Preparation for repairing cartilage defects or cartilage/bone defects in human or animal joints

• US 20030100947A1
• Filed: 10/17/2002
• Published: 05/29/2003
• Est. Priority Date: 12/15/1999
• Status: Active Grant

• Current Assignee: Zimmer GmbH (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Zimmer GmbH (Zimmer Biomet Holdings, Inc.)
• Inventors: Akens, Margarete, Nadler, Daniel, Auer, Jorg, Bittmann, Pedro, Rechenberg, Brigitte
• Granted Patent: US 6,858,042 B2
• Time in Patent Office: Days
• US Class Current: 623/11.11
• CPC Class Codes: A61B 17/1637 Hollow drills or saws producing a curved cut, e.g. cylindrical A61B10/025, A61B17/1695 take precedence
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 2017/00969 used for transplantation
• CPC Class Codes: A61F 2/28 Bones joints A61F2/30
• CPC Class Codes: A61F 2/30756 Cartilage endoprostheses A61F2/3603 takes precedence
• CPC Class Codes: A61F 2/4601 for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• CPC Class Codes: A61F 2002/2839 Bone plugs or bone graft dowels
• CPC Class Codes: A61F 2002/30032 differing in absorbability or resorbability, i.e. in absorption or resorption time
• CPC Class Codes: A61F 2002/30062 (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/30113 circular
• CPC Class Codes: A61F 2002/30143 hexagonal
• CPC Class Codes: A61F 2002/30153 rectangular
• CPC Class Codes: A61F 2002/30154 square
• CPC Class Codes: A61F 2002/30156 triangular
• CPC Class Codes: A61F 2002/30172 T-shaped
• CPC Class Codes: A61F 2002/30224 cylindrical
• CPC Class Codes: A61F 2002/30233 Stepped cylinders, i.e. having discrete diameter changes
• CPC Class Codes: A61F 2002/30299 umbrella-shaped or mushroom-shaped
• CPC Class Codes: A61F 2002/30327 differing in diameter
• CPC Class Codes: A61F 2002/30733 Inserts placed into an endoprosthetic cavity, e.g. for modifying a material property
• CPC Class Codes: A61F 2002/30751 : for attaching cartilage scaffolds to underlying bone
• CPC Class Codes: A61F 2002/30759 : Mosaicplasty, i.e. using a plurality of individual cartilage plugs for filling a substantial cartilage defect
• CPC Class Codes: A61F 2002/30808 : parallel
• CPC Class Codes: A61F 2002/30929 : having at least two superposed coatings
• CPC Class Codes: A61F 2002/30971 : Laminates, i.e. layered products
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2002/4649 : Bone graft or bone dowel harvest sites
• CPC Class Codes: A61F 2002/4685 : by means of vacuum
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2230/0006 : circular
• CPC Class Codes: A61F 2230/0017 : Angular shapes
• CPC Class Codes: A61F 2230/0019 : rectangular
• CPC Class Codes: A61F 2230/0021 : square
• CPC Class Codes: A61F 2230/0023 : triangular
• CPC Class Codes: A61F 2230/0052 : T-shaped
• CPC Class Codes: A61F 2230/0069 : cylindrical
• CPC Class Codes: A61F 2230/0093 : Umbrella-shaped, e.g. mushroom-shaped
• CPC Class Codes: A61F 2240/001 : Designing or manufacturing processes
• CPC Class Codes: A61F 2250/003 : differing in adsorbability or resorbability, i.e. in adsorption or resorption time
• CPC Class Codes: A61F 2250/0039 : differing in diameter
• CPC Class Codes: A61F 2310/00293 : containing a phosphorus-containing compound, e.g. apatite
• CPC Class Codes: A61F 2310/00964 : Coating or prosthesis-covering structure made of cartilage

Abstract

Repairs of cartilage defects or of cartilage/bone defects in human or animal joints with the help of devices comprising a bone part (1), a cartilage layer (2) and a subchondral bone plate (4) or an imitation of such a plate in the transition region between the cartilage layer (2) and the bone part (1) show that after implantation the bone part (4) is resorbed and is replaced by reparative tissue only after being essentially totally resorbed. In a critical phase of the healing process, a mechanically inferior cyst is located in the place of the implanted bone part (1). In order to prevent the cartilage layer (2) from sinking into the cyst space during this critical phase of the healing process it is suggested to design the device (10) in a manner such that its cartilage layer (2) after implantation is supported on regions with resorbabilities differing from one another. This is for example realized by a device which has a top part (11) and a bottom part (12), wherein the top part (11) consists essentially of the cartilage layer (2) and the subchondral bone plate (4) and the bottom part (12) corresponds essentially to the bone part (1) and wherein the top part (11) parallel to the subchondral bone plate (4) has a larger diameter than the bottom part (12). After implantation in a suitable opening or bore (20), the cartilage layer (2) and the subchondral bone plate (4) are supported not only on the bone part (1) but also on native bone tissue having a loading capacity not changing during the healing process. Therefore, the implanted cartilage layer cannot sink during the healing process.

Claims

1. A device (10) for repairing cartilage defects or cartilage/bone defects in human or animal joints, said device comprising a bone part (11), a cartilage layer (2) grown onto the bone part (1) and forming a cartilage surface (3), and in the transition region between the bone part (1) and the cartilage layer (2) a subchondral bone plate (4) or an imitation of such a bone plate, and said device being implantable into an opening or a bore (20) set up in the defect region in a manner such that the bone part is anchored in the healthy bone tissue and the cartilage surface (3) is flush with a native cartilage surface (3′

), characterized in that for supporting the subchondral bone plate (4) and the cartilage layer (2) of the implanted device on at least two materials with differing resorbabilities, the bone part (1) has a smaller cross section than the subchondral bone plate (4) and the cartilage layer (2) or the bone part has column regions (40, 41) which extend to the subchondral bone plate (4) and have a resorbability different from the resorbability of the regions between the column regions.

2. A device according to claim 1, characterized in that it comprises a top part (11) and a bottom part (12), wherein the top part (11) substantially comprises the cartilage layer (2) and the subchondral bone plate (4), and the bottom part (12) substantially corresponds to the bone part and wherein the subchondral bone plate (4) is larger than a cross section parallel to the subchondral bone plate through the bottom part (12) in a manner such that the subchondral bone plate (4) of the implanted device (30) is supported on native bone tissue.

3. A device according to claim 2, characterized in that the top part (11) and the bottom part (12) are coaxial circular cylinders.

4. A device according to claim 2, characterized in that the bottom part (12) is a circular cylinder and that the top part (11) has a square, rectangular, triangular or hexagonal cartilage surface (3).

5. A device according to claim 1, characterized in that it comprises column regions (40, 41) extending perpendicular to the subchondral bone plate (4) through the bone part (1) up to the subchondral bone plate (4), wherein the column regions (40, 41) and regions between the column regions have different resorbabilities.

6. A device according to claim 5, characterized in that it is essentially cylindrical and the cartilage layer (3) is arranged on one of its end faces.

7. A device according to one of claims 5 or 6, characterized in that the resorption behaviour of the column regions (40) is altered with respect to the resorption behaviour of the regions between the column regions by way of chemical treatment.

8. A device according to claim 7, characterized in that the column regions (40) consist of bone tissue treated with biphosphonate.

9. A device according to one of claims 5 or 6, characterized in that the column regions (41) consist of a bone replacement material filled into corresponding axial bores.

10. A device according to one of claims 1 to 9, characterized in that it is made of autologous tissue.

11. A device according to one of claims 1 to 9, characterized in that it is made of homologous or heterologous, immunologically deactivated tissue.

12. A device according to claim 11, characterized in that it is made of tissue which is immunologically deactivated by way of photo-oxidation.

13. A device according to one of claims 11 or 12, characterized in that it consists of tissue removed from slaughtered animals.

14. A device according to claim 13, characterized in that it is removed from cattle or pig'"'"'s joints.

15. A method for repairing cartilage defects or cartilage/bone defects in human or animal joints using a device (10) according to claim 2, comprising the steps of producing in the defect region an opening or bore (20) extending into healthy bone material and implanting the device (10) in the opening or bore, characterized in that the opening (20) comprises an outer region (21) and an inner region (22), wherein the cross section of the outer region (21) is larger than the cross section of the inner region (22) and that the opening (20) is adapted to the device (10) in a manner such that the device is implantable with a press fit and that the cartilage surface (3) of the implanted device (30) is flush with the native cartilage surface (3′

).

16. A method according to claim 15, characterized in that the transition between the outer region (21) and the inner region (22) lies directly below the native subchondral bone plate (4′

).

17. A method according to one of the claims 15 or 16, characterized in that the opening (20) is produced by drilling.

18. A method according to one of claims 15 to 17, characterized in that for repairing larger defects a plurality of devices are implanted in a mosaic-like manner, wherein positions for openings or bores (2) and the shape and size of top parts (11) of the devices (10) are coordinated to one another in a manner such that a cartilage surface (3, 3′

) essentially without interruption is achieved.

19. A method according to claim 18, characterized in that missing bone material between the openings is replaced with a bone replacement material having a resorbability which is different from the resorbability of the bone parts (1) of the devices (10).

20. A tool for producing the device according to claim 2, characterized by means for positioning a cylindrical pre-device and by means for reducing the cross section of the pre-device in the region of the bone part.

21. A tool for producing a two-stage bore for implanting a device according to claim 2, characterized by a blade with a circular cutting edge and two drills or hollow drills with different diameters and being movable relative to the cutting edge in an axially differently limited manner.

22. A tool for implanting a device according to one of claims 1 to 14, characterized by a sleeve and a plunger axially movable in the sleeve, wherein the sleeve has an inner cross section coordinated to the largest cross section of the implant and wherein the plunger comprises a suction channel which ends on one end face of the plunger and is connectable to a suction conduit in the region of the other plunger end.