to 8, from 3 to 7, from 1 to 9, from 3.6 to 4.6, from 3.5 to 9.9, and so forth. 
     Reference throughout the specification to “various aspects,” “some aspects,” “some examples,” “other examples,” or “one aspect” means that a particular feature, structure, or characteristic described in connection with the aspect is included in at least one example. Thus, appearances of the phrases “in various aspects,” “in some aspects,” “certain embodiments,” “some examples,” “other examples,” “certain other embodiments,” or “in one aspect” in places throughout the specification are not necessarily all referring to the same aspect. Furthermore, the particular features, structures, or characteristics illustrated or described in connection with one example may be combined, in whole or in part, with features, structures, or characteristics of one or more other aspects without limitation. 
     It is to be understood that at least some of the figures and descriptions herein have been simplified to illustrate elements that are relevant for a clear understanding of the disclosure while eliminating, for purposes of clarity, other elements. Those of ordinary skill in the art will recognize, however, that these and other elements may be desirable. However, because such elements are well known in the art, and because they do not facilitate a better understanding of the disclosure, a discussion of such elements may not be provided herein. 
     The terminology used herein is intended to describe particular embodiments only and is not intended to be limiting of the present disclosure. As used herein, the singular forms “a,” “an,” and “the” are intended to include the plural forms as well, unless otherwise indicated. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. As used herein, the term ‘at least one of X or Y’ or ‘at least one of X and Y’ should be interpreted as X, or Y, or X and Y. 
     Without further elaboration, it is believed that one skilled in the art can use the preceding description to utilize the claimed inventions to their fullest extent. The examples and aspects disclosed herein are to be construed as merely illustrative and not a limitation of the scope of the present disclosure in any way. It will be apparent to those having skill in the art that changes may be made to the details of the above-described examples without departing from the underlying principles discussed. In other words, various modifications and improvements of the examples specifically disclosed in the description above are within the scope of the appended claims. For instance, any suitable combination of features of the various examples described is contemplated.