A tissue anchor insertion system for inserting a tissue anchor into a body tissue such as bone, comprising a cutting device having a sharp leading end to create an aperture in the bone for insertion of the tissue anchor therein. The cutting device is deployed through a sleeve which is a close fit with the cutting device. The distal end of the sleeve is typically configured to penetrate the tissue in which the tissue anchor is to be inserted. A tissue anchor is also deployed through the sleeve, after the sleeve is in position, on a delivery device configured to support the tissue anchor during its insertion into the tissue. Typically the leading end of the sleeve is embedded within the tissue when the tissue anchor emerges from the distal end during the insertion process, so the tissue anchor is not damaged by insertion through the tissue.