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 tendon repair implant for repair of a partial thickness tear of a supraspinatus tendon, the tendon repair implant comprising:
a sheet-like structure comprising a reconstituted collagen material, the sheet-like structure having a first compact configuration for delivery from an arthroscopic instrument and a second planar configuration having a longitudinal dimension, a lateral dimension, a thickness dimension, and a longitudinal surface, wherein the longitudinal surface is conformable to a bursal side surface of the supraspinatus tendon and the longitudinal dimension is aligned with a load bearing direction of the supraspinatus tendon when positioned thereon,
wherein the sheet-like structure has an initial tensile modulus of 1 MPa to 100 MPa in the range of 1% to 3% strain in the longitudinal dimension prior to implantation, where 0% strain is defined with a 1 N preload applied to the sheet-like structure, and a porosity of 30% to 90%, and
wherein the sheet-like structure includes longitudinal pathways defined in the thickness dimension for at least some tissue in-growth oriented in the longitudinal dimension, wherein the reconstituted collagen material has a longitudinal alignment of collagen fibers in the longitudinal dimension to form the longitudinal pathways.
2. The implant of claim 1 , wherein the sheet-like structure is bioresorbable.
3. The implant of claim 2 , wherein the sheet-like structure maintains at least 70% of its tensile strength after 2 months of implantation.
4. The implant of claim 2 , wherein the sheet-like structure has a retention of strength of at least 70% at 2 months after implantation.
5. The implant of claim 1 , wherein upon initial fixation of the sheet-like structure to the bursal side surface of the supraspinatus tendon, the anatomical load on the tendon and implant combination is distributed with 1% to 50% of the load carried by the sheet-like structure.
6. The implant of claim 1 , wherein upon initial fixation of the sheet-like structure to the bursal side surface of the supraspinatus tendon, the anatomical load on the tendon and implant combination is distributed with 5% to 33% of the load carried by the sheet-like structure.
7. The implant of claim 1 , wherein the longitudinal pathways have a cross section of 100 to 200 microns.
8. The implant of claim 1 , wherein upon fixation to the bursal side tendon surface, cyclic loading during rehabilitation facilitates remodeling of tissue in-growth to form tendon-like tissue.
9. The implant of claim 1 , wherein the sheet-like structure has a maximum of 0.5% creep over three months.
10. The implant of claim 1 , wherein the sheet-like structure is configured to have an initial load share representing between 1% to 50% of an anatomical load applied to the supraspinatus tendon and sheet-like structure at the time that the sheet-like structure is affixed to the supraspinatus tendon.
11. The implant of claim 10 , wherein between 1% and 50% of the anatomical load applied to the supraspinatus tendon and sheet-like structure at the time that the sheet-like structure is affixed to the supraspinatus tendon comprises between 0.5 N and 50 N.
12. The implant of claim 10 , wherein between 1% and 50% of the anatomical load applied to the supraspinatus tendon and sheet-like structure at the time that the sheet-like structure is affixed to the supraspinatus tendon comprises between 0.5 N and 25 N.
13. A tendon repair implant for repair of a partial thickness tear of a supraspinatus tendon, the tendon repair implant comprising:
a sheet-like structure comprising a reconstituted collagen material, the sheet-like structure having a longitudinal dimension extending parallel to the supraspinatus tendon when affixed thereto, the sheet-like structure having an initial tensile modulus of 5 MPa to 50 MPa in the range of 1% to 3% strain in the longitudinal dimension prior to implantation, where 0% strain is defined with a 1 N preload applied to the sheet-like structure, and a porosity of 30% to 90%, and
wherein the reconstituted collagen material has a longitudinal alignment of collagen fibers to form longitudinal pathways for tissue in-growth running in the longitudinal dimension within a thickness of the sheet-like structure.
14. The implant of claim 13 , wherein the longitudinal pathways have a cross section of 150 to 200 microns.
15. The implant of claim 13 , wherein the sheet-like structure has a maximum of 0.5% creep over three months.
16. The implant of claim 13 , wherein the sheet-like structure is configured to have an initial load share representing between 1% to 50% of an anatomical load applied to the supraspinatus tendon and sheet-like structure at the time that the sheet-like structure is affixed to the supraspinatus tendon.
17. The implant of claim 16 , wherein between 1% and 50% of the anatomical load applied to the supraspinatus tendon and sheet-like structure at the time that the sheet-like structure is affixed to the supraspinatus tendon comprises between 0.5 N and 50 N.
18. The implant of claim 16 , wherein between 1% and 50% of the anatomical load applied to the supraspinatus tendon and sheet-like structure at the time that the sheet-like structure is affixed to the supraspinatus tendon comprises between 0.5 N and 25 N.