Tendon repair implant and method of arthroscopic implantation
A tendon repair implant for treatment of a partial thickness tear in the supraspinatus tendon of the shoulder is provided. The implant may incorporate features of rapid deployment and fixation by arthroscopic means that compliment current procedures; tensile properties that result in desired sharing of anatomical load between the implant and native tendon during rehabilitation; selected porosity and longitudinal pathways for tissue in-growth; sufficient cyclic straining of the implant in the longitudinal direction to promote remodeling of new tissue to tendon-like tissue; and, may include a bioresorbable construction to provide transfer of additional load to new tendon-like tissue and native tendon over time.
1. A method of repairing a partial thickness tear in a supraspinatus tendon without suturing the supraspinatus tendon together, the method comprising:
using a sheet-like structure, the sheet-like structure having a longitudinal dimension and lateral dimension, the sheet-like structure having a tensile modulus of 1 MPa to 100 MPa in the range of 1% to 3% strain in the longitudinal dimension, where 0% strain is defined with a 1 N preload applied to the sheet-like structure, a compressive modulus of at least 0.1 MPa, and having a porosity of 50% to 80% defining longitudinally elongated pathways along the longitudinal dimension, said porosity being sized and adapted to allow tissue in-growth within said pathways, said pathways having cross-section widths of 150-200 microns;
arthroscopically accessing a bursal side surface of the supraspinatus tendon with the sheet-like structure in a first configuration;
deploying the sheet-like structure by transforming the sheet-like structure to a second configuration wherein a surface of the sheet-like structure extends over the partial thickness tear;
contacting and conforming the sheet-like structure to the bursal side surface of the supraspinatus tendon with the longitudinal dimension extending in a lengthwise direction of the supraspinatus tendon; and,
affixing the sheet-like structure to the bursal side surface of the supraspinatus tendon such that a first portion of the sheet-like structure is affixed to the partially torn tendon on a muscle side of the partial tear without using sutures and a second portion of the sheet-like structure is affixed to a tuberosity side of the of the partial tear without using sutures;
wherein upon affixing the sheet-like structure to the bursal side surface of the supraspinatus tendon, an anatomical load on the supraspinatus tendon and sheet-like structure combination is distributed with 5% to 33% of the anatomical load carried by the sheet-like structure.
2. The method of claim 1 , wherein the torn portion of the partial thickness tear comprises less than 50% of a cross-sectional area of the tendon adjacent to the site of the partial thickness tear.
3. The method of claim 1 , wherein the sheet-like structure has a compressive modulus of at least 0.2 MPa.
4. The method of claim 1 , wherein the sheet-like structure has a coating that encourages tissue in-growth.
5. The method of claim 4 , wherein tissue which has grown within the sheet-like structure experiences tendon-like strain when the sheet-like structure is subjected to longitudinally elongating loads following implantation.
6. The method of claim 1 , wherein the sheet-like structure is at least one of bioresorbable, biodegradable, or otherwise absorbable after implantation.
7. The method of claim 1 , wherein distribution of the anatomical load on the supraspinatus tendon and sheet-like structure combination is such that the sheet-like structure sustains less of the anatomical load one month after being affixed to the partially torn tendon than the sheet-like structure did upon initially affixing the sheet-like structure to the partially torn tendon.