Suture anchor

• US 5,718,717 A
• Filed: 08/19/1996
• Issued: 02/17/1998
• Est. Priority Date: 08/19/1996
• Status: Expired due to Term

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Peter M. Bonutti
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Jackson, Gary
• Application Number:
  US08/699,553
• Time in Patent Office: 547 Days
• Field of Search: 606/232, 606/75, 606/213, 606/214, 606/215
• US Class Current: 606/232
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 2017/0403 Dowels
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/047 having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body

Abstract

A suture anchor is formed of a material which absorbs body liquid when exposed to body liquid. The anchor may be at least partially formed of a material having a strong affinity for body liquids. This enables the anchor to absorb body liquid and expand upon being inserted into a patient'"'"'s body. At least one embodiment of the suture anchor has portions formed of a relatively hard material which does not absorb body liquids and is pressed against body tissue by the material which absorbs body liquid to mechanically interlock the suture anchor and the body tissue. The anchor may be at least partially formed of a cellular material. The-cells expand to absorb body liquid. At least one embodiment of the anchor has a pointed leading end portion to form an opening in an imperforate surface on body tissue. The configuration of the anchor may be changed by tensioning the suture while the anchor is disposed in body tissue.

Claims

1. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue, expanding the anchor in the body tissue, said step of expanding the anchor includes absorbing body liquid into the anchor and increasing the volume of the anchor as body liquid is absorbed into the anchor, and tensioning the suture to transmit force to the anchor.

2. A method as set forth in claim 1 wherein said step of providing an anchor includes providing an anchor which is formed of a first material which absorbs body liquid and a second material which is ineffective to absorb body liquid, said step of expanding the anchor includes pressing the second material against the body tissue under the influence of force transmitted to the second material from the first material as the first material absorbs body liquid.

3. A method as set forth in claim 1 further including the step of resiliently compressing the anchor, said step of inserting the anchor into body tissue is at least partially performed with the anchor compressed, said step of expanding the anchor includes removing compressive forces from the anchor and allowing the anchor to expand under the influence of its own natural resilience.

4. A method as set forth in claim 3 wherein said step of absorbing body liquid into the anchor is at least partially performed as the anchor expands under the influence of its own natural resilience.

5. A method as set forth in claim 1 wherein said step of inserting the anchor into body tissue includes piercing an imperforate surface area on the body tissue with a leading end portion of the anchor and moving the anchor through an opening which is formed in the imperforate surface area of the body tissue by the leading end portion of the anchor.

6. A method as set forth in claim 1 wherein said step of providing an anchor includes providing an anchor having a first portion formed of a material which absorbs body liquid and a jacket which at least partially encloses the first portion of the anchor, said step of absorbing body liquid into the anchor includes absorbing body liquid into the first portion of the anchor, increasing the volume of the first portion of the anchor as body liquid is absorbed into the first portion of the anchor, and expanding the jacket under the influence of force applied against the jacket by the first portion of the anchor as the volume of the first portion of the anchor increases.

7. A method as set forth in claim 1 wherein said step of inserting the anchor into body tissue includes inserting the anchor into a tubular member, positioning the tubular member relative to body tissue, and applying force against a trailing end portion of the anchor to move the anchor out of the tubular member, said steps of inserting the anchor into the tubular member and applying force against a trailing end portion of the anchor being performed while the anchor has a first volume, said step of expanding the anchor being performed with the anchor outside of the tubular member and includes increasing the volume of the anchor from the first volume to a second volume which is larger than the first volume.

8. A method as set forth in claim 1 wherein the anchor has an outer side surface which engages body tissue when the anchor is disposed in body tissue, said step of increasing the volume of the anchor includes effecting expansion of the outer side surface of the anchor throughout the extent of the outer side surface of the anchor when the anchor is disposed in the body tissue.

9. A method as set forth in claim 1 wherein the anchor is at least partially formed of a cellular material, said step of inserting the anchor into body tissue is performed with cells in the cellular material of the anchor in a contracted condition, said step of expanding the anchor includes increasing the size of the cells of the anchor.

10. A method as set forth in claim 1 wherein said step of inserting the anchor into body tissue is performed while the anchor has a volume corresponding to an unrestrained volume of the anchor, said step of increasing the volume of the anchor includes increasing the volume of the anchor from the volume corresponding to the unrestrained volume of the anchor to a volume which is substantially greater than the unrestrained volume of the anchor as body liquid is absorbed into the anchor.

11. A method as set forth in claim 1 wherein said step of inserting the anchor into body tissue includes positioning the anchor in an inserter member with the suture extending from the anchor and moving the anchor into body tissue with a first end portion of the anchor leading and a second end portion of the anchor trailing, said steps of absorbing body liquid into the anchor and increasing the volume of the anchor includes absorbing body liquid into the first and second end portions of the anchor and increasing the volume of the first and second end portions of the anchor.

12. A method as set forth in claim 1 wherein said step of absorbing body liquid into the anchor includes attracting body liquid to the material of the anchor under the influence of molecular attraction.

13. A method as set forth in claim 1 wherein said step of absorbing body liquid into the anchor includes establishing molecular linkages between the body liquid and the material forming the anchor.

14. A method as set forth in claim 1 wherein the anchor is at least partially formed of a material which is body liquid permeable, said step of absorbing body liquid into the anchor includes holding body liquid by attractive force between the body liquid and the material of the anchor.

15. A method as set forth in claim 1 wherein the anchor is at least partially formed of a porous material, said step of absorbing body liquid into the anchor includes conducting body liquid into minute cavities in the material of the anchor under the influence of capillary action.

16. A method as set forth in claim 1 wherein said step of absorbing body liquid into the anchor includes holding body liquid in the material of the anchor under the influence of attractive forces between the body liquid and the material of the anchor.

17. A method as set forth in claim 1 wherein the anchor is at least partially formed of a material which is hydrophilic, said step of absorbing body liquid into the anchor is performed under the influence of attraction between the hydrophilic material of the anchor and the body liquid.

18. A method of anchoring a suture, said method comprising the steps of providing an anchor having a suture extending from the anchor and having a longitudinal central axis which extends through first and second end portions of the anchor and a first cross sectional area as viewed in a plane extending perpendicular to the longitudinal central axis at a location midway between the first and second end portions of the anchor, inserting the anchor into body tissue with the suture extending from the anchor, and expanding the anchor in the body tissue to establish an interlock between the anchor and body tissue, said step of expanding the anchor includes increasing the distance between the first and second end portions of the anchor and increasing the first cross sectional area of the anchor as viewed in a plane extending perpendicular to the longitudinal central axis of the anchor at a location midway between the first and second end portions of the anchor.

19. A method as set forth in claim 18 wherein said step of inserting the anchor into body tissue with the suture extending from the anchor is performed with a first portion of the suture extending from the first end portion of the anchor and a second portion of the suture extending from the second end portion of the anchor.

20. A method as set forth in claim 18 further including the step of pivoting the anchor relative to the body tissue after inserting the anchor into the body tissue and prior to performance of said step of expanding the anchor.

21. A method as set forth in claim 18 wherein the step of inserting of the anchor into body tissue includes moving the anchor along an insertion path into the body tissue with the longitudinal central axis of the anchor extending parallel to a longitudinal central axis of the insertion path, said method further including changing the orientation of the anchor in the body tissue to an orientation in which the longitudinal central axis of the anchor extends transverse to the longitudinal central axis of the insertion path prior to performance of said step of expanding the anchor.

22. A method as set forth in claim 21 wherein said step of changing the orientation of the anchor includes tensioning the suture to apply torque to the anchor.

23. A method as set forth in claim 18 wherein said step of expanding the anchor in the body tissue includes absorbing body liquid into the anchor.

24. A method of anchoring a suture, said method comprising the steps of providing an anchor having a plurality of cells and a suture extending from the anchor, collapsing the plurality of cells in the anchor, inserting the anchor into body tissue with the suture extending from the anchor and with the plurality of cells collapsed, and expanding the anchor in the body tissue, said step of expanding the anchor in the body tissue includes expanding the plurality of collapsed cells in the anchor.

25. A method as set forth in claim 24 wherein said step of inserting the anchor into body tissue includes moving the anchor along an inner side surface of a tubular member and applying force against an outer side surface of the anchor with an inner side surface of the tubular member to maintain the plurality of cells in the anchor collapsed as the anchor moves along the inner side surface of the tubular member.

26. A method as set forth in claim 24 wherein said step of inserting the anchor into body tissue is performed with a first portion of the suture extending from a leading end portion of the anchor and a second portion of the suture extending from a trailing end portion of the anchor.

27. A method as set forth in claim 24 wherein said step of collapsing the plurality of cells in the anchor includes resiliently compressing the anchor from an initial volume to a volume which is less than the initial volume, said step of inserting the anchor into body tissue includes maintaining the anchor compressed to a volume which is less than the initial volume, said step of expanding the anchor in the body tissue includes expanding the anchor under the influence of natural resilience of material of the anchor.

28. A method as set forth in claim 24 wherein said step of inserting the anchor into body tissue includes inserting the anchor into an elongated tubular member with the suture extending from the anchor and with the plurality of cells collapsed, inserting an open end portion of the tubular member into body tissue, and pushing the anchor through the open end portion of the tubular member into the body tissue.

29. A method as set forth in claim 28 wherein said step of inserting the anchor into body tissue includes applying force against an outer side surface of the anchor with an inner side surface of the tubular member to maintain the plurality of cells collapsed.

30. A method as set forth in claim 24 wherein said step of expanding the anchor in the body tissue includes absorbing body liquid into the anchor.

31. A method as set forth in claim 24 wherein said step of inserting the anchor into body tissue includes piercing an imperforate surface area on the body tissue and moving the anchor through an opening which is formed in the imperforate surface area of the body tissue during performance of said step of piercing the imperforate surface area on the body tissue.

32. A method as set forth in claim 24 wherein said step of inserting the anchor into body tissue includes inserting the anchor into an elongated tubular member, piercing an imperforate surface area on the body tissue adjacent a leading end portion of the tubular member, moving the leading end portion of the tubular member through an opening formed in the imperforate surface area of the body tissue during performance of said step of piercing the imperforate surface area on the body tissue, and moving the anchor from the leading end portion of the tubular member while the tubular member extends through an opening formed in the imperforate surface area of the body tissue.

33. A method as set forth in claim 32 wherein said step of moving the anchor from the leading end portion of the tubular member includes withdrawing the tubular member from the body tissue while applying force against a trailing end portion of the anchor.

34. A method as set forth in claim 32 wherein said step of moving the anchor from the leading end portion of the tubular member includes moving at least a portion of the anchor transversely to a longitudinal central axis of the tubular member into the body tissue under the influence of force applied against a trailing end portion of the anchor.

35. A method as set forth in claim 34 further including the step of withdrawing the tubular member from the body tissue along a path which extends parallel to the longitudinal central axis of the tubular member after having moved at least a portion of the anchor transversely to the longitudinal central axis of the tubular member into the body tissue.

36. A method as set forth in claim 32 wherein said step of piecing an imperforate surface area on the body tissue includes forming an opening in the imperforate surface area on the body tissue with a pointed member which is at least partially disposed in the elongate tubular member.

37. A method as set forth in claim 32 wherein said step of piercing an imperforate surface area on the body tissue includes forming an opening in the imperforate surface area on the body tissue with a pointed end portion of the tubular member.

38. A method of anchoring a suture, said method comprising the steps of providing an anchor with a suture extending from the anchor, moving the anchor into body tissue along a path in a member while the anchor has a first volume and a first orientation in which an axis of the anchor extends parallel to a longitudinal central axis of the path, changing the orientation of the anchor from the first orientation to a second orientation in which the axis of the anchor extends transverse to the longitudinal central axis of the path, and expanding the anchor from the first volume to a second volume while the anchor is in the body tissue.

39. A method as set forth in claim 38 wherein said step of expanding the anchor from the first volume to a second volume includes absorbing body liquid into the anchor.

40. A method as set forth in claim 38 wherein said step of absorbing body liquid into the anchor includes absorbing body liquid into a material forming the anchor.

41. A method as set forth in claim 38 wherein said step of absorbing body liquid into the anchor includes expanding a plurality of cells in the anchor and at least partially filling the cells with body liquid.

42. A method as set forth in claim 38 further including the step of piercing an imperforate surface on body tissue with a leading end portion of the anchor prior to changing the orientation of the anchor from the first orientation to the second orientation.

43. A method as set forth in claim 38 further including the step of piercing an imperforate surface on body tissue with a leading end portion of the member prior to changing the orientation of the anchor from the first orientation to the second orientation.

44. A method as set forth in claim 38 further including the step of moving the anchor out of the member into the body tissue, said step of changing the orientation of the anchor from a first orientation to a second orientation being performed during performance of said step of moving the anchor out of the member into the body tissue.

45. A method as set forth in claim 38 wherein said step of providing an anchor includes providing an anchor of a first material and a second material, said step of expanding the anchor includes conducting body liquid into the first material and pressing the second material against the body tissue under the influence of force transmitted to the second material from the first material as the first material absorbs body liquid.

46. A method as set forth in claim 38 further including the step of resiliently compressing the anchor, said step of expanding the anchor from a first volume to a second volume includes allowing the anchor to expand under the influence of its own natural resilience.

47. A method as set forth in claim 38 wherein the anchor is at least partially formed of cellular material, said step of expanding the anchor includes the size of cells in the cellular material of the anchor.

48. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue, said step of inserting the anchor into body tissue being at least partially performed while a longitudinal central axis of the anchor has a first configuration, and changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration which is different than the first configuration while the anchor is in the body tissue.

49. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue with the suture extending from the anchor, changing the orientation of the anchor from a first orientation to a second orientation while the anchor is in the body tissue, and expanding the anchor while the anchor is disposed in the second orientation in the body tissue.

50. A method of anchoring a suture, said method comprising the steps of providing an anchor with a suture extending from the anchor, engaging an imperforate surface on body tissue with a first end portion of the anchor, applying force against a second end portion of the anchor to press the first end portion of the anchor against the body tissue and for an opening in the surface on the body tissue, moving the anchor through the opening into body tissue, and expanding the anchor in the body tissue, said step of expanding the anchor includes absorbing body liquid into the anchor and increasing the volume of the anchor as body liquid is absorbed into the anchor.

51. A method of as set forth in claim 50 further including the step of tensioning the suture to transmit force to the anchor.

52. A method as set forth in claim 50 wherein said step of providing an anchor includes providing an anchor which is formed of a first material which absorbs body liquid and a second material which is ineffective to absorb body liquid, said step of applying force against a second end portion of the anchor to press the first end portion of the anchor against the body tissue and form an opening in the surface on the body tissue includes pressing the second material against the body tissue and perforating the surface on the body tissue with the second material.

53. A method of anchoring a suture, said method comprising the steps of providing an anchor with a suture extending from the anchor, engaging an imperforate surface on body tissue with a member, forming an opening in the imperforate surface of the body tissue, moving at least a portion of the member into the body tissue through the opening in the surface of the body tissue, moving the anchor along a passage in the member with the suture extending from the anchor, moving the anchor out of the passage in the member into the body tissue, and expanding the anchor, said step of expanding the anchor includes absorbing body liquid into the anchor and increasing the volume of the anchor as body liquid is absorbed into the anchor.

54. A method of as set forth in claim 53 further including the step of resiliently compressing the anchor, said step of moving the anchor along a passage in the member is at least partially performed with the anchor compressed, said step of moving the anchor out of the passage in the member includes allowing the anchor to expand under the influence of its own natural resilience.

55. A method of as set forth in claim 53 further including the step of moving the anchor along a passage in the member is performed with a plurality of cells in the anchor collapsed, said method further expanding the plurality of collapsed cells as the anchor is moved out of the passage in the member into the body tissue.

56. A method of as set forth in claim 55 further including the step of absorbing body liquid with the anchor while expanding the plurality of collapsed cells.

57. A method as set forth in claim 53 wherein said method further includes withdrawing the member from the opening in the body tissue, said step of expanding the anchor being at least partially performed after having performed said step of withdrawing the member from the opening in the body tissue.

58. A method as set forth in claim 53 wherein said step forming an opening in the imperforate surface of the body tissue includes piercing the imperforate surface area on the body tissue with a leading end portion of the member.

59. A method as set forth in claim 53 wherein said steps of moving the anchor along a passage in the member and moving the anchor out of the passage in the member are at least partially performed with a portion of the member extending through the opening in the surface of the body tissue.

60. A method as set forth in claim 53 wherein said step o moving the anchor out of the passage in the member into the body tissue includes changing the orientation of the anchor from a first orientation to a second orientation which is different than the first orientation.

61. A method as set forth in claim 53 wherein said step of moving the anchor along a passage in the member is performed with an axis of the anchor extending parallel to an axis of the member, said method further including changing the orientation of the anchor to an orientation in which the axis of the anchor extends transverse to the axis of the member during performance of said step of moving the anchor out of the passage in the member into the body tissue.

62. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue, said step of inserting the anchor into body tissue being at least partially performed while a longitudinal central axis of the anchor has a first configuration, changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration which is different than the first configuration while the anchor is in the body tissue, and expanding the anchor in the body tissue, said step of expanding the anchor includes absorbing body liquid into the anchor and increasing the volume of the anchor as the body liquid is absorbed into the anchor.

63. A method as set forth in claim 62 wherein said step of inserting the anchor into body tissue is at least partially performed with the anchor compressed, said step of expanding the anchor includes removing compressive forces from the anchor and allowing the anchor to expand under the influence of its own natural resilience.

64. A method as set forth in claim 63 wherein said step of absorbing body liquid into the anchor is at least partially performed as the anchor expands under the influence of its own natural resilience.

65. A method as set forth in claim 62 wherein the anchor is at least partially formed of a cellular material, said step of inserting the anchor into body tissue being performed with cells in the cellular material of the anchor in a contracted condition, said step of expanding the anchor includes increasing the size of the cells of the anchor.

66. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue, said step of inserting the anchor into body tissue being at least partially performed while a longitudinal central axis of the anchor has a first configuration, and changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration which is different than the first configuration while the anchor is in the body tissue, said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes tensioning the suture to transmit force through the suture to the anchor and applying force against an outer side surface of the anchor with the body tissue in opposition to the force transmitted to the anchor through the suture.

67. A method as set forth in claim 66 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes changing the configuration of the longitudinal central axis of the anchor from a linear configuration to an arcuate configuration.

68. A method as set forth in claim 66 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes bending the anchor about an axis which extends transverse to the longitudinal central axis of the anchor.

69. A method as set forth in claim 66 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes applying force against a central portion of the anchor while performing said step of tensioning the suture.

70. A method as set forth in claim 66 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes applying force to opposite end portions of the anchor with the suture.

71. A method as set forth in claim 66 wherein said step of tensioning the suture to transmit force through the suture to the anchor and applying force against an outer side surface of the anchor with the body tissue includes moving a portion of the anchor and deflecting the anchor under the influence of force transmitted through the suture to the anchor.

72. A method as set forth in claim 66 wherein said step of inserting the anchor into body tissue includes moving the anchor into body tissue in a first direction, said step of tensioning the suture to transmit force through the suture to the anchor and applying force against an outer side surface of the anchor with the body tissue includes moving a central portion of the anchor relative to opposite end portions of the anchor in a direction opposite to the first direction.

73. A method as set forth in claim 66 wherein said step of inserting the anchor into body tissue includes moving the anchor into the body tissue in a first direction, said step of tensioning the suture to transmit force through the suture to the anchor and applying force against an outer side surface of the anchor with the body tissue includes moving opposite end portions of the anchor relative to a central portion of the anchor in a direction opposite to the first direction.

74. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue, said step of inserting the anchor into body tissue being at least partially performed while a longitudinal central axis of the anchor has a first configuration, and changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration which is different than the first configuration while the anchor is in the body tissue, said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration which is different than the first configuration includes applying force to opposite end portions of the anchor with the suture.

75. A method as set forth in claim 74 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes bending the anchor under the influence of the force applied to opposite end portions of the anchor with the suture.

76. A method as set forth in claim 74 wherein said step of inserting the anchor into body tissue is performed with the suture extending through the opposite end portions of the anchor, said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration includes tensioning a first section of the suture which extends from a first end portion of the anchor and tensioning a second section of the suture which extends from a second end portion of the anchor.

77. A method as set forth in claim 74 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes decreasing the distance between opposite end portions of the anchor.

78. A method as set forth in claim 74 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes changing the configuration of the longitudinal central axis of the anchor from a linear configuration to an arcuate configuration.

79. A method as set forth in claim 74 wherein said step of inserting the anchor into body tissue includes moving the anchor into body tissue in a first direction, said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes moving opposite end portions of the anchor relative to a central portion of the anchor in a direction opposite to the first direction.

80. A method as set forth in claim 74 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes bending the anchor about an axis which extends transverse to the longitudinal central axis of the anchor.

81. A method as set forth in claim 74 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes changing the configuration of the longitudinal central axis of the anchor from a linear configuration to an arcuate configuration.

82. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue, said step of inserting the anchor into body tissue being at least partially performed while a longitudinal central axis of the anchor has a first configuration, and changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration which is different than the first configuration while the anchor is in the body tissue, said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration which is different than the first configuration includes applying force to a central portion of the anchor with the suture.

83. A method as set forth in claim 82 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes bending the anchor under the influence of the force applied to the central portion of the anchor with the suture.

84. A method as set forth in claim 82 wherein said step of inserting the anchor into body tissue is performed with the suture connected with the central portion of the anchor, said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration includes tensioning the suture.

85. A method as set forth in claim 82 wherein said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes decreasing the distance between opposite end portions of the anchor.

86. A method as set forth in claim 82 wherein said step of inserting the anchor into body tissue includes moving the anchor into the body tissue in a first direction, said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes moving the central portion of the anchor relative to opposite end portions of the anchor in a direction opposite to the first direction.

87. A method as set forth in claim 82 wherein said step changing the configuration of the longitudinal central axis of the anchor from the first configuration to the second configuration includes changing the configuration of the longitudinal central axis of the anchor from a linear configuration to an arcuate configuration.

88. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue, said step of inserting the anchor into body tissue being at least partially performed while a longitudinal central axis of the anchor has a first configuration, and changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration which is different than the first configuration while the anchor is in the body tissue, said step of changing the configuration of the longitudinal central axis of the anchor from the first configuration to a second configuration which is different than the first configuration includes changing the configuration of at least a portion of the longitudinal central axis of the anchor from a linear configuration to an arcuate configuration.

89. A method as set forth in claim 88 further including the step of expanding the anchor in the body tissue.

90. A method as set forth in claim 88 further including the step of absorbing body liquid into the anchor while the anchor is in the body tissue.

91. A method as set forth in claim 88 wherein said step of changing the configuration of at least a portion of the longitudinal central axis of the anchor from a linear configuration to an arcuate configuration includes bending the anchor.

92. A method as set forth in claim 88 wherein said step of changing the configuration of at least a portion of the longitudinal central axis of the anchor from a linear configuration to an arcuate configuration includes tensioning the suture to apply force to the anchor.

93. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue with the suture extending from the anchor, changing the orientation of the anchor from a first orientation to a second orientation while the anchor is in the body tissue, and expanding the anchor while the anchor is disposed in the second orientation in the body tissue, said step of expanding the anchor includes absorbing body liquid into the anchor and increasing the volume of the anchor as body liquid is absorbed into the anchor.

94. A method as set forth in claim 93 wherein said step of changing the orientation of the anchor from a first orientation to a second orientation includes tensioning the suture and moving the anchor relative to the body tissue under the influence of force transmitted through the suture to the anchor.

95. A method as set forth in claim 93 wherein said step of inserting the anchor into body tissue includes moving the anchor along a path with a central axis of the anchor parallel to a central axis of the path, said step of changing the orientation of the anchor from the first orientation to the second orientation includes moving the anchor to an orientation in which the central axis of the anchor is skewed to the central axis of the path.

96. A method as set forth in claim 95 wherein said step of moving the anchor to an orientation in which the central axis of the anchor is skewed to the central axis of the path includes applying force to the anchor by tensioning the suture.

97. A method as set forth in claim 93 wherein said step of absorbing body liquid into the anchor includes attracting body liquid to the material of the anchor under the influence of molecular attraction.

98. A method as set forth in claim 93 wherein said step of absorbing body liquid into the anchor includes establishing molecular linkages between the body liquid and the material forming the anchor.

99. A method as set forth in claim 93 wherein the anchor is at least partially formed of a porous material, said step of absorbing body liquid into the anchor includes conducting body liquid into minute cavities in the material of the anchor under the influence of capillary action.

100. A method as set forth in claim 93 wherein said step of absorbing body liquid into the anchor includes holding body liquid in the material of the anchor under the influence of attractive forces between the body liquid and the material of the anchor.

101. A method as set forth in claim 93 wherein the anchor is at least partially formed of a material which is hydrophilic, said step of absorbing body liquid into the anchor is performed under the influence of attraction between the hydrophilic material of the anchor and the body liquid.

102. A method as set forth in claim 93 wherein the anchor is at least partially formed of a cellular material, said step of inserting the anchor into body tissue being performed with cells in the cellular material in a collapsed condition, said step of expanding the anchor includes increasing the size of the cells in the anchor.

103. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue with the suture extending from the anchor, changing the orientation of the anchor from a first orientation to a second orientation while the anchor is in the body tissue, and expanding the anchor while the anchor is disposed in the second orientation in the body tissue, the anchor is at least partially formed of a cellular material, said step of inserting the anchor into body tissue is performed with cells in the cellular material in a contracted condition, said step of expanding the anchor includes increasing the size of the cells of the anchor.

104. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue with the suture extending from the anchor, changing the orientation of the anchor from a first orientation to a second orientation while the anchor is in the body tissue, and expanding the anchor while the anchor is disposed in the second orientation in the body tissue, the anchor is at least partially formed of a material which is hydrophilic, said step of expanding the anchor includes conducting body liquid into the anchor under the influence of attraction between the hydrophilic material of the anchor and the body liquid.

105. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue with the suture extending from the anchor, changing the orientation of the anchor from a first orientation to a second orientation while the anchor is in the body tissue, and expanding the anchor while the anchor is disposed in the second orientation in the body tissue, said step of inserting the anchor into body tissue includes piercing an imperforate surface area on the body tissue with a leading end portion of the anchor and moving the anchor through an opening formed in the body tissue during performance of said step of piercing an imperforate surface area on the body tissue.

106. A method as set forth in claim 105 wherein said step of piercing an imperforate surface area on the body tissue with a leading end portion of the anchor includes applying force against a trailing end portion of the anchor with an inserter member, said step of changing the orientation of the anchor from the first orientation to the second orientation includes pivoting the anchor relative to the inserter member.

107. A method as set forth in claim 106 wherein said step of pivoting the anchor relative to the inserter member includes tensioning the suture.

108. A method as set forth in claim 105 wherein said step of piercing an imperforate surface area on the body tissue with the leading end portion of the anchor includes transmitting force from an inserter member to a trailing end portion of the anchor, said step of changing the orientation of the anchor the first orientation to the second orientation includes tensioning the suture and transmitting force between the inserter member and the trailing end portion of the anchor.

109. A method as set forth in claim 105 wherein said step of expanding the anchor includes absorbing body liquid into the anchor.

110. A method as set forth in claim 105 wherein said step of changing the orientation of the anchor from a first orientation to a second orientation includes applying torque to the anchor to move the anchor relative to the body tissue.

111. A method as set forth in claim 105 wherein said step of providing an anchor includes providing an anchor having a leading end portion formed of a first material and a second portion formed of a second material, said step of expanding the anchor includes absorbing body liquid with the second material.

112. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue with the suture extending from the anchor, changing the orientation of the anchor from a first orientation to a second orientation while the anchor is in the body tissue, expanding the anchor while the anchor is disposed in the second orientation in the body tissue, and changing the configuration of at least a portion of a longitudinal central axis of the anchor from a linear configuration to an arcuate configuration while the anchor is in the body tissue.

113. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue with the suture extending from the anchor, changing the orientation of the anchor from a first orientation to a second orientation while the anchor is in the body tissue, and expanding the anchor while the anchor is disposed in the second orientation in the body tissue, said step of changing the orientation of the anchor from a first orientation to a second orientation includes pivoting the anchor relative to body tissue while an outer side surface of the anchor is disposed in engagement with the body tissue.

114. A method as set forth in claim 113 wherein said step of pivoting the anchor relative to the body tissue includes applying torque to the anchor while the outer side surface of the anchor is disposed in engagement with body tissue.

115. A method as set forth in claim 113 wherein said step of pivoting the anchor relative to body tissue includes tensioning the suture to apply force against a portion of the anchor.

116. A method as set forth in claim 113 wherein said step of inserting the anchor into body tissue includes moving the anchor along a path with a central axis of the anchor parallel to a central axis of the path, said step of pivoting the anchor relative to the body tissue includes moving the anchor to an orientation in which central axis of the anchor is skewed relative to the central axis of the path.

117. A method as set forth in claim 113 wherein said step of expanding the anchor includes conducting body liquid into the anchor and increasing the size of at least a portion of the anchor while the anchor is disposed in the body tissue.

118. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue with the suture extending from the anchor, changing the orientation of the anchor from a first orientation to a second orientation while the anchor is in the body tissue, and expanding the anchor while the anchor is disposed in the second orientation in the body tissue, said step of changing the orientation of the anchor from a first orientation to a second orientation includes tensioning the suture to apply torque to the anchor while an outer side surface of the anchor is disposed in engagement with body tissue.

119. A method as set forth in claim 118 wherein said step of inserting the anchor into body tissue includes moving the anchor along a path with a central axis of the anchor parallel to a central axis of the path, said step of changing the orientation of the anchor from a first orientation to a second orientation includes moving the anchor to an orientation in which the central axis of the anchor is skewed to the central axis of the path.

120. A method as set forth in claim 118 wherein said step of inserting the anchor into body tissue includes transmitting force from an inserter member to a trailing end portion of anchor, said step of changing the orientation of the anchor from a first orientation to a second orientation includes transmitting force between the inserter member and the trailing end portion of the anchor while performing said step of tensioning the suture.

121. A method as set forth in claim 118 wherein said step of expanding the anchor includes absorbing body liquid into the anchor.

122. A method of anchoring a suture, said method comprising the steps of providing an anchor which has a suture extending from the anchor, inserting the anchor into body tissue with the suture extending from the anchor, changing the orientation of the anchor from a first orientation to a second orientation while the anchor is in the body tissue, and expanding the anchor while the anchor is disposed in the second orientation in the body tissue, said step of inserting the anchor into body tissue includes moving the anchor along a passage formed in a tubular member, said step of changing the orientation of the anchor from a first orientation to a second orientation includes moving the anchor along a bend formed in the passage in the tubular member.

123. A method as set forth in claim 122 wherein said step of expanding the anchor includes absorbing body liquid into the anchor.

124. A method of anchoring a suture, said method comprising the steps of providing an anchor which is formed of collagen, inserting the anchor formed of collagen into body tissue, expanding the anchor formed of collagen in the body tissue, said step of expanding the anchor formed of collagen includes absorbing body liquid into the anchor formed of collagen and increasing the volume of the anchor formed of collagen as body liquid is absorbed into the anchor, and tensioning a suture connected with the anchor formed of collagen to transmit force to the anchor formed of collagen.