Surgical procedures often require an implant to attach tissue or sutures in and/or against a substrate. The substrate may be bone or bony material or soft tissue. A surgeon may use the sutures to capture and retain other objects including tissue. For bone and like bony material, the implant can insert into the bone at a fixation site (e.g., a pre-formed hole in the bone or self-made hole that the implant causes to form in the bone). Suture, graft, or tissue will extend from the implant out of the fixation site. Where the substrate is soft tissue, the implant may reside on a side of the soft tissue so that the suture extends from the implant, through a hole in the tissue, and further beyond the soft tissue on a side opposite the implant.