Method and apparatus for positioning a suture anchor

• US 6,056,772 A
• Filed: 05/26/1998
• Issued: 05/02/2000
• Est. Priority Date: 02/04/1993
• 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): NGO, LIEN M
• Application Number:
  US09/084,627
• Time in Patent Office: 707 Days
• Field of Search: 606/232, 606/139, 604/264, 604/230
• 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 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3431 being collapsible, e.g. made of thin flexible material A61B17/3423 takes precedence
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• 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 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle
• CPC Class Codes: A61B 2017/3486 Balloon
• CPC Class Codes: A61M 2025/0024 Expandable catheters or sheaths
• CPC Class Codes: A61M 2025/0089 Single injection needle protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip
• CPC Class Codes: A61M 2025/0095 being one or more needles protruding from the distal tip and which are not used for injection nor for electro-stimulation, e.g. for fixation purposes
• CPC Class Codes: A61M 25/0084 being one or more injection needles
• CPC Class Codes: A61M 25/04 in the body, e.g. expansible A61M25/10, A61M16/0488 take precedence
• CPC Class Codes: A61M 25/06 Body-piercing guide needles or the like
• CPC Class Codes: A61M 25/0662 Guide tubes

Abstract

An inserter assembly is operable between a closed condition blocking movement of a suture anchor through the inserter assembly and an open condition in which the inserter assembly is ineffective to block movement of the anchor. The inserter assembly may have an end portion which pierces body tissue. In one embodiment, a tubular member has a plurality of segments which are moved from a closed condition to an open condition. In another embodiment, a plurality of wires extend along an inner side of a passage in a sheath. As the suture anchor slides along the wires, force is transmitted to the sheath to expand the sheath and operate the inserter assembly from the closed condition to the open condition. If desired, the wires may be omitted and the sheath resiliently expanded by a member which encloses the suture anchor. Indicia may be provided to indicate the depth to which the inserter assembly is inserted into body tissue.

Claims

1. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor having a suture disposed in engagement with the suture anchor, positioning an end portion of a tubular member having a sheath which encloses a plurality of wires relative to body tissue, and moving the suture anchor through the end portion of the tubular member into the body tissue with the suture engaging the suture anchor, said step of moving the suture anchor through the end portion of the tubular member into the body tissue includes sliding an outer side surface of the suture anchor along side surfaces of the wires.

2. A method as set forth in claim 1 wherein said step of positioning an end portion of a tubular member having a sheath which encloses a plurality of wires relative to body tissue includes engaging the body tissue with a leading end portion of at least one of the wires and a leading end portion of the sheath and piercing the body tissue with the leading end portion of the one wire and the sheath under the influence of force transmitted through the tubular member.

3. A method as set forth in claim 1 wherein said step of moving the suture anchor through the end portion of the tubular member into the body tissue includes transmitting force from the suture anchor to the side surfaces of the wires and expanding the sheath under the influence of the force transmitted from the suture anchor to the wires.

4. A method as set forth in claim 1 wherein said step of moving the suture anchor through the end portion of the tubular member includes maintaining the outer side surface of the suture anchor in a spaced apart relationship with an inner side surface of the sheath while sliding the suture anchor along side surfaces of the wires.

5. A method as set forth in claim 1 wherein said step of moving the suture anchor through the end portion of the tubular member includes holding longitudinally extending portions of an inner side surface of the sheath spaced apart from an outer side surface of the suture anchor as the suture anchor moves through the end portion of the tubular member.

6. A method as set forth in claim 1 further including moving the suture anchor along a main portion of the tubular member connected with the end portion of the tubular member prior to moving the suture anchor through the end portion of the tubular member, at least a portion of said step of moving the suture anchor along a main portion of the tubular member includes engaging side surfaces of portions of the wires with the suture anchor.

7. A method as set forth in claim 6 wherein the main portion of the tubular member has a first cross-sectional area as viewed in a plane extending perpendicular to a longitudinal central axis of the tubular member and the end portion of the tubular member has a second cross-sectional area as viewed in a plane extending perpendicular to a longitudinal central axis of the tubular member, the first cross-sectional area being greater than the second cross-sectional area, said step of moving the suture anchor through the end portion of the tubular member includes increasing the cross-sectional area of the end portion of the tubular member from the second cross-sectional area to a cross-sectional area which is greater than the second cross-sectional area.

8. A method as set forth in claim 1 wherein the tubular member has a main portion with a first cross-sectional area as viewed in a plane extending perpendicular to a longitudinal central axis of the tubular member, the end portion of the tubular member has a cross-sectional area which is smaller than the first cross-sectional area as viewed in a plane extending perpendicular to the longitudinal central axis of the tubular member, and a transition portion of the tubular member has a cross-sectional area which tapers from the first cross-sectional area to the second cross-sectional area, said method further including moving a leading end portion of the suture anchor along the side surfaces of the wires in the transition portion of the tubular member and expanding at least a portion of the transition portion of the tubular member under the influence of force transmitted to the side surfaces of the wires in the transition portion of the tubular member.

9. A method as set forth in claim 1 wherein said step of positioning an end portion of a tubular member relative to body tissue includes inserting the end portion of the tubular member into body tissue, measuring the distance which the end portion of the tubular member is inserted into body tissue during insertion of the end portion of the tubular member into body tissue, and interrupting said step of inserting an end portion of the tubular member into body tissue in response to measuring of a distance which corresponds to a desired distance of insertion of the tubular member into body tissue.

10. A method as set forth in claim 1 wherein said step of positioning an end portion of a tubular member relative to body tissue includes inserting the end portion of the tubular member into body tissue, covering indicia on the tubular member with body tissue as the tubular member is inserted into the body tissue, and interrupting said step of inserting the tubular member into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular member into body tissue.

11. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor which has a passage, providing a suture having a first portion which extends through the passage in the suture anchor and a second portion which extends along an outer side of the suture anchor, providing a tubular member having a sheath with a plurality of wires which extend along an inner side of at least a portion of a passage in the sheath, and moving the anchor along the passage in the sheath, said step of moving the anchor along the passage in the sheath being at least partially performed with the first portion of the suture extending through the passage in the suture anchor and the second portion of the suture extending along the outer side surface of the suture anchor at a location between adjacent wires of the plurality of wires.

12. A method as set forth in claim 11 wherein said step of moving the suture anchor along the passage in the sheath includes sliding an outer side surface of the suture anchor along side surfaces of the wires.

13. A method as set forth in claim 11 wherein said step of moving the anchor along the passage in the sheath includes applying force against a trailing end portion of the anchor with a pusher member and applying force against the wires with a leading end portion of the anchor to expand the passage in the sheath.

14. A method as set forth in claim 11 further including the steps of inserting at least a portion of the tubular member into body tissue and piercing the body tissue with the tubular member.

15. A method as set forth in claim 14 wherein said step of piercing the body tissue includes engaging the body tissue with a leading end portion of at least one of the wires and a leading end portion of the sheath.

16. A method as set forth in claim 11 further including the steps of inserting at least a portion of the tubular member into body tissue, covering indicia on the tubular member with body tissue as the tubular member is inserted into the body tissue, and interrupting said step of inserting the tubular member into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular member into body tissue.

17. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a tubular sheath having a passage and a plurality of wires which extend along an inner side of the passage, inserting an end portion of the sheath and end portions of the wires into body tissue, and moving a suture anchor through the passage in the sheath into the body tissue with a suture engaging the suture anchor, said step of moving the suture anchor through the passage in the sheath into body tissue includes expanding the sheath by applying force against the wires and transmitting force through the wires to the sheath.

18. A method as set forth in claim 17 wherein said step of expanding the sheath includes increasing a cross-sectional size of at least a portion of the passage in the sheath from a first cross-sectional size in which movement of the anchor through at least the portion of the passage in the sheath is blocked to a second cross-sectional size in which the anchor can move through the portion of the passage in the sheath.

19. A method as set forth in claim 17 wherein said step of applying force against the wires includes pressing an outer side surface of the suture anchor against the wires.

20. A method as set forth in claim 17 further including the step of at least partially enclosing the suture anchor with an expansion member during movement of the anchor through the passage in the sheath, said step of applying force against the wires includes pressing an outer side surface of the expansion member against the wires.

21. A method as set forth in claim 17 wherein said step of inserting an end portion of the sheath and end portions of the wires into body tissue includes piercing the body tissue to form an opening in the body tissue and moving the end portion of the sheath and end portions of the wires into the opening in the body tissue.

22. A method as set forth in claim 21 wherein said step of piercing the body tissue to form an opening in the body tissue includes cutting body tissue with a leading end portion of the sheath.

23. A method as set forth in claim 21 wherein said step of piercing the body tissue includes engaging the body tissue with a leading end portion of a t least one of the wires and a leading end portion of the sheath.

24. A method as set forth in claim 21 wherein said step of piercing the body tissue includes initiating the formation of an opening in an imperforate surface area on the body tissue.

25. A method as set forth in claim 17 wherein said step of inserting an end portion of a tubular sheath into body tissue includes covering indicia on the tubular sheath with body tissue as the tubular sheath is inserted into the body tissue, and interrupting said step of inserting the tubular sheath into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular sheath into body tissue.

26. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a tubular sheath having a passage which extends through the sheath, inserting an end portion of the sheath into body tissue, expanding the end portion of the sheath inserted into the body tissue, said step of expanding the end portion of the sheath includes moving a tubular member cross-sectional size of the end portion of the sheath from a first cross-sectional size to a second cross-sectional size under the influence of force transmitted from the tubular member to the sheath, and moving a suture anchor through the tubular member into the body tissue while the end portion of the sheath has the second cross-sectional size.

27. A method as set forth in claim 26 wherein said step of inserting an end portion of the sheath into body tissue includes piercing the body tissue with the end portion of the sheath and moving the end portion of the sheath into the body tissue.

28. A method as set forth in claim 26 wherein said step of increasing the cross-sectional size of the end portion of the sheath from a first cross-sectional size to a second cross-sectional size under the influence of force transmitted from the tubular member to the sheath includes transmitting force from the tubular member to the outer side surfaces of the wires and transmitting force from the wires to the sheath.

29. A method as set forth in claim 26 wherein said step of inserting an end portion of the sheath into body tissue includes covering indicia on the sheath with body tissue as the sheath is inserted into the body tissue, and interrupting said step of inserting the sheath into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the sheath into body tissue.

30. An apparatus for use in positioning a suture anchor relative to body tissue, said apparatus comprising a tubular member through which the suture anchor is movable and a pusher member which is at least partially disposed in and is movable relative to said tubular member to move the suture anchor relative to said tubular member, said tubular member includes a sheath and an array of wires which extend along an inner side of said sheath, said wires of said array of wires have longitudinally extending surface means for engaging the suture anchor as the suture anchor is moved through said tubular member by said pusher member.

31. An apparatus as set forth in claim 30 wherein said sheath is resiliently expandable under the influence of force transmitted from the suture anchor to said sheath as the suture anchor is moved through said tubular member by said pusher member.

32. An apparatus as set forth in claim 30 wherein said tubular member has an end portion which is operable between a closed condition blocking movement of the suture anchor through the end portion of said tubular member and an open condition in which the end portion of said tubular member is ineffective to block movement of the suture anchor through the end portion of said tubular member into body tissue.

33. An apparatus as set forth in claim 30 wherein at least a portion of each of said wires is integrally formed as one piece with said sheath to interconnect said wires and said sheath.

34. An apparatus as set forth in claim 30 wherein each of said wires includes a longitudinally extending core having a generally circular cross sectional configuration and a jacket which at least partially encloses said core, said surface means for engaging the suture anchor being disposed on said jackets of said wires.

35. An apparatus as set forth in claim 30 wherein said array of wires blocks engagement of the suture anchor with the sheath during movement of the suture anchor relative to at least a portion of said tubular member.

36. An apparatus as set forth in claim 30 wherein said tubular member has a pointed end portion for piercing body tissue, said pointed end portion of said tubular member being formed by said sheath and said wires.

37. An apparatus for use in positioning a suture anchor in body tissue, said apparatus comprising a longitudinally extending tubular sheath, a plurality of longitudinally extending wires which are enclosed by said sheath and extend along an inner side of said sheath, and pusher means for transmitting force which moves the suture anchor along said wires and into the body tissue, said wires have surface means for engaging the suture anchor and holding the suture anchor in a spaced apart relationship with said sheath during movement of the suture anchor along said wires.

38. An apparatus as set forth in claim 37 wherein a pair of said wires cooperate with said sheath to at least partially define a longitudinally extending channel, said pusher means being effective to move the suture anchor along said wires with a suture connected with the suture anchor at least partially disposed in the channel.

39. An apparatus as set forth in claim 37 wherein said sheath is formed of a material capable of being extended from a first condition in which at least a portion of a longitudinally extending passage through said sheath has a relatively small cross sectional size to a second condition in which at least a portion of the passage has a relatively large cross sectional size, said pusher means being effective to transmit force which is transmitted from the suture anchor through said wires to said sheath to extend at least a portion of said sheath from the first condition to the second condition during movement of the suture anchor along said wires.

40. An apparatus as set forth in claim 39 wherein said sheath is formed of a material which is resiliently expandable, said sheath being extended from the first condition to the second condition by resilient expansion of the material of said sheath.

41. An apparatus as set forth in claim 37 wherein each of said wires is integrally formed as one piece with said sheath to interconnect said sheath and said wires.

42. An apparatus as set forth in claim 37 wherein each of said wires includes a longitudinally extending core having a generally circular cross sectional configuration and a jacket which at least partially encloses said core, said surface means for engaging the suture anchor being disposed on said jackets of said wires.

43. An apparatus as set forth in claim 42 wherein said jackets are integrally formed as one piece with said sheath to interconnect said wires and said sheath.

44. An apparatus as set forth in claim 37 wherein said plurality of wires extend along the inner side of said sheath between opposite end portions of said sheath.

45. An apparatus as set forth in claim 44 wherein said plurality of wires extend along the inner side of said sheath from a location disposed between opposite end portions of said sheath to one of the end portions of said sheath.

46. An apparatus as set forth in claim 45 wherein said one of said end portions of said sheath has a pointed configuration to facilitate piercing of body tissue.

47. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor having a suture disposed in engagement with the suture anchor, providing a tubular member, said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, moving the suture anchor along a passage in the tubular member with the suture disposed in engagement with the suture anchor, said step of moving the suture anchor along a passage in the tubular member includes sliding the suture anchor along the wires, expanding at least a portion of the passage in the tubular member while moving the suture anchor along the passage in the tubular member, and moving the suture anchor out of the passage in the tubular member into the body tissue with the suture disposed in engagement with the suture anchor.

48. A method as set forth in claim 47 wherein said step of expanding at least a portion of the passage in the tubular member includes transmitting force from a leading end portion of the suture anchor to the tubular member while moving the suture anchor along the passage in the tubular member and expanding at least a portion of the tubular member under the influence of the force transmitted from the leading end portion of the suture anchor to the tubular member.

49. A method as set forth in claim 47 further including the step of inserting the tubular member into the body tissue by piercing the body tissue with an end portion of the tubular member prior to performing said step of expanding at least a portion of the passage in the tubular member.

50. A method as set forth in claim 47 wherein said step of expanding at least a portion of the passage in the tubular member includes resiliently stretching material which forms at least a portion of the tubular member.

51. A method as set forth in claim 47 further including the steps of inserting the tubular member into body tissue, covering indicia on the tubular member with body tissue as the tubular member is inserted into the body tissue, and interrupting said step of inserting the tubular member into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular member into body tissue.

52. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor having a suture disposed in engagement with the suture anchor, providing a tubular member, said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, moving the suture anchor along a passage in the tubular member with the suture disposed in engagement with the suture anchor, said step of moving the suture anchor along a passage in the tubular member includes applying force against the suture anchor with a pusher member and sliding the pusher member along the wires, expanding at least a portion of the passage in the tubular member while moving the suture anchor along the passage in the tubular member, and moving the suture anchor out of the passage in the tubular member into the body tissue with the suture disposed in engagement with the suture anchor.

53. A method as set forth in claim 52 wherein said step of expanding at least a portion of the passage in the tubular member includes transmitting force from a leading end portion of the suture anchor to the tubular member while moving the suture anchor along the passage in the tubular member and expanding at least a portion of the tubular member under the influence of the force transmitted from the leading end portion of the suture anchor to the tubular member.

54. A method as set forth in claim 52 further including the step of inserting the tubular member into the body tissue by piercing the body tissue with an end portion of the tubular member prior to performing said step of expanding at least a portion of the passage in the tubular member.

55. A method as set forth in claim 52 wherein said step of expanding at least a portion of the passage in the tubular member includes resiliently stretching material which forms at least a portion of the tubular member.

56. A method as set forth in claim 52 further including the steps of inserting the tubular member into body tissue, covering indicia on the tubular member with body tissue as the tubular member is inserted into the body tissue, and interrupting said step of inserting the tubular member into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular member into body tissue.

57. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a tubular sheath having a passage which extends through the sheath, said step of providing a tubular sheath includes providing a tubular sheath having a plurality of wires disposed in the passage through the sheath, inserting an end portion of the sheath into body tissue, expanding the end portion of the sheath inserted into the body tissue, said step of expanding the end portion of the sheath includes moving a tubular member into the end portion of the sheath and increasing the cross-sectional size of the end portion of the sheath from a first cross-sectional size to a second cross-sectional size under the influence of force transmitted from the tubular member to the sheath, said step of moving a tubular member into the end portion of the sheath includes sliding an outer side surface of the tubular member along outer side surfaces of the wires, and moving a suture anchor through the tubular member into the body tissue while the end portion of the sheath has the second cross-sectional size.

58. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor having a suture disposed in engagement with the suture anchor, providing a tubular member having a longitudinally extending body portion and an end portion, moving the suture anchor along a passage in the tubular member with the suture disposed in engagement with the suture anchor, expanding at least a portion of the passage in the tubular member while moving the suture anchor along the passage in the tubular member, said step of expanding at least a portion of the passage in the tubular member includes expanding at least a portion of the longitudinally extending body portion of the tubular member while the suture anchor is spaced from the end portion of the tubular member, and moving the suture anchor out of the passage in the tubular member into the body tissue through the end portion of the tubular member with the suture disposed in engagement with the suture anchor.

59. A method as set forth in claim 58 wherein said step of expanding at least a portion of the passage in the tubular member includes expanding the end portion of the tubular member after performing said step of expanding the body portion of the tubular member.

60. A method as set forth in claim 59 wherein said step of moving the suture anchor out of the passage in the tubular member into the body tissue through the end portion of the tubular member is at least partially performed after performing said step of expanding the end portion of the tubular member.

61. A method as set forth in claim 59 wherein said step of expanding the end portion of the tubular member is performed while at least a portion of the longitudinally extending body portion remains expanded.

62. A method as set forth in claim 58 wherein said step of expanding at least a portion of the passage in the tubular member includes transmitting force from a leading end portion of the suture anchor to the tubular member while the suture anchor is spaced from the end portion of the tubular member and while moving the suture anchor along the passage in the tubular member and expanding at least a portion of the tubular member under the influence of the force transmitted from the leading end portion of the suture anchor to the tubular member while the suture anchor is spaced from the end portion of the tubular member.

63. A method as set forth in claim 58 further including the step of inserting the tubular member into the body tissue by piercing the body tissue with an end portion of the tubular member prior to performing said step of expanding at least a portion of the passage in the tubular member.

64. A method as set forth in claim 58 wherein said step of expanding at least a portion of the passage in the tubular member includes resiliently stretching material which at least partially forms the body portion of the tubular member while the suture anchor is spaced from the end portion of the tubular member.

65. A method as set forth in claim 58 wherein said step of moving the suture anchor out of the passage in the tubular member includes moving segments of the tubular member from an initial position in which portions of the segments of the tubular member are disposed in engagement with each other to an extended position in which the portions of the segments of the tubular member are spaced apart from each other.

66. A method as set forth in claim 58 wherein said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, said step of expanding at least a portion of the longitudinally extending body portion of the tubular member includes sliding the suture anchor along the wires.

67. A method as set forth in claim 66 wherein said step of expanding at least a portion of the passage in the tubular member includes expanding at least a portion of the sheath under the influence of force applied against the wires by the suture anchor while sliding the suture anchor along the wires while the suture anchor is spaced from the end portion of the tubular member.

68. A method as set forth in claim 58 wherein said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, said step of expanding at least a portion of the passage in the tubular member includes applying force against the suture anchor with a pusher member and moving the pusher member along the wires.

69. A method as set forth in claim 58 further including the steps of inserting the tubular member into body tissue, covering indicia on the tubular member with body tissue as the tubular member is inserted into the body tissue, and interrupting said step of inserting the tubular member into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular member into body tissue.

70. A method of positioning a suture anchor relative to a patient'"'"'s body tissue, said method comprising the steps of providing a suture anchor formed of body tissue having a suture disposed in engagement with the suture anchor, providing a tubular member, moving the suture anchor formed of body tissue along a passage in the tubular member with the suture disposed in engagement with the suture anchor, and moving the suture anchor formed of body tissue out of the passage in the tubular member into the patient'"'"'s body tissue with the suture disposed in engagement with the suture anchor formed of body tissue.

71. A method as set forth in claim 70 further including the step of expanding at least a portion of the passage in the tubular member by transmitting force from an expansion member to the tubular member while moving the suture anchor formed of body tissue along the passage in the tubular member without transmitting force from the suture anchor formed of body tissue to the tubular member and expanding at least a portion of the tubular member under the influence of the force transmitted from the expansion member to the tubular member.

72. A method as set forth in claim 70 further including the step of forming an opening in the patient'"'"'s body tissue by piercing the patient'"'"'s body tissue with an end portion of the tubular member, said step of moving the suture anchor formed of body tissue out of the passage in the tubular member includes moving the suture anchor through an opening in the end portion of the tubular member which pieced the patient'"'"'s body tissue.

73. A method as set forth in claim 71 further including the step of expanding at least a portion of the passage in the tubular member by resiliently stretching material which forms at least a portion of the tubular member without transmitting force from the suture anchor formed of body tissue to the tubular member.

74. A method as set forth in claim 70 further including the step of moving segments of the tubular member from an initial position in which portions of the segments of the tubular member are disposed in engagement with each other to an extended position in which the portions of the segments of the tubular member are spaced apart from each other without transmitting force from the suture anchor formed of body tissue to the tubular member.

75. A method as set forth in claim 70 further including the step of providing an inner member, said step of moving the suture anchor formed of body tissue along the passage in the tubular member is performed with the suture anchor formed of body tissue enclosed by the inner member and spaced from the tubular member.

76. A method as set forth in claim 72 further including the step of expanding at least a portion of the passage in the tubular member without transmitting force from the suture anchor formed of body tissue to the tubular member.

77. A method as set forth in claim 75 further including the step of expanding at least a portion of the passage in the tubular member by applying force against the tubular member with the inner member while the suture anchor formed of body tissue is enclosed by the inner member and is spaced from the tubular member.

78. A method as set forth in claim 70 wherein said step of moving the suture anchor formed of body tissue along a passage in the tubular member is performed with at least a portion of the suture anchor formed of body tissue enclosed by an inner member, said method further includes the step of expanding at least a portion of the passage in the tubular member includes transmitting force from the inner member to the tubular member while moving the inner member and the suture anchor formed of body tissue together along the passage in the tubular member.

79. A method as set forth in claim 70 further including the steps of inserting the tubular member into the patient'"'"'s body tissue, covering indicia on the tubular member with body tissue as the tubular member is inserted into the patient'"'"'s body tissue, and interrupting said step of inserting the tubular member into the patient'"'"'s body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular member into the patient'"'"'s body tissue.

80. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor having a suture disposed in engagement with the suture anchor, providing a tubular member, inserting the tubular member into body tissue, covering indicia on the tubular member with body tissue as the tubular member is inserted into the body tissue, interrupting said step of inserting the tubular member into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular member into body tissue, moving the suture anchor along a passage in the tubular member with the suture disposed in engagement with the suture anchor, and moving the suture anchor out of the passage in the tubular member into the body tissue with the suture disposed in engagement with the suture anchor while the indicia corresponding the a desired depth of insertion of the tubular member into body tissue is covered with body tissue.

81. A method as set forth in claim 80 further including the step of expanding at least a portion of the passage in the tubular member by transmitting force from a leading end portion of the suture anchor to the tubular member while moving the suture anchor along the passage in the tubular member.

82. A method as set forth in claim 80 wherein said step of inserting the tubular member into the body tissue includes piercing the body tissue with an end portion of the tubular member.

83. A method as set forth in claim 80 further including the step of expanding at least a portion of the passage in the tubular member by resiliently stretching material which forms at least a portion of the tubular member.

84. A method as set forth in claim 80 further including the step of moving segments of the tubular member from an initial position in which portions of the segments of the tubular member are disposed in engagement with each other to an extended position in which the portions of the segments of the tubular member are spaced apart from each other.

85. A method as set forth in claim 80 wherein said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, said step of moving the suture anchor along a passage in the tubular member includes sliding the suture anchor along the wires.

86. A method as set forth in claim 85 further including the step of expanding at least a portion of the passage in the tubular member by expanding at least a portion of the sheath under the influence of force applied against the wires by the suture anchor while sliding the suture anchor along the wires.

87. A method as set forth in claim 80 wherein said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, said step of moving the suture anchor along a passage in the tubular member includes applying force against the suture anchor with a pusher member and sliding the pusher member along the wires.

88. A method as set forth in claim 80 wherein said step of moving the suture anchor along a passage in the tubular member is performed with at least a portion of the suture anchor enclosed by an expansion member, said method further includes the step of expanding at least a portion of the passage in the tubular member by transmitting force from the expansion member to the tubular member while moving the expansion member and the suture anchor together along the passage in the tubular member.

111. A method as set forth in claim 81 wherein said step of expanding at least a portion of the passage in the tubular member includes expanding at least a portion of the sheath under the influence of force applied against the wires by the suture anchor while sliding the suture anchor along the wires.

89. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor having a suture disposed in engagement with the suture anchor, providing a tubular member, inserting the tubular member into body tissue by piercing the body tissue with an end portion of the tubular member and moving at least a portion of the tubular member through an opening formed in the body tissue by piercing the body tissue with the end portion of the tubular member, moving the suture anchor along a passage in the tubular member with the suture disposed in engagement with the suture anchor, and moving the suture anchor out of the passage in the tubular member through the end portion of the tubular member into the body tissue with the suture disposed in engagement with the suture anchor.

90. A method as set forth in claim 89 further including the step of expanding at least a portion of the passage in the tubular member by transmitting force from a leading end portion of the suture anchor to the tubular member while moving the suture anchor along the passage in the tubular member.

91. A method as set forth in claim 89 wherein said step of piercing the body tissue includes forming an opening in the body tissue at a location which is free of naturally occurring openings.

92. A method as set forth in claim 89 further including the step of expanding at least a portion of the passage in the tubular member by resiliently stretching material which forms at least a portion of the tubular member.

93. A method as set forth in claim 89 further including the step of moving segments of the end portion of tubular member which pierced the body tissue from an initial position in which portions of the segments of the end portion of the tubular member are disposed in engagement with each other to an extended position in which the portions of the segments of the end portion of the tubular member are spaced apart from each other.

94. A method as set forth in claim 89 wherein said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, said step of moving the suture anchor along a passage in the tubular member includes sliding the suture anchor along the wires.

95. A method as set forth in claim 94 further including the step of expanding at least a portion of the passage in the tubular member under the influence of force applied against the wires by the suture anchor while sliding the suture anchor along the wires.

96. A method as set forth in claim 89 wherein said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, said step of moving the suture anchor along a passage in the tubular member includes applying force against the suture anchor with a pusher member and sliding the pusher member along the wires.

97. A method as set forth in claim 89 wherein said step of moving the suture anchor along a passage in the tubular member is performed with at least a portion of the suture anchor enclosed by an expansion member, said method further includes the step of expanding at least a portion of the passage in the tubular member by transmitting force from the expansion member to the tubular member while moving the expansion member a nd the suture anchor together along the passage in the tubular member.

98. A method as set fort h in claim 89 further including the steps of covering indicia on the tubular member with body tissue as the tubular member is inserted into the body tissue, and interrupting said step of inserting the tubular member into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular member into body tissue.

99. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor having a suture disposed in engagement with the suture anchor, providing a tubular member, providing a tubular inner member, at least partially enclosing one end portion and at least a portion of an outer side surface of the suture anchor with the tubular inner member, inserting the tubular inner member into the tubular outer member, moving the suture anchor and the tubular inner member along a passage in the tubular outer member with the suture anchor at least partially enclosed by the tubular inner member, and moving the suture anchor out of the passage in the tubular outer member into the body tissue with the suture disposed in engagement with the suture anchor.

100. A method as set forth in claim 99 further including the step of transmitting force from a leading end portion of the tubular inner member to the tubular outer member while moving the suture anchor along the passage in the tubular outer member and expanding at least a portion of the tubular outer member under the influence of the force transmitted from the leading end portion of the tubular inner member to the tubular outer member.

101. A method as set forth in claim 99 further including the step of inserting the tubular outer member into the body tissue by piercing the body tissue with an end portion of the tubular outer member.

102. A method as set forth in claim 99 further including the step of expanding at least a portion of the passage in the tubular outer member by resiliently stretching material which forms at least a portion of the tubular outer member.

103. A method as set forth in claim 99 further including the step of moving segments of the tubular outer member from an initial position in which portions of the segments of the tubular outer member are disposed in engagement with each other to an extended position in which the portions of the segments of the tubular outer member are spaced apart from each other.

104. A method as set forth in claim 103 wherein said step of moving segments of the tubular outer member from an initial position to an extended position is performed under the influence of force transmitted from the tubular inner member to the segments of the tubular outer member while the suture anchor is spaced from the segments of the tubular outer member.

105. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a tubular sheath having a main portion and an end portion, inserting the end portion and at least part of the main portion of the sheath into body tissue, expanding at least the part of the main portion of the sheath which is inserted into the body tissue in a direction transverse to a longitudinal central axis of the sheath, said step of expanding at least the part of the main portion of the sheath which is inserted into the body tissue is at least partially performed while the suture anchor is spaced from the end portion of the sheath, expanding the end portion of the sheath while the end portion of the sheath is inserted into the body tissue, said step of expanding the end portion of the sheath is performed after performing said step of expanding at least part of the main portion of the sheath, and moving the suture anchor along a passage in the sheath and out of the sheath into the body tissue while the end portion and at least part of the main portion of the sheath are inserted into the body tissue.

106. A method as set forth in claim 105 wherein said step of inserting an end portion and at least part of the main portion of the sheath into body tissue includes piercing the body tissue with the end portion of the sheath and moving the end portion and at least part of the main portion of the sheath into the body tissue prior to performing said step of expanding at least part of the main portion of the sheath and prior to performing said step of expanding the end portion of the sheath.

107. A method as set forth in claim 105 wherein said step of providing a tubular sheath includes providing a tubular sheath having a plurality of wires disposed in at least part of the main portion of the sheath, said step of moving the suture anchor along a passage in the sheath includes sliding an outer side surface of the suture anchor along outer side surfaces of the wires.

108. A method as set forth in claim 107 wherein said step of expanding at least part of the main portion of the sheath includes transmitting force from the suture anchor to the outer side surfaces of the wires and transmitting force from the wires to the sheath.

109. A method as set forth in claim 105 wherein said step of inserting an end portion of the sheath into body tissue includes covering indicia on the sheath with body tissue as the sheath is inserted into the body tissue, and interrupting said step of inserting the sheath into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the sheath into body tissue.

110. A method as set forth in claim 105 further including the steps of inserting a tubular member into the sheath, said step of expanding at least part of the main portion of the sheath includes moving the tubular member along the passage in the sheath.