Method and apparatus for anchoring a suture

• US 5,733,306 A
• Filed: 06/21/1996
• Issued: 03/31/1998
• Est. Priority Date: 05/14/1993
• 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): Buiz, Michael
• Assistant Examiner(s): TRUONG, KEVIN THAO
• Application Number:
  US08/667,549
• Time in Patent Office: 648 Days
• Field of Search: 606/232, 606/72, 606/220, 606/77, 128/898
• 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 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0411 Instruments for removing suture anchors for removing suture clamps, clips or locks A61B2017/049
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2090/062 penetration depth

Abstract

A tubular anchor may have a polygonal cross-sectional configuration with flat outer side surfaces areas connected by a plurality of outer corner portions. A passage through the anchor may be formed by flat inner side surfaces interconnected by inner corner portions. A suture is inserted through the passage. A concentrated force may be applied against a limited area on a trailing end of the anchor to rotate the anchor to move an outer corner portion of the anchor into engagement with body tissue. The suture may engage an inner corner portion of the anchor. The suture may be inserted through a plurality of anchors and the anchors moved through a tubular member into the body tissue under the influence of force transmitted from a trailing anchor to a leading anchor. When the leading anchor is moved into the body tissue, it is rotated under the influence of force applied against a trailing end of the leading anchor. If desired, two anchors may be interconnected. A groove may advantageously be provided along the leading end and side of an anchor to receive the suture.

Claims

1. A method of anchoring a suture, said method comprising the steps of providing an anchor, inserting a tubular member through an opening in body tissue, inserting a suture through a passage in the anchor, inserting the anchor and a portion of the suture into the tubular member, retaining the anchor against rotational movement about a longitudinal central axis of the tubular member by engaging the anchor with a locating surface in the tubular member, moving the anchor along the tubular member and through the opening in the body tissue, engaging the anchor with the locating surface in the tubular member during movement of the anchor along the tubular member, and moving the anchor from the tubular member into the body tissue.

2. A method as set forth in claim 1 wherein said step of retaining the anchor against rotational movement about a longitudinal central axis of the tubular member by engaging the anchor with a locating surface in the tubular member includes engaging a flat outer side surface on the anchor with a flat locating surface in the tubular member, said step of engaging the anchor with the locating surface in the tubular member includes sliding the flat outer side surface on the anchor along the flat locating surface in the tubular member during movement of the anchor along the tubular member.

3. A method as set forth in claim 1 wherein said step of retaining the anchor against rotational movement about a longitudinal central axis of the tubular member by engaging the anchor with a locating surface in the tubular member includes engaging an outer corner portion on the anchor with a groove in the tubular member, said step of engaging the anchor with the locating surface in the tubular member includes sliding the outer corner portion on the anchor along the groove in the tubular member during movement of the anchor along the tubular member.

4. A method as set forth in claim 1 wherein said step of providing an anchor includes providing an anchor having an outer side with flat outer side surface areas interconnected by an outer corner portion, the passage in the anchor having an inner surface having flat inner side surface areas interconnected by an inner corner portion which extend axially through the anchor, said step of retaining the anchor against rotational movement about a longitudinal central axis of the tubular member by engaging the anchor with a locating surface in the tubular member includes engaging the outer side of the anchor with the locating surface, said step of engaging the anchor with the locating surface in the tubular member includes sliding the outer side on the anchor along the locating surface in the tubular member during movement of the anchor along the tubular member.

5. A method as set forth in claim 4 further including the steps of moving the suture into engagement with the inner corner portion of the anchor and, thereafter, urging the outer corner portion and flat outer surface areas of the anchor into engagement with body tissue by tensioning the suture and transmitting force from the suture to the inner corner portion of the anchor.

6. A method as set forth in claim 1 wherein said step of moving the anchor along the tubular member is performed with the suture extending from a location disposed to one side of the body tissue, through the passage in the anchor, across a leading end portion of the anchor, along an outer side of the anchor, and to the location disposed to one side of the body tissue.

7. A method as set forth in claim 1 wherein said step of moving the anchor along the tubular member includes moving the anchor along a first path length, said step of moving the anchor from the tubular member into the body tissue includes moving the anchor along a second path length which extends transversely to the first path length under the influence of force applied against a trailing end of the anchor.

8. A method as set forth in claim 1 wherein said step of inserting the anchor and a portion of the suture into the tubular member includes positioning the anchor in the tubular member with the suture extending inward from an outer end of the tubular member through the passage in the anchor, across a leading end of the anchor, and back along a side portion of the anchor which is spaced from an inner side surface of the tubular member.

9. A method as set forth in claim 1 wherein said step of moving the anchor along the tubular member includes applying force against a trailing end of the anchor by pressing a second anchor against the trailing end of the anchor.

10. A method of anchoring a suture, said method comprising the steps of providing first and second anchors having axially extending central passages, inserting a suture through the central passages in the first and second anchors, and moving the first and second anchors into body tissue with the suture extending through the central passages in the first and second anchors, said step of moving the first and second anchors into body tissue including changing the orientation of the first anchor relative to the second anchor with the first anchor in the body tissue.

11. A method as set forth in claim 10 further including tensioning the suture to transmit force from the suture to at least one of the first and second anchors and transmitting force between the first and second anchors to move the first and second anchors relative to the body tissue with the first and second anchors in engagement with each other after having changed the orientation of the first anchor relative to the second anchor.

12. A method as set forth in claim 11 wherein each of the first and second anchors has a polygonal cross-sectional configuration with a plurality of flat outer side surfaces which extend axially along the anchor and a plurality of outer corner portions which extend axially along the anchor and interconnect the outer side surfaces of the anchor, said method further including urging a first corner portion on the first anchor and a first corner portion on the second anchor into engagement with the body tissue, urging flat outer side surfaces interconnected by the first corner portion of the first anchor into engagement with body tissue, and urging flat outer side surfaces interconnected by the first corner portion of the second anchor into engagement with body tissue by tensioning the suture.

13. A method as set forth in claim 12 wherein the central passages in the first and second anchors have inner corner portions, said steps of urging the corner portions and flat outer side surfaces on the first and second anchors into engagement with body tissue include transmitting force from the suture to the inner corner portions of the first and second anchors.

14. A method as set forth in claim 10 wherein said step of changing the orientation of the first anchor relative to the second anchor includes transmitting force from a leading end of the second anchor to a trailing end of the first anchor with the force applied to the trailing end of the first anchor concentrated at a small area on the trailing end of the first anchor at a location offset from a central axis of the first anchor.

15. A method as set forth in claim 10 wherein said step of changing the orientation of the first anchor relative to the second anchor includes applying torque to the first anchor to induce rotation of the first anchor about an axis which extends transversely to a central axis of the first anchor.

16. A method as set forth in claim 10 wherein said step of moving the first and second anchors into body tissue includes moving the first and second anchors along a first path length, said step of changing the orientation of the first anchor relative to the second anchor includes moving the first anchor along a path length which extends transversely to the first path length while continuing to move the second anchor along the first path length.

17. A method as set forth in claim 10 wherein said step of moving the first and second anchors into body tissue includes transmitting force to the suture from the first anchor to pull the suture into the body tissue with a first portion of the suture extending from a leading end portion of the first anchor through the central passages in the first and second anchors and with a second portion of the suture extending from the leading end portion of the first anchor along outer sides of the first and second anchors.

18. A method as set forth in claim 10 wherein said step of moving the first and second anchors into the body tissue includes transmitting force from a first portion of a leading end of the second anchor to a trailing end of the first anchor with a second portion of the leading end of the second anchor spaced from the trailing end of the first anchor, said step of changing the orientation of the first anchor relative to the second anchor includes engaging the second portion of the leading end of the second anchor with the trailing end of the first anchor.

19. A method as set forth in claim 10 wherein said step of changing the orientation of the first anchor relative to the second anchor includes moving the first anchor from an orientation in which a central axis of the first anchor is parallel to a central axis of the second anchor to an orientation in which the central axis of the first anchor is skewed relative to the central axis of the second anchor.

20. A method as set forth in claim 10 wherein the first and second anchors are interconnected by a connector portion, said step of changing the orientation of the first anchor relative to the second anchor includes bending the connector portion.

21. A method as set forth in claim 10 further including urging the first and second anchors into engagement with the body tissue after changing the orientation of the first anchor relative to the second anchor to an orientation in which a central axis of the first anchor is skewed relative to a central axis of the second anchor, said step of urging the first and second anchors into engagement with the body tissue includes tensioning the suture to press ends of the first and second anchors together with the central axis of the first anchor skewed relative to the central axis of the second anchor.

22. A method as set forth in claim 10 wherein said step of providing first and second anchors includes providing first and second anchors each of which has an outer side with flat outer side surface areas interconnected by an outer corner portion, the first and second anchors each having a central passage with an inner surface having flat inner side surface areas interconnected by an inner corner portion, said method further including moving the suture into engagement with the inner corner portion of the first anchor, moving the suture into engagement with the inner corner portion of the second anchor, urging the outer corner portion and flat outer side surface areas of the first anchor into engagement with body tissue under the influence of force transmitted to the inner corner portion of the first anchor from the suture, and urging the outer corner portion and flat outer side surface areas of the second anchor into engagement with body tissue under the influence of force transmitted to the inner corner portion of the second anchor into engagement with body tissue under the influence of force transmitted to the inner corner portion of the first anchor from the suture.

23. A method as set forth in claim 10 further including the steps of inserting a tubular member into the body tissue, and inserting the first and second anchors into the tubular member with the first anchor leading and with the suture extending from an open outer end of the tubular member through the central passage in the second anchor, through the central passage in the first anchor, across a leading end of the first anchor, along outer sides of the first and second anchors, and through the open outer end of the tubular member.

24. A method as set forth in claim 23 wherein said step of moving the first and second anchors into body tissue includes applying force against a trailing end of the second anchor to move the second anchor along the tubular member, and pressing a leading end of the second anchor against a trailing end of the first anchor to move the first anchor through the tubular member under the influence of force transmitted from the second anchor to the first anchor.

25. A method as set forth in claim 23 wherein said step of moving the first and second anchors into body tissue includes moving the first and second anchors along the tubular member and moving the first anchor through an open inner end of the tubular member into the body tissue while the second anchor remains in the tubular member, said step of changing the orientation of the first anchor relative to the second anchor includes moving first anchor transversely to a longitudinal central axis of the tubular member while the second anchor is in the tubular member and after the first anchor has moved through the open inner end of the tubular member.

26. A method as set forth in claim 25 wherein said step of moving the first anchor transversely to a longitudinal central axis of the tubular member includes tensioning the suture to apply force to a leading end portion of the first anchor.

27. A method as set forth in claim 25 wherein said step of moving the first anchor transversely to a longitudinal central axis of the tubular member includes transmitting force from a leading end of the second anchor to the trailing end of the first anchor.

28. A method as set forth in claim 10 further including the steps of inserting a tubular member into the body tissue, and inserting the first and second anchors into the tubular member with the first anchor leading and with the suture extending through the central passages in the first and second anchors, said step of moving the first and second anchors into body tissue includes moving the first and second anchors along the tubular member by transmitting force from a leading end portion of the second anchor to a trailing end portion of the first anchor with the force transmitted to the trailing end portion of the first anchor being offset to one side of a central axis of the first anchor and a central axis of the tubular member, and retaining the first anchor against rotational movement relative to the tubular member about an axis which extends transversely to the central axis of the tubular member by engaging the first anchor with the tubular member as first anchor moves along the tubular member.

29. A method as set forth in claim 28 wherein said step of moving the first and second anchors into body tissue includes moving the first anchor through an open end of the tubular member into the body tissue while the second anchor remains in the tubular member, said step of changing the orientation of the first anchor relative to the second anchor includes moving the first anchor transversely to the central axis of the tubular member under the influence of force transmitted from the leading end portion of the second anchor to a trailing end portion of the first anchor with the force transmitted to the trailing end portion of the first anchor being offset to one side of the central axis of the first anchor.

30. A method as set forth in claim 29 wherein said step of changing the orientation of the first anchor relative to the second anchor includes tensioning the suture to apply force to a leading end portion of the first anchor.

31. A method as set forth in claim 29 wherein said step of moving the first and second anchors into body tissue includes moving the second anchor through the open end of the tubular member into the body tissue, said method further including moving the first and second anchors transversely to the central axis of the tubular member by tensioning the suture.

32. A method as set forth in claim 10 further including the steps of inserting a tubular member into the body tissue, and inserting the first and second anchors into the tubular member with the first anchor leading and with the suture extending through the central passages in the first and second anchors, said step of moving the first and second anchors into body tissue includes moving the first anchor through an open end of the tubular member into the body tissue and thereafter moving the second anchor through the open end of the tubular member into the body tissue with the suture extending through the central passages in the first and second anchors.

33. A method as set forth in claim 32 further including moving the first and second anchors transversely to the central axis of the tubular member by tensioning the suture after having performed said step of moving the second anchor through the open end of the tubular member.

34. A method as set forth in claim 10 wherein said step of changing the orientation of the first anchor relative to the second anchor includes deforming a connector extending between the first and second anchors.

35. A method as set forth in claim 10 further including the steps of inserting a tubular member into the body tissue, and inserting the first and second anchors into the tubular member with the first anchor leading and with the suture extending through the central passages in the first and second anchors, said step of moving the first and second anchors into body tissue includes moving the first anchor through an open end of the tubular member into the body tissue, said step of changing the orientation of the first anchor relative to the second anchor includes tensioning the suture and deforming a connector extending between the first and second anchors under the influence of force transmitted through the suture, said step of tensioning the suture being performed with the second anchor at least partially disposed in the tubular member and after have performed said step of moving the first anchor through the open end of the tubular member into the body tissue.

36. A method as set forth in claim 10 further including the steps of inserting a tubular member into the body tissue, and inserting the first and second anchors into the tubular member with the first anchor leading and with the suture extending through the central passages in the first and second anchors, said step of moving the first and second anchors into body tissue includes applying force against a trailing end of the second anchor to move the second anchor along the tubular member, and pressing a leading end of the second anchor against a trailing end of the first anchor to move the first anchor along the tubular member under the influence of force transmitted from the second anchor to the first anchor.

37. A method as set forth in claim 36 further including the steps of retaining the first and second anchors against rotational movement about a longitudinal central axis of the tubular member by engaging the first and second anchors with a locating surface in the tubular member during movement of the first and second anchors along the tubular member.

38. A method as set forth in claim 37 wherein said step of retaining the first and second anchors against rotational movement about a longitudinal central axis of the tubular member by engaging the anchor with a locating surface in the tubular member includes engaging flat outer side surfaces on the anchors with a flat locating surface in the tubular member, said step of engaging the anchors with the locating surface in the tubular member includes sliding the flat outer side surfaces on the anchors along the flat locating surface in the tubular member during movement of the anchors along the tubular member.

39. A method as set forth in claim 38 wherein said step of retaining the first and second anchors against rotational movement about a longitudinal central axis of the tubular member by engaging the anchors with a locating surface in the tubular member includes engaging an outer corner portion on the first anchor and an outer corner portion on the second anchor with a groove in the tubular member, said step of engaging the anchors with the locating surface in the tubular member includes sliding the outer corner portions on the first and second anchors along the groove in the tubular member during movement of the first and second anchors along the tubular member.

40. A method of anchoring a suture, said method comprising the steps of providing first and second anchors having passages extending therethrough, each of the anchors having first and second end portions, inserting a suture through the passages in the first and second anchors, and moving the first and second anchors into body tissue with the suture extending through the passages in the first and second anchors, said step of moving the first and second anchors into body tissue including moving the first anchor through an opening in body tissue with the first end portion of the first anchor leading and the second end portion of the first anchor trailing, moving the second anchor through the opening in the body tissue with the first end portion of the second anchor pressing against the second end portion of the first anchor, and changing the orientation of the first anchor relative to the body tissue after moving the first anchor through the opening in the body tissue.

41. A method as set forth in claim 40 wherein said step of moving the first anchor through an opening in body tissue is performed under the influence of force transmitted from the first end portion of the second anchor to the second end portion of the first anchor.

42. A method as set forth in claim 40 wherein said step of changing the orientation of the first anchor relative to the body tissue includes transmitting force through the suture to the first end portion of the first anchor and transmitting force through the first end portion of the second anchor to the second end portion of the first anchor.

43. A method as set forth in claim 40 wherein said step of changing the orientation of the first anchor relative to the body tissue is performed with the first end portion of the second anchor in engagement with the second end portion of the first anchor.

44. A method as set forth in claim 40 wherein said step of changing the orientation of the first anchor relative to the body tissue includes transmitting force from the first end portion of the second anchor to the second end portion of the second anchor with the force applied to the send end portion of the first anchor concentrated at a small area on the second end portion of the first anchor at a location offset from a central axis of the first anchor.

45. A method as set forth in claim 40 wherein said step of changing the orientation of the first anchor relative to the body tissue includes applying torque to the first anchor to induce rotational movement of the first anchor along a path which extends transverse to a path of movement of the first anchor into the body tissue.

46. A method as set forth in claim 40 wherein said steps of moving the first and second anchors into body tissue and changing the orientation of the first anchor relative to the body tissue include moving the first and second anchors along a first path length and moving the first anchor along a second path length which extends transverse to the first path length while continuing to move the second anchor along the first path length.

47. A method as set forth in claim 40 further including the step of urging the first and second anchors into engagement with the body tissue after moving the first and second anchors into the body tissue and after changing the orientation of the first anchor relative to the body tissue, said step of urging the first and second anchors into engagement with the body tissue includes tensioning the suture and pressing the second end portion of the first anchor and the first end portion of the second anchor together under the influence of force transmitted through the suture.

48. A method as set forth in claim 40 further including the steps of inserting a tubular member through the opening in the body tissue, and inserting the first and second anchors into the tubular member, said steps of moving the first and second anchors into body tissue and changing the orientation of the first anchor relative to the body tissue include moving the first and second anchors along the tubular member with the first anchor leading, moving the first anchor through an open end of the tubular member while the second anchor is at least partially disposed in the tubular member, and, thereafter moving the first anchor transversely to a path of movement of the first and second anchors along the tubular member.

49. A method as set forth in claim 40 wherein said step of changing the orientation of the first anchor relative to the body tissue includes tensioning the suture.

50. A method as set forth in claim 40 wherein the first anchor has flat outer side surface areas, said step of changing the orientation of the first anchor relative to the body tissue includes pressing the flat outer side surface areas on the first anchor relative to the body tissue.

51. A method of anchoring a suture, said method comprising the steps of providing first and second anchors having passages extending therethrough, inserting a suture through the passages in the first and second anchors, and moving the first and second anchors into body tissue with the suture extending through the passages in the first and second anchors, said step of moving the first and second anchors into body tissue being performed with the first anchor leading the second anchor, said step of moving the first and second anchors into body tissue includes transmitting force from a leading end of the second anchor to a trailing end of the first anchor with the force transmitted to the trailing end of the first anchor concentrated at a small area on the trailing end of the first anchor at a location offset from a central axis of the first anchor.

52. A method as set forth in claim 51 wherein said step of moving the first and second anchors into body tissue includes transmitting force to the suture from the first anchor to pull the suture into the body tissue with a first portion of the suture extending from a leading end of the first anchor through the passages in the first and second anchors and with a second portion of the suture extending from the leading end of the first anchor along outer sides of the first and second anchors.

53. A method as set forth in claim 51 wherein said step moving the first and second anchors into body tissue includes moving the first anchor from an orientation in which a central axis of the first anchor is parallel to a central axis of the second anchor to an orientation in which the central axis of the first anchor is skewed relative to the central axis of the second anchor.

54. A method as set forth in claim 51 further including tensioning the suture to transmit force from the suture to at least the first anchor to move the first anchor relative to the body tissue with the first and second anchors in engagement with each other.

55. A method as set forth in claim 51 wherein the first anchor has a plurality of outer side surfaces which extend axially along the anchor and a corner portion which interconnects the outer side surfaces of the first anchor, said method further including urging the first corner portion on the first anchor into engagement with the body tissue and urging the flat outer side surfaces interconnected by the corner portion of the first anchor into engagement with body tissue by tensioning the suture.

58. A method as set forth in claim 51 wherein said step of moving first and second anchors into body tissue includes transmitting force from a rigid member to a trailing end of the second anchor with at least a portion of the force transmitted to the trailing end of the second anchor being concentrated at first and second small areas which are spaced apart on the trailing end of the second anchor.

56. A method as set forth in clam 51 wherein said step of moving first and second anchors into body tissue includes transmitting force from a rigid member to a trailing end of the second anchor with at least a portion of the force transmitted to the trailing end of the second anchor concentrated at a small area on the trailing end of the second anchor at a location offset from a central axis of the second anchor.

57. A method as set forth in claim 56 wherein the second anchor has a polygonal cross sectional cross sectional configuration with a plurality of flat outer side surfaces which extend axially along the anchor, said step of transmitting force from a rigid member to a trailing end of the second anchor with at least a portion of the force concentrated at a small area on the trailing end of the second anchor includes transmitting the force to an area which is disposed adjacent to one of the flat outer side surfaces of the second anchor.

59. A method of anchoring a suture, said method comprising the steps of providing at least one anchor having a passage extending therethrough, inserting a suture through the passage in the anchor, and moving the anchor into body tissue with the suture extending through the passage in the anchor, said step of moving the anchor into body tissue including transmitting force from a rigid member to a trailing end of the anchor with at least a portion of the force transmitted to the trailing end of the anchor being concentrated at first and second small areas which are spaced apart on the trailing end of the anchor.

60. A method as set forth in claim 59 wherein said step of providing at least one anchor includes providing an anchor having an outer side with surface areas interconnected by an outer corner portion, the passage through the anchor has inner side surface areas interconnected by an inner corner portion, said method further including moving the suture into engagement with the inner corner portion of the anchor, urging the outer corner portion and outer surface areas of the anchor into engagement with body tissue under the influence of force transmitted to the inner corner portion of the anchor from the suture.

61. A method as set forth in claim 59 further including the steps of transmitting force to a leading end of the anchor by tensioning the suture contemporaneously with performance of said step of transmitting force from a rigid member to a trailing end of the anchor.

62. A method of anchoring a suture, said method comprising the steps of providing first and second anchors having passages extending therethrough, inserting a suture through the passages in the first and second anchors, moving the first and second anchors into body tissue with the suture extending through the passages in the first and second anchors, and tensioning the suture to transmit force from the suture to at least one of the first and second anchors to move at least the one anchor relative to the body tissue.

63. A method as set forth in claim 62 wherein at least the one anchor has a plurality of outer side surfaces which extend axially along the one anchor and an outer corner portions which extend axially along the one anchor and interconnects the outer side surfaces of the one anchor, said method further including urging the corner portion on the one anchor into engagement with the body tissue, and urging outer side surfaces interconnected by the corner portion of the one anchor into engagement with body tissue under the influence of force transmitted from the suture to the one anchor.

64. A method as set forth in claim 62 further including the step of transmitting force from a leading end of the second anchor to a trailing end of the first anchor with the force applied to the trailing end of the first anchor concentrated at a small area on the trailing end of the first anchor at a location offset from a central axis of the first anchor contemporaneously with performance of said step of tensioning the suture.

65. A method of anchoring a suture, said method comprising the steps of providing first and second anchors, inserting a suture through passages in the first and second anchors, and moving the first and second anchors into body tissue with the suture extending through the passages in the first and second anchors, said step of moving the first and second anchors into body tissue including changing the orientation of the first and second anchors relative to the body tissue by tensioning the suture and transmitting force between the first and second anchors.

66. A method as set forth in claim 65 wherein each of the first and second anchors has a polygonal cross-sectional configuration with a plurality of flat outer side surfaces which extend axially along the anchor and a plurality of outer corner portions which extend axially along the anchor and interconnect the outer side surfaces of the anchor, said method further including urging a first corner portion on the first anchor and a first corner portion on the second anchor into engagement with the body tissue, urging flat outer side surfaces interconnected by the first corner portion of the first anchor into engagement with body tissue, and urging flat outer side surfaces interconnected by the first corner portion of the second anchor into engagement with tissue by tensioning the suture.

67. A method as set forth in claim 66 wherein the passages in the first and second anchors are central passages which extend axially through the first and second anchors and have inner corner portions, said steps of urging the corner portions and flat outer side surfaces on the first and second anchors into engagement with body tissue include transmitting force from the suture to the inner corner portions of the first and second anchors.

68. A method as set forth in claim 65 wherein said step of changing the orientation of the first and second anchors relative to body tissue by tensioning the suture and transmitting force between the first and second anchors includes transmitting force from a leading end of the second anchor to a trailing end of the first anchor with the force applied to the trailing end of the first anchor concentrated at a small area on the trailing end of the first anchor at a location offset from a central axis of the first anchor.

69. A method as set forth in claim 65 wherein said step of changing the orientation of the first and second anchors relative to body tissue by tensioning the suture and transmitting force between the first and second anchors includes applying torque to the first anchor to induce rotation of the first anchor about an axis which extends transversely to a central axis of the first anchor.

70. A method as set forth in claim 65 wherein said step of moving the first and second anchors into body tissue includes moving the first and second anchors along a first path length, said step of changing the orientation of the first and second anchors relative to body tissue by tensioning the suture and transmitting force between the first and second anchors includes moving the first anchor along a path length which extends transversely to the first path length while continuing to move the second anchor along the first path length.

71. A method as set forth in claim 65 wherein said step of moving the first and second anchors into body tissue includes transmitting force to the suture from the first anchor to pull the suture into the body tissue with a first portion of the suture extending through the passages in the first and second anchors and with a second portion of the suture extending along outer sides of the first and second anchors.

72. A method as set forth in claim 65 wherein said step of moving the first and second anchors into the body tissue is performed with the first anchor leading the second anchor and includes transmitting force from a leading end of the second anchor to a trailing end of the first anchor, said step of changing the orientation of the first and second anchors relative to body tissue by tensioning the suture and transmitting force between the first and second anchors includes transmitting force between the leading end of the second anchor and the trailing end of the first anchor.

73. A method as set forth in claim 65 wherein said step of changing the orientation of the first and second anchors to body tissue by tensioning the suture and transmitting force between the first and second anchors includes moving the first anchor from an orientation in which a central axis of the first anchor is parallel to a central axis of the second anchor to an orientation in which the central axis of the first anchor is skewed relative to the central axis of the second anchor.

74. A method as set forth in claim 65 wherein the first and second anchors are interconnected by a connector portion, said step of changing the orientation of the first and second anchors relative to body tissue by tensioning the suture and transmitting force between the first and second anchors includes bending the connector portion.

75. A method of anchoring a suture to a bone having an outer layer of harder bone and an inner layer of softer bone, said method comprising the steps of:

providing an opening extending through the outer layer of bone to the inner layer of bone;

connecting a suture with first and second suture anchors;

inserting the first and second suture anchors with the suture connected thereto through the opening into the inner layer of bone; and

tensioning the suture to change the orientation of the first and second suture anchors within the inner layer of bone to block movement of the first and second suture anchors out of the opening in the outer layer of bone.

76. A method as set forth in claim 75 wherein said step of connecting a suture with first and second suture anchors includes the step of providing first and second suture anchors each of which has a length greater than its width, and said step of providing an opening in the bone includes providing an opening which is at least as large as the width of either one of said first and second suture anchors but substantially smaller than a combined length of said first and second suture anchors.

77. A method of anchoring a suture, said method comprising the steps of providing first and second anchors, each of the anchors having an outer side which extends axially along the anchor between first and second end portions of the anchor and a passage which extends through the anchor, inserting a suture through the passages extending through the first and second anchors, moving the first and second anchors through an opening in body tissue with the first end portion of the first anchor leading and with the second end portion of the first anchor trailing and with the first end portion of the second anchor leading and disposed adjacent to the second end portion of the first anchor and with the second end portion of the second anchor trailing, said step of moving the first and second anchors through the opening in body tissue being performed with the suture extending through the passages in the first and second anchors and along the outer sides of the first and second anchors, and, thereafter, urging the outer sides of the first and second anchors into engagement with the body tissue by tensioning the suture and transmitting force from the suture to the first and second anchors.

78. A method as set forth in claim 77 wherein the outer sides of each of the first and second anchors include flat outer side surface areas interconnected by an outer corner portion each of the first and second anchors having flat inner side surface areas which are interconnected by an inner corner portion, said step of urging the outer sides of the first and second anchors into engagement with body tissue by tensioning the suture and transmitting force from the suture to the inner side of the first and second anchors includes transmitting force from the suture to the inner corner portion of the first anchor to urge the outer corner portion of the first anchor into engagement with the body tissue and transmitting force from the suture to the inner corner portion of the second anchor to urge the outer corner portion of the second anchor into engagement with the body tissue.

79. A method as set forth in claim 77 further including the step of changing the orientation of the first and second anchors relative to the body tissue during performance of said step of tensioning the suture.

80. A method as set forth in claim 77 wherein said step of tensioning the suture includes pressing the second end portion of the first anchor and the first end portion of the second anchor together under the influence of force transmitted from the suture.

81. A method of anchoring a suture, said method comprising the steps of providing at least one anchor having a polygonal cross-sectional configuration, the one anchor being formed by a plurality of side portions which extend axially along the one anchor and a plurality of corner portions which extend axially along the one anchor and interconnect the side portions, inserting a suture through a passage formed in the one anchor, moving the one anchor along a first path length into body tissue by applying force against a trailing end of the one anchor, pressing the one corner portion of the one anchor against body tissue under the influence of force applied against one anchor, moving the one anchor along a second path length which extends transversely to the first path length under the influence of force applied against the trailing end of the one anchor, and pressing side portions of the one anchor interconnected by the one corner portion against the body tissue under the influence of force transmitted from the suture to the one anchor.

82. A method as set forth in claim 81 wherein said step of providing at least one anchor includes providing a second anchor having a polygonal cross-sectional configuration, the second anchor being formed by a plurality of side portions which extend axially along the second anchor and a plurality of corner portions which extend axially along the second anchor and interconnect the side portions of the second anchor, said method further including the steps of inserting the suture through a passage formed in the second anchor and moving the second anchor along the first path length with the one anchor and with the suture extending through the one anchor and the second anchor, said step of pressing the one corner portion of the one anchor against body tissue under the influence of force applied against the one anchor including transmitting force from a leading end of the second anchor to a trailing end of the one anchor, said step of moving the one anchor along the second path length which extends transversely to the first path length under the influence of force applied against the one anchor includes transmitting force from the leading end of the second anchor to the trailing end of the one anchor.

83. A method of anchoring a suture in body tissue, said method comprising the steps of positioning a tubular member relative to the body tissue, providing first and second anchors, inserting a suture through passages in the first and second anchors, inserting the first and second anchors into the tubular member with the first anchor leading and with the suture extending from a location outside of the tubular member through the passages in the first and second anchors, along outer sides of the first and second anchors and back to a location outside of the tubular member, applying force against an end portion of the second anchor and transmitting force from the second anchor to the first anchor, moving the first anchor and a portion of the suture through an open end of the tubular member, moving at least a portion of the first anchor to a location offset to a first side of the tubular member under the influence of force which is applied to the second anchor and transmitted from the second anchor to the first anchor, thereafter, moving the second anchor through the open end of the tubular member, and moving at least a portion of the second anchor to a location offset to a second side of the tubular member under the influence of force which is transmitted to the second anchor through the suture and first anchor.

84. A method as set forth in claim 83 wherein the first and second anchors are interconnected by a connector section, said step of moving at least a portion of the first anchor to a location offset to a first side of the tubular member includes deforming the connector section.

85. A method as set forth in claim 83 further including pressing a corner portion on an outer side of the first anchor against body tissue adjacent to the first side of the tubular member and pressing a corner portion on an outside of the second anchor against body tissue adjacent to the second side of the tubular member after having performed said steps of moving the first and second anchors through the open end of the tubular member.

86. A method as set forth in claim 83 wherein said step of transmitting force from the second anchor to the first anchor includes applying force against a trailing end portion of the first anchor with the force concentrated at an area which is offset to one side of a central axis of the first anchor, said step of moving at least a portion of the first anchor to a location offset to a first side of the tubular member includes moving the first anchor under the influence of the force which is applied against the trailing end portion of the first anchor and is concentrated in an area which is offset to one side of a central axis of the first anchor.