CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    This is a continuation of U.S. patent application Ser. No. 14/935,778 filed Nov. 9, 2015, now U.S. Pat. No. 9,706,986, which is a continuation of U.S. patent application Ser. No. 14/272,601 filed May 8, 2014, now U.S. Pat. No. 9,179,907, which is a continuation of U.S. patent application Ser. No. 13/765,218 filed Feb. 12, 2013, which is a divisional of U.S. application Ser. No. 13/182,893, filed Jul. 14, 2011, now U.S. Pat. No. 8,430,909, which is a continuation of U.S. application Ser. No. 12/022,868, filed Jan. 30, 2008, now U.S. Pat. No. 7,993,369, which is a continuation-in-part of U.S. application Ser. No. 10/405,707, filed Apr. 3, 2003, now U.S. Pat. No. 7,329,272, which is a continuation-in-part of U.S. application Ser. No. 09/886,280, filed Jun. 22, 2001, now U.S. Pat. No. 6,544,281, which claims the benefit of U.S. Provisional Application No. 60/213,263, filed Jun. 22, 2000. 
     
    
     BACKGROUND 
       [0002]    When soft tissue such as a ligament or a tendon becomes detached from a bone, surgery is usually required to reattach or reconstruct the tissue. Often, a tissue graft is attached to the bone to facilitate regrowth and permanent attachment. Various fixation devices, including sutures, screws, staples, wedges, and plugs have been used in the past to secure soft tissue to bone. In typical interference screw fixation, for example, the soft tissue or graft is fixed to the bone by driving the screw into a blind hole or a tunnel in the bone while trapping the end of the graft or tissue between the screw and the bone tunnel. In other methods, the graft is simply pinned against the bone using staples or sutures tied around the end of the graft to the bone. 
         [0003]    More recently, various types of threaded suture anchors have been developed. The application of such suture anchors generally requires the surgeon to tie knots in the suture to secure the tissue to the bone, which is tedious and time-consuming. The surgical procedure would be less cumbersome for the surgeon and ultimately more beneficial to the patient if the tissue could be attached to the bone without the surgeon having to tie suture knots. 
       SUMMARY 
       [0004]    Illustrative embodiments disclosed below are useful for securing soft tissue to bone with excellent pull-out strength without requiring a surgeon to tie suture knots to secure the suture in place or to secure the tissue to the bone. The disclosed examples may be used to secure any type of soft tissue, graft, or tendon. 
         [0005]    An illustrative example suture securing assembly includes an inserter, a rigid member and a second member. The inserter includes a distal end, a proximal end, and a longitudinal axis between the distal end and the proximal end. The inserter includes a handle near the proximal end and a rotatable portion near the handle. The rigid member includes an eyelet oriented to thread suture across the longitudinal axis. The rigid member is situated near the distal end of the inserter. The rigid member is configured to be placed in bone. The second member is situated near the distal end of the inserter and is configured to be rotated by the rotatable portion of the inserter to rotationally advance the second member in a distal direction toward the eyelet into a suture securing position where the second member holds suture in place. 
         [0006]    Another illustrative example suture securing assembly includes an inserter, a first member and a second member. The inserter includes a distal end, a proximal end, and a longitudinal axis between the distal end and the proximal end. The first member include an eyelet oriented to thread suture across the longitudinal axis. The first member is supported on the inserter near the distal end of the inserter. The first member is configured to be placed in bone. The second member is on the inserter situated near the distal end of the inserter where at least a portion of the first member is more distal than a distal end of the second member. The second member is moveable by a portion of the inserter relative to the first member in a distal direction toward the eyelet into a suture securing position where the second member engages a portion of the suture and prevents the portion of the suture from moving relative to the second member. The second member at least partially covers the eyelet of the first member in the suture securing position. 
         [0007]    Various features and advantages associated with disclosed embodiments of the present invention will become apparent from the following detailed description, which refers to the accompanying drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0008]      FIG. 1  illustrates a proximal end, side elevational view of an interference screw according to an embodiment of the present invention. 
           [0009]      FIG. 2  is a proximal end view of the screw shown in  FIG. 1 . 
           [0010]      FIG. 3  is a cross-sectional view, drawn along line III-III of  FIG. 2 , of the screw shown in  FIG. 1 . 
           [0011]      FIG. 4  illustrates a side elevational view of an interference plug according to an embodiment of the present invention. 
           [0012]      FIG. 5  is a cross-sectional view of the plug shown in  FIG. 4 . 
           [0013]      FIG. 6  is a distal end view of the plug shown in  FIG. 6 . 
           [0014]      FIG. 7  illustrates a driver according to an embodiment of the present invention for driving the interference screw shown in  FIG. 1 . 
           [0015]      FIG. 8  shows a handle according to a variation of the driver seen in  FIG. 7 . 
           [0016]      FIG. 9  shows the inner shaft attachable to the driver handle shown in  FIG. 8 . 
           [0017]      FIG. 10  shows the outer shaft of the driver according to an embodiment of the present invention. 
           [0018]      FIG. 11  illustrates an alternative embodiment of a driver and an interference screw. 
           [0019]      FIGS. 12A and 12B  illustrate a driver according to an embodiment of the present invention usable for the interference plug shown in  FIG. 4 . 
           [0020]      FIG. 13  illustrates a punch usable in connection with an embodiment of the present invention to create a bone socket for securing the graft. 
           [0021]      FIG. 14  illustrates a graft to be secured to the bone with attached sutures, and a socket created in the bone at the location at which the graft is to be affixed. 
           [0022]      FIG. 15  shows the driver of  FIG. 7  loaded with an interference screw and having a traction suture loop formed near the distal end of the driver. 
           [0023]      FIG. 16  illustrates the sutures attached to the graft being passed through the suture loop according to an embodiment of present invention. 
           [0024]      FIG. 17  is a view through a cross-section of the bone socket which shows the sutures attached to the graft being held in contact with the bottom of the bone socket with the interference screw positioned just out of the socket. 
           [0025]      FIG. 18A  is a view through a cross-section of the bone through the socket. 
           [0026]      FIG. 18B  illustrates the same step of the invention as shown in  FIG. 18A , but provides a close-up view from the surgeon&#39;s perspective. 
           [0027]      FIG. 19  shows the graft secured to the bone as a result of a method according to an embodiment of the present invention. 
           [0028]      FIG. 20  illustrates an alternative embodiment of a method according to the present invention in which the sutures attached to the graft are threaded directly into and through the driver instead of through a suture loop at the distal end of the driver. 
           [0029]      FIG. 21  illustrates a perspective view of a distal end of a push lock driver of an embodiment of the present invention. 
           [0030]      FIG. 22  illustrates a perspective view of the push lock driver of  FIG. 21 . 
           [0031]      FIG. 23  is a schematic cross-sectional view of a surgical site undergoing a graft fixation technique according to a method of an embodiment of the present invention. 
           [0032]      FIG. 24  is a schematic view of the surgical site of  FIG. 23  undergoing a graft fixation technique with the push lock driver of  FIGS. 21 and 22 . 
           [0033]      FIG. 25  is a schematic view of the surgical site of  FIG. 23  undergoing a graft fixation technique with the push lock driver of  FIGS. 21 and 22  and at a stage subsequent to that shown in  FIG. 24 . 
           [0034]      FIG. 26  is a schematic view of the surgical site of  FIG. 23  undergoing a graft fixation technique with the push lock driver of  FIGS. 21 and 22  and at a stage subsequent to that shown in  FIG. 25 . 
           [0035]      FIG. 27  is a schematic view of the surgical site of  FIG. 23  undergoing a graft fixation technique with the push lock driver of  FIGS. 21 and 22  and at a stage subsequent to that shown in  FIG. 26 . 
           [0036]      FIG. 28  is a schematic view of an eyelet implant of an embodiment of the present invention secured by and locked into an interference device in accordance with an embodiment of the present invention. 
           [0037]      FIG. 29  illustrates a perspective view of a distal end of a push lock driver in accordance with an embodiment of the present invention. 
           [0038]      FIG. 30  illustrates a perspective view of a distal end of a push lock driver in accordance with another embodiment of the present invention. 
           [0039]      FIG. 31  illustrates a perspective view of a distal end of a push lock driver in accordance with another embodiment of the present invention. 
           [0040]      FIG. 32  illustrates another perspective view of the push lock driver of  FIG. 31  with a strand passed through an aperture of the push lock. 
           [0041]      FIG. 33  is a schematic cross-sectional view of a surgical site undergoing a graft fixation technique with the push lock driver of  FIGS. 31 and 32 . 
           [0042]      FIGS. 34 and 34A  are schematic views of the surgical site of  FIG. 33  at a graft fixation stage subsequent to that shown in  FIG. 33 . 
           [0043]      FIGS. 35 and 35A  are schematic views of the surgical site of  FIG. 33  at a graft fixation stage subsequent to that shown in  FIGS. 34 and 34A . 
       
    
    
     DETAILED DESCRIPTION 
       [0044]    Referring to  FIGS. 1-3 , an interference screw  10  according to an embodiment of the present invention is shown. Screw  10  is preferably formed of a bioabsorbable material such as PLLA and has a cannulated body  12  provided with a continuous thread  16  having rounded outer edges  18 . The head  14  of the screw is rounded to minimize abrasion or cutting of tissue, and the screw tapers toward the distal end. A hexagonal bore  15  formed through the screw accepts a driver shaft described in more detail below. 
         [0045]      FIGS. 4-6  illustrate an interference plug  20  according to an alternative embodiment of the present invention. Plug  20  is also preferably formed of a bioabsorbable material and has a cannulated body  22  provided with rounded annular ribs  24  separated by rounded annular grooves  26 . The outer diameter of the ribs and grooves is substantially constant. The plug tapers significantly toward the distal end. Cannula  28  is preferably round in cross-section but may also be hexagonal or any other shape, and is designed to accommodate the shaft of a corresponding driver. 
         [0046]      FIG. 7  illustrates a driver  30  according to an embodiment of the present invention for driving the interference screw described above. Generally, driver  30  includes a handle  32 , inner shaft  34 , and outer shaft  36 .  FIG. 8  shows a handle having a connector  31  for coupling with driver  30 . 
         [0047]      FIG. 9  shows the inner shaft of driver  30 . Inner shaft  34  has a cannula extending through its entire length and has openings at the proximal and distal ends to enable sutures to be passed therethrough. Inner shaft  34  includes a shaft body  38  having a threaded proximal section  39  and a hex-shaped distal section  35  for being fitted through the cannula  15  in interference screw  10 . The diameter of the shaft body  38  is reduced slightly along the hex section  35 , forming a shoulder  37  at the junction between the hex section  35  and the central portion of shaft body  38  for abutting the proximal end of an interference screw loaded onto the driver. Shaft  34  can be permanently affixed to the handle  32  as shown in  FIG. 7 , or can be releasably attached, as shown in the embodiment represented in  FIGS. 8 and 9 , by means of a collet  33  at the proximal end of the threaded section  39  being fittable within a connector  31  at the distal end of handle  32 . 
         [0048]      FIG. 10  shows the outer shaft  36  of the driver  30 . Outer shaft  36  includes a sleeve  40  which covers and is slidable over shaft body  38 , and a thumb pad  41  for being gripped by a user. Outer shaft  36  is cannulated through its entire length, of course, with the diameter of the cannula being slightly larger than the outer diameter of the central portion of inner shaft body  38 . The portion of the cannula through thumb pad  41  is threaded to mate with the threads on the threaded proximal section  39  on inner shaft  34 . The inner diameter of the inner threads in thumb pad  41  is smaller than the outer diameter of the central portion of shaft body  38 , so as to limit the proximal movement of the outer shaft  36  relative to the inner shaft  34 . 
         [0049]    The proximal threaded section  39  on the inner shaft  34  has a length such that when the outer shaft  36  is unscrewed to its proximal-most position with the thumbpad adjacent the distal end of handle  32  or connector  31 , shoulder  37  on the inner shaft  34  is flush with or exposed through the distal end of sleeve  40  of outer shaft  36 . 
         [0050]    The length of hex section  35  is such that when a cannulated interference screw is loaded onto the driver with the proximal end of the screw abutting the shoulder  37 , the hex driver portion exposed distally of the mounted screw can reach the bottom of a socket created in the bone where the screw will be inserted, while the screw is positioned just outside the hole. Thus, the hex section  35  has a length which is approximately twice the length of the interference screw usable with the driver. Similarly, the length of the threaded proximal section  39  is also approximately equal to the length of the screw. 
         [0051]    An alternative embodiment of the driver for the interference screw is shown in  FIG. 11 . In this embodiment, the outer shaft is eliminated so that the driver  30 ′ is comprised of a single cannulated shaft. The shaft body  38 ′ has an enlarged outer diameter relative to that of the previous embodiment, and tapers down to hex section  35 ′ via a tapered section  37 ′. When loading a screw onto the driver  30 ′, the proper initial position of the screw is established by inserting the hex section through the cannula of the screw until the travel of the proximal end of the screw  10  is limited by the increased diameter in tapered section  37 ′. As before, the hex section has a length which enables the distal end of the hex section to be inserted to the bottom of the socket while positioning an interference screw loaded onto the driver just outside the socket with the bottom thread of the screw able to engage the opening of the hole upon the application of a small amount of force into the hole. 
         [0052]      FIGS. 12A and 12B  illustrate an example of a driver usable with an interference plug in accordance with an embodiment of the present invention, in which the plug is driven into the socket by impaction rather than being screwed into place. Driver  50  comprises essentially of an outer shaft  52  and a cannulated inner shaft  54 . Inner shaft  54  is inserted into the cannula  51  of outer shaft  52  and has a proximal portion  55  which has an outer diameter slightly smaller than the diameter of cannula  51  to enable the outer shaft  52  to slide along proximal portion  55 . Inner shaft  54  also has a distal portion  57  which has a diameter smaller than that of proximal portion  55  and sized for insertion into the cannula  28  of interference plug  20 . The cross-sectional shape of distal portion  57 , and hence of cannula  28  of plug  20 , is preferably round, but can also be hex or any other shape, as long as the distal portion  57  of inner shaft  54  is matingly shaped with the distal portion  57  of driver  50  to be insertable into cannula  28  of plug  20 . The junction between proximal portion  55  and distal portion  57  forms shoulder  56  for abutting the proximal end of the plug when the plug is loaded onto the driver  50 . 
         [0053]    The length of outer shaft  52  is equal to the length of proximal portion  55  of inner shaft  54  plus a distance “a” equal to the length of the interference plug usable therewith. The length of distal section  57  is approximately equal to twice the length of a plug  20 , and shoulder  56  on the inner shaft  54  is flush with or just exposed through the distal end of outer shaft  52  when outer shaft  52  is in its fully retracted (proximal) position. 
         [0054]    A method of performing soft tissue fixation in accordance with an embodiment of the present invention will now be described with reference to  FIGS. 14-19 . 
         [0055]    As shown in  FIG. 14 , sutures  62  are passed through the graft  60  at desired points, and a blind hole or socket  66  is created in the bone  64 , using a drill or punch, at the location where the tissue is to be secured. A punch provides the advantages of rounding the opening edge of the bone socket to protect the sutures attached to the graft from being sheared during the insertion process, and also compacts the bone at the punch site for better purchase of the bone by the anchor in cases where the bone is a soft bone. An example of such a punch is illustrated in  FIG. 13 , the punch having a constant diameter section  72 , a tip  74 , a flared section  76 , and a main body portion  78 . The diameter of the constant diameter section corresponds to the diameter of the driver. 
         [0056]    Next, as shown in  FIG. 15 , driver  30  is pre-loaded with screw  10  with outer shaft  36  in the fully retracted position and the distal end of the screw abutting shoulder  37  of inner shaft  34  and the distal end surface of outer shaft  36 . Traction suture  68  is passed into the cannula of the driver, such that a looped end  70  is exposed at the distal end of the driver. Sutures  62  attached to graft  60  are then passed through traction suture loop  70  at the end of driver  30  as seen in  FIG. 16 , to position the graft at an appropriate distance from the distal end of driver  30 , either at a distance corresponding to the length of the screw or so that the graft is located directly at the distal end of the driver. 
         [0057]    Referring now to  FIG. 17 , the driver  30  is held with gentle pressure with the distal end of hex section  35  at the bottom of the hole  66 , keeping the screw  10  just outside the hole. Tension can then be placed on the graft sutures  62  by drawing on traction suture  68  to tighten suture loop  70 . Once adequate tension is achieved on the sutures, the driver is manipulated so that the first thread edge of the screw engages the bone at the edge of the hole  66 . The driver is turned by rotating handle  32  and thus inner shaft  34  while preventing outer shaft  36  from rotating by holding thumb pad  41  in place during rotation of handle  32 . This maneuver causes the outer shaft to move distally along the inner shaft by the interaction of the inner threads in the outer shaft  62  with the threads on threaded portion  39  of inner shaft  34 , while also causing the screw threads to engage the sides of the hole and pull the screw into the hole. The inner shaft of the driver thus rotates without advancing further into the hole, while the outer shaft guides the insertion of the screw into the socket. In this manner, the screw advances along the hex section of the driver until the screw is fully installed to the position shown in  FIGS. 18A and 18B , with sutures  62  or the graft  60  pinned and/or wound between the base and sidewall of socket  66  and interference screw  10 . Optionally, sutures  62  may be twisted together at the time they are passed through loop  70  to increase contact with the screw upon insertion of the screw into the socket. 
         [0058]    After the screw is fully inserted, traction loop  70  is disengaged from the handle, and the driver is removed. As seen in  FIG. 19 , the ends of the sutures can be removed by clipping them short, leaving the graft securely fastened in place to the bone. 
         [0059]    A procedure similar to that just described is performed with respect to the installation of an interference plug, except that a driver such as driver  50  shown in  FIGS. 12A and 12B  is used instead of driver  30  of  FIGS. 7-10 , and the plug is advanced into the hole using impact force supplied by a mallet, for example, rather than by turning. When the proximal end of outer shaft  52  is hit with the mallet, the proximal end of plug  20  abutting against shoulder  56  on the inner shaft  54  and the distal surface of outer shaft  52  pushes the plug into the socket  66 . In this method, the plug is fully inserted into the hole when the proximal end of outer shaft  52  is flush with the proximal end of inner shaft  54 . 
         [0060]    In a first alternative to the method described above, sutures  62  attached to the graft  60  are eliminated, so that in the step shown in  FIG. 16 , the graft itself is passed through the suture loop  70  to be secured from the bottom of the hole  66  by the tip of plug  20 . 
         [0061]    In an alternative to the method described above, traction suture  68  and loop  70  are eliminated, so that in the step shown in  FIG. 16 , instead of passing sutures  62  through loop  70 , the ends of sutures  62  are threaded into the cannula of the inner shaft  34  through the distal end thereof, through the length of driver  30  or  50 , and out the opening at the proximal end thereof, as illustrated in  FIG. 20 . 
         [0062]      FIGS. 21 and 22  illustrate an implant driver  100  of another embodiment of the present invention. Driver  100  includes a body  104 , preferably in the form of a cylinder, and having a distal end  112  ( FIG. 21 ) and a proximal end  113  ( FIG. 22 ). The body  104  of driver  100  includes an outer shaft  117  and an inner shaft  119 . The outer shaft  117  is cannulated for receiving inner shaft  119 . 
         [0063]    As illustrated in  FIG. 21 , driver  100  is pre-loaded with an interference device  120 . Preferably, the interference device  120  is a screw or an interference plug, preferably formed of a bioabsorbable material such as PLLA. If a screw is employed, the screw may be provided with a cannulated body provided with a continuous thread having rounded outer edges. The head of the screw may be rounded to minimize abrasion or cutting of tissue. The cannulation formed through the screw is preferably hex-shaped and accepts the correspondingly shaped inner shaft  119  of driver  100 . If an interference plug is desired, the plug is provided with rounded annular ribs separated by rounded annular grooves. The outer diameter of the ribs and grooves is substantially constant. The plug tapers significantly toward the distal end. The plug also comprises a cannula, preferably hex-shaped, for accommodating the inner correspondingly shaped shaft  119  of the corresponding driver  100 . 
         [0064]    As also shown in  FIG. 21 , an eyelet implant  150  is provided at the distal end  112  of driver  100 . The eyelet implant  150  is releasably attached to the distal end  112  of driver  100  by means of a connector  157 . The eyelet implant  150  is formed of a transparent polymer material, and is preferably made of a bioabsorbable material such as PLLA, polyglycolic or polylactic acid polymers. Advantageously, the eyelet implant  150  is made of a material similar to that of the interference device  120 . As illustrated in  FIG. 21 , the eyelet implant  150  is provided with aperture  155  for receiving a suture attached to a graft to pass through the eyelet implant  150 , as described in more detail below. The width “w” ( FIG. 21 ) of the eyelet implant  150  is about equal the diameter of the inner shaft  119  and slightly smaller than the diameter of the outer shaft  117  and of the cannula of the interference device  120 . 
         [0065]      FIG. 22  illustrates proximal end  113  of driver  100 , showing a handle  115  disposed coaxially with the body  104  and outer shaft  117  and provided with handle slots or protuberances  116 . As described below, handle slots or protuberances  116  allow a suture strand to be wrapped around the handle  115  and be subsequently tensioned prior to the impaction of the interference device  120  into the pilot hole. In this manner, the graft is precisely positioned at an appropriate distance from the pilot hole, and the suture with the attached graft is secured at the bottom of the pilot hole and prevented from exiting the pilot hole. 
         [0066]    A method of a graft fixation technique according to an embodiment of the present invention is now described with reference to  FIGS. 23-28 . The present invention may be used to secure any type of soft tissue, graft, or tendon, such as, for example, a biceps tendon or a rotator cuff.  FIG. 23  illustrates at least one suture  180  passed though the graft  170  at desired points.  FIG. 23  also illustrates a pilot hole or socket  190  formed in the bone or cartilage  193  using a drill or punch, at the location where the tissue is to be secured. A punch provides the advantages of rounding the opening edge of the bone socket to protect the sutures  180  attached to the graft  170  from being sheared during the insertion process, and also compacts the bone at the punch site for better attachment of the bone by the anchor in cases where the bone is a soft bone. 
         [0067]    Next, as shown in  FIG. 24 , driver  100  with a pre-loaded interference device  120  and with the outer shaft  117  in the retracted position is provided in the proximity of the bone socket  190 . Sutures  180  attached to the graft  170  are subsequently passed through the aperture  155  of the eyelet implant  150  at the end of driver  100 , as shown in  FIG. 24 . 
         [0068]    Referring now to  FIG. 25 , driver  100  is held with gentle pressure so that the eyelet implant  150  at the distal end  112  is held at the bottom of the hole  190 , keeping the interference device  120  just outside the pilot hole  190 . Tension is then applied to the suture  180  by wrapping the suture  180  around the slots  116  of the handle  115  and tensioning it, as shown in  FIGS. 26-27 . The suture  180  freely slides through aperture  155  of the eyelet implant  150 , allowing the graft  170  to be positioned close to the edge of the pilot hole  190 . Once tensioning of the suture  180  has been completed, the interference device  120  is then impacted into the pilot hole  190  so that the interference device  120  advances toward the distal end  112  of driver  100  and securely engages and locks in the eyelet implant  150  with the sutures  180 , as shown in  FIGS. 27-28 . After the interference device  120  is fully inserted, the driver is removed and the ends of the sutures can be removed by clipping them short, leaving the graft  170  securely fastened to bone  193 . 
         [0069]    A significant advantage of the present invention is that the sutures attached to the graft or the graft itself can be securely attached to the bone without the need to tie knots. Additionally, the suture attached to the graft is secured both by the eyelet implant and by the interference device, along the bottom and sidewalls of the pilot hole between the bone and the screw or plug, conferring a much stronger fixation of the graft to the bone than is achievable with prior art procedures and devices. More importantly, the suture attached to the graft is allowed to freely slide though the aperture of the eyelet implant to allow precise advancement and guiding of the plug or screw into the blind hole or socket during the procedure. 
         [0070]    In another embodiment of the present invention illustrated in  FIG. 29 , driver  200  is provided with a horseshoe-shaped implant  250  (i.e., an implant with an open distal end) at the distal end of the driver in lieu of the eyelet implant. The horseshoe-shaped implant  250  is provided in the form of a wedge  255  that allows the suture attached to a graft to be securely contained within the wedge, yet be capable to freely slide within the wedge. The horseshoe-shaped implant  250  is formed of a transparent polymer material, and is preferably made of a bioabsorbable material such as PLLA, polyglycolic or polylactic acid polymers. Advantageously, the horseshoe-shaped implant  250  is made of a material similar to that of the interference device  20 . 
         [0071]    The horseshoe-shaped implant  250  may be detachable from the distal end  112  of the driver  200 , similar to the eyelet implant described in detail above. In this embodiment, the detachable horseshoe-shaped implant  250  is securely engaged within the cannulated ribbed body of the interference plug or screw  120 . Alternatively, the horseshoe-shaped implant  250  may be integral with the distal end  112  of the driver  200  and, after the interference screw or plug  120  is fully inserted into the pilot hole, the horseshoe-shaped implant  250  is removed from the site together with the driver  200 . 
         [0072]    In yet another embodiment of the present invention and as illustrated in  FIG. 30 , driver  300  of the present invention is provided with a metal tubing  350  at the distal end of a driver, which in turn, is provided with a cut or pair of protuberances  355  at its most distal end to allow at least one end of a suture attached to a graft to be securely contained within the cut, yet be capable to freely slide within the cut. Preferably, the metal tubing  350  is integral with the distal end  112  of the driver  300  and, subsequent to the full insertion of the interference screw or plug  120  into the pilot hole, the metal tubing  350  is removed from the site together with the driver  300 . 
         [0073]      FIGS. 31-35  illustrate another embodiment of the present invention, according to which driver  400  is provided with a pointed tip implant  450  at the distal end of the driver, which is also an eyelet implant but which, because of its pointed tip, does not require the pre-drilling or pre-formation of a hole for fixating the device (implant with suture attached to graft) in the bone. The conical configuration of the most distal end of the pointed tip implant  450  allows the driver  400  with the attached implant to undergo a self-punching operation during graft fixation, eliminating any need to pre-drill a hole in the bone and providing increased fixation of the overall operation of securing the soft tissue. The conical configuration of the most distal end of the pointed tip implant  450  also provides suture fixation strength, as well as accelerated graft/tendon healing to bone. The pointed tip implant  450  may be detachable from the driver. 
         [0074]    As illustrated in  FIGS. 31 and 32 , pointed tip implant  450  is provided with an eyelet or aperture  455  for receiving at least one strand (for example, a suture strand) attached to a graft to pass through the eyelet implant  450 . Pointed tip implant  450  is also provided, at its most distal end, with a conical portion  451  which allows direct advancement of the implant (by simply tapping the device with a mallet, for example) without the formation of a bone hole. Preferably, the conical portion  451  of the implant is formed of titanium or titanium alloy. In a preferred embodiment, eyelet or aperture  455  is also formed of titanium or similar material, to withstand impaction forces during the graft fixation procedure. 
         [0075]    As in one of the previously-described embodiments, strand  180  (attached to graft  170 ) is passed through the aperture  455  of the implant  450  at the end of the driver  400 , as shown in  FIGS. 31 and 32 . Although  FIG. 32  illustrate two strands  80  (i.e., two suture strands  180 ) passed through the aperture  455 , the invention is not limited to this exemplary embodiment and contemplates additional embodiments wherein one strand or any number of strands are passed through the aperture  455 . Preferably, at least one of the strands is formed of a high strength suture material such as FIBREWIRE® suture, sold by Arthrex, Inc. of Naples, Fla., and described in U.S. Pat. No. 6,716,234, the disclosure of which is incorporated by reference herein. The high strength suture may be available in various lengths and widths. FIBREWIRE® suture is formed of an advanced, high-strength fiber material, namely ultrahigh molecular weight polyethylene (UHMWPE), sold under the tradenames SPECTRA (Honeywell) and DYNEEMA (DSM), braided with at least one other fiber, natural or synthetic, to form lengths of suture material. The preferred FIBREWIRE® suture includes a core within a hollow braided construct, the core being a twisted yarn of UHMWPE. The suture may optionally include filaments of various colors. 
         [0076]    An example method of graft fixation using the pointed tip implant  450  is illustrated with reference to  FIGS. 33-35 . This exemplary method illustrated in  FIGS. 33-35  relates to a specific graft fixation technique (i.e., SUTUREBRIDGE® Lateral Row fixation); however, the invention is not limited to this exemplary embodiment and applies to any other method of soft tissue fixation known in the art. 
         [0077]    Referring to  FIG. 33 , an Arthrex SUTUREBRIDGE® medial row is completed as known in the art and the strands  180  (suture strands  180 ) are threaded through the titanium eyelet  455 . As shown in  FIG. 34A , a protective cap  194  (or other device that prevents anchor deployment) is malleted to advance the PUSHLOCK® implant  450  until the anchor  420  contacts bone  193 . The suture is then tensioned, as shown in  FIG. 34 . The protective cap  194  is subsequently removed ( FIG. 35A ) and the button  420  is malleted until a mark (for example, a predefined laser line) is flush with the bone ( FIG. 35 ). The ribbed, spiked configuration of plug or button  420  facilitates the insertion of the device  400  into the bone by simply exerting force upon the device, without the need to drill or form a hole in the bone. 
         [0078]    Although the above embodiments have been described including implants having an aperture of a predefined configuration (e.g., an eyelet or horseshoe configuration), it should be understood that the invention is not limited to these embodiments. Accordingly, the present invention also contemplates implants affixed to or detachable from a preloaded driver and having an aperture of any configuration or geometrical shape that captures suture and allows the captured suture to freely slide within the aperture until the suture is locked in place. 
         [0079]    A significant advantage provided by the example methods is that the sutures attached to the graft or the graft itself can be securely attached to the bone without the need to tie knots. 
         [0080]    Another advantage achieved by the example embodiments of present invention is that the suture attached to the graft or the graft is secured both along the bottom of the bone socket by the tip of the interference screw or plug, as well as along the sidewall of the socket between the bone and the screw or plug. This arrangement results in a much stronger fixation of the graft to the bone than is achievable with prior art suture anchor procedures. 
         [0081]    Although particular embodiments are described above, many other variations and modifications and other uses will become apparent to those skilled in the art who have the benefit of this description. For example, the various features of the example embodiments are not necessarily limited to the particular embodiments shown in the drawings. One or more features of an embodiment may be combined with one or more features of another to realize a different embodiment. Additionally, entirely different embodiments having similar features may be realized. The present invention cannot be limited by the specific disclosure herein, but only by the appended claims.
An illustrative example suture securing assembly includes an inserter, a rigid member and a second member. The inserter includes a distal end, a proximal end, and a longitudinal axis between the distal end and the proximal end. The inserter includes a handle near the proximal end and a rotatable portion near the handle. The rigid member includes an eyelet oriented to thread suture across the longitudinal axis. The rigid member is situated near the distal end of the inserter. The rigid member is configured to be placed in bone. The second member is situated near the distal end of the inserter and is configured to be rotated by the rotatable portion of the inserter to rotationally advance the second member in a distal direction toward the eyelet into a suture securing position where the second member holds suture in place.