A bone anchor insertion device comprises a handle, a nosepiece connected to a distal end of the handle, a bone anchor connected to the nosepiece, and an actuator disposed on the handle for deploying the bone anchor, which suture is also fixed to a portion of soft tissue to be attached to a portion of bone. A suture ratchet or tensioning mechanism is disposed in the handle for tensioning suture which is associated with the bone anchor. This mechanism permits precise tensioning, while also permitting one-handed operation, thereby allowing the practitioner to use his or her other hand for other activities, such as camera operation or the like.