CA2699005A1 - Articular cartilage, device and method for repairing cartilage defects - Google Patents
Articular cartilage, device and method for repairing cartilage defects Download PDFInfo
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- CA2699005A1 CA2699005A1 CA2699005A CA2699005A CA2699005A1 CA 2699005 A1 CA2699005 A1 CA 2699005A1 CA 2699005 A CA2699005 A CA 2699005A CA 2699005 A CA2699005 A CA 2699005A CA 2699005 A1 CA2699005 A1 CA 2699005A1
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- Prior art keywords
- cartilage
- articular cartilage
- incisions
- articular
- bone
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- 210000000845 cartilage Anatomy 0.000 title claims abstract description 72
- 210000001188 articular cartilage Anatomy 0.000 title claims abstract description 58
- 238000000034 method Methods 0.000 title claims abstract description 23
- 230000007547 defect Effects 0.000 title claims description 18
- 238000005520 cutting process Methods 0.000 claims abstract description 34
- 210000000988 bone and bone Anatomy 0.000 claims abstract description 29
- 238000003306 harvesting Methods 0.000 claims abstract description 14
- 210000003321 cartilage cell Anatomy 0.000 claims abstract description 13
- 125000006850 spacer group Chemical group 0.000 claims abstract description 13
- 108010080379 Fibrin Tissue Adhesive Proteins 0.000 claims abstract description 5
- 238000004519 manufacturing process Methods 0.000 claims abstract description 3
- 210000004027 cell Anatomy 0.000 claims description 22
- 210000004276 hyalin Anatomy 0.000 claims description 4
- 229910052729 chemical element Inorganic materials 0.000 claims 1
- 210000000629 knee joint Anatomy 0.000 description 7
- 239000011159 matrix material Substances 0.000 description 7
- 230000007812 deficiency Effects 0.000 description 4
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- 238000012258 culturing Methods 0.000 description 3
- 238000005516 engineering process Methods 0.000 description 3
- 239000007943 implant Substances 0.000 description 3
- 210000001519 tissue Anatomy 0.000 description 3
- 238000002054 transplantation Methods 0.000 description 3
- IJGRMHOSHXDMSA-UHFFFAOYSA-N Atomic nitrogen Chemical compound N#N IJGRMHOSHXDMSA-UHFFFAOYSA-N 0.000 description 2
- 102000008186 Collagen Human genes 0.000 description 2
- 108010035532 Collagen Proteins 0.000 description 2
- 102000055008 Matrilin Proteins Human genes 0.000 description 2
- 108010072582 Matrilin Proteins Proteins 0.000 description 2
- 208000013201 Stress fracture Diseases 0.000 description 2
- 230000008901 benefit Effects 0.000 description 2
- 210000001185 bone marrow Anatomy 0.000 description 2
- 239000011797 cavity material Substances 0.000 description 2
- 210000001612 chondrocyte Anatomy 0.000 description 2
- 229920001436 collagen Polymers 0.000 description 2
- 210000003035 hyaline cartilage Anatomy 0.000 description 2
- 238000002513 implantation Methods 0.000 description 2
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- 238000012856 packing Methods 0.000 description 2
- 238000011069 regeneration method Methods 0.000 description 2
- 210000005065 subchondral bone plate Anatomy 0.000 description 2
- 210000004233 talus Anatomy 0.000 description 2
- 206010007710 Cartilage injury Diseases 0.000 description 1
- 238000005299 abrasion Methods 0.000 description 1
- 210000003423 ankle Anatomy 0.000 description 1
- 210000000544 articulatio talocruralis Anatomy 0.000 description 1
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- 239000006285 cell suspension Substances 0.000 description 1
- 230000001413 cellular effect Effects 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
- 238000001804 debridement Methods 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 230000006735 deficit Effects 0.000 description 1
- 229920006237 degradable polymer Polymers 0.000 description 1
- 208000002925 dental caries Diseases 0.000 description 1
- 238000005553 drilling Methods 0.000 description 1
- 230000003203 everyday effect Effects 0.000 description 1
- 239000012530 fluid Substances 0.000 description 1
- 230000008014 freezing Effects 0.000 description 1
- 238000007710 freezing Methods 0.000 description 1
- 239000003292 glue Substances 0.000 description 1
- 230000035876 healing Effects 0.000 description 1
- 238000010348 incorporation Methods 0.000 description 1
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- 229910052757 nitrogen Inorganic materials 0.000 description 1
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- 210000000323 shoulder joint Anatomy 0.000 description 1
- 210000000130 stem cell Anatomy 0.000 description 1
- 238000006467 substitution reaction Methods 0.000 description 1
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Classifications
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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Abstract
The articular cartilage according to the invention is made of pure cartilage and is provided with incisions (12) on the surface facing the bone. The cartilage cells are preferably seeded on the surface provided with incisions (12). The method for producing the articular cartilage comprises the step of collecting cartilage from joints, wherein pure cartilage is collected without bone, and incisions are made on the surface of the cartilage intended to face the bone. It is preferably fresh frozen until use. The device for harvesting articular cartilage, comprises handle and cutting blade, wherein the cutting blade (4) is curvilinear and is pro-vided with spacer elements (5), meanwhile the device for producing incisions in articular cartilages comprises handle (2) and a bridge (3) connected to said handle (2) and being provided with one or more cutting blade(s) (4). During the method for applying the articular cartilage the articular cartilage is fixed by thin surgical yarn stitches, by fibrin glue or by small anchors (Fig.8).
Description
ARTICULAR CARTILAGE, DEVICE AND METHOD FOR REPAIRING CARTI-LAGE DEFECTS
FIELD OF THE DISCLOSURE
The present invention relates to articular cartilages for repairing cartilage defects and a method for producing articular cartilage comprising the step of collecting cartilage from joints. Further object of the invention is a device for harvesting articular cartilage, comprising handle and cutting edge as well as another device for producing incisions in articular cartilages.
BACKGROUND OF THE INVENTION
Joint cartilage defects or deceases can result in progressive impairment of life quality. The so called biological regeneration methods are more and more ap-plied worldwide, besides the protetical reconstructions. One of these methods is tissue engineering, advancing continuously. Tissue engineering offers a wide field of applications in clinical work, and it seems that this method will be the revolutionary technology for healing, further to the gene-technology. The major-ity of people above 65 years have joint defects due to the decreased ability of regeneration (primary osteoarthrosis) or to the increased load (secundary os-teoarthrosis) of the cartilage tissues. All these cartilage defects are still curable in initial stage. However, the simple biological reparation methods available for the time being (abrasion, drilling, debridement, shaving or microfracture) proved in long term examinations to be insufficient, as the produced fibrous cartilage is mechanically weak.
Recently, mosaic-plasty and autologous cell transplantation have been devel-oped as modern cartilage replacement technologies.
In the case of mosaic-plasty, bone based bone-cartilage coloumns of 4 - 8 mm diameter are taken from non-weight-bearing surface of the knee joint of the pa-tient, and grafts are implanted to the affected area of the same knee joint (Han-gody L, Rathonyi GK, Duska Z, Vasarhelyi G, Fules P, and Modis L. 2004.
Autologous osteochondral mosaicplasty. Surgical technique. J Bone Joint Surg Am65-72.). US 6.241.756 or US 6.358.253 disclose similar methods. Such os-teochondral (bone based cartilage graft) replacements may be sufficient for reparing smaller (< 4 cm2) defects, but medium or greater surfaces can not be treated in this way, as the amount of donor regions of the knee joint are re-stricted. A further problem is that the integrity of the subchondral bone is broken during the preparation.
The method of autologous chondrocyte implantation (ACI) advanced quickly since the first publication (Brittberg M, Lindahi A, Ohisson C, Isaksson 0, and Peterson L. 1994. Treatment of deep cartilage defects in the knee with autolo-gous chondrocyte transplantation. N Engi J Med.889-895.). It is almost an eve-ryday practice in the US and Western - Europe to gather cartilage cells from do-nor area, to culture them in a laboratory specified to this work and to implant them back to the damaged joint cartilage. The number of ACI operations ex-ceeds 20 000. In case of first generation ACI (developed first), cells cultured for - 50 days are reimplanted in cell suspension, without supporting matrix, by injecting them below a graft stitched to the cartilage. In case of second genera-15 tion ACI, the cells grown in the laboratory are seeded onto a supporting matrix (coliagen filaments or artificial degradable polymers), and only the final graft should be secured to the defected cartilage area.
These methods are already applicable for replacing greater defects (up to 10 cm2), however, the structure of the tissue is not the preferred hyaline-cartilage 20 structure, i.e. the orientation of the collagen filaments does not show the original cartilage structure.
Object of the present invention is therefore to provide a solution to eliminate the problems outlined above.
SUMMARY OF THE INVENTION
According to the invention articular cartilages are provided, which are made of pure cartilage and have incisions on the surface facing the bone.
The distance between the incisions may be of 0,1 - 1 mm, and the incisions are parallel with each other or are of different directions. They preferably have a depth leaving an intact layer of at least 50pm thickness.
According to a preferred embodiment, cartilage cells, first of all hyaline cells taken from joint cartilages are seeded on the surface provided with incisions.
FIELD OF THE DISCLOSURE
The present invention relates to articular cartilages for repairing cartilage defects and a method for producing articular cartilage comprising the step of collecting cartilage from joints. Further object of the invention is a device for harvesting articular cartilage, comprising handle and cutting edge as well as another device for producing incisions in articular cartilages.
BACKGROUND OF THE INVENTION
Joint cartilage defects or deceases can result in progressive impairment of life quality. The so called biological regeneration methods are more and more ap-plied worldwide, besides the protetical reconstructions. One of these methods is tissue engineering, advancing continuously. Tissue engineering offers a wide field of applications in clinical work, and it seems that this method will be the revolutionary technology for healing, further to the gene-technology. The major-ity of people above 65 years have joint defects due to the decreased ability of regeneration (primary osteoarthrosis) or to the increased load (secundary os-teoarthrosis) of the cartilage tissues. All these cartilage defects are still curable in initial stage. However, the simple biological reparation methods available for the time being (abrasion, drilling, debridement, shaving or microfracture) proved in long term examinations to be insufficient, as the produced fibrous cartilage is mechanically weak.
Recently, mosaic-plasty and autologous cell transplantation have been devel-oped as modern cartilage replacement technologies.
In the case of mosaic-plasty, bone based bone-cartilage coloumns of 4 - 8 mm diameter are taken from non-weight-bearing surface of the knee joint of the pa-tient, and grafts are implanted to the affected area of the same knee joint (Han-gody L, Rathonyi GK, Duska Z, Vasarhelyi G, Fules P, and Modis L. 2004.
Autologous osteochondral mosaicplasty. Surgical technique. J Bone Joint Surg Am65-72.). US 6.241.756 or US 6.358.253 disclose similar methods. Such os-teochondral (bone based cartilage graft) replacements may be sufficient for reparing smaller (< 4 cm2) defects, but medium or greater surfaces can not be treated in this way, as the amount of donor regions of the knee joint are re-stricted. A further problem is that the integrity of the subchondral bone is broken during the preparation.
The method of autologous chondrocyte implantation (ACI) advanced quickly since the first publication (Brittberg M, Lindahi A, Ohisson C, Isaksson 0, and Peterson L. 1994. Treatment of deep cartilage defects in the knee with autolo-gous chondrocyte transplantation. N Engi J Med.889-895.). It is almost an eve-ryday practice in the US and Western - Europe to gather cartilage cells from do-nor area, to culture them in a laboratory specified to this work and to implant them back to the damaged joint cartilage. The number of ACI operations ex-ceeds 20 000. In case of first generation ACI (developed first), cells cultured for - 50 days are reimplanted in cell suspension, without supporting matrix, by injecting them below a graft stitched to the cartilage. In case of second genera-15 tion ACI, the cells grown in the laboratory are seeded onto a supporting matrix (coliagen filaments or artificial degradable polymers), and only the final graft should be secured to the defected cartilage area.
These methods are already applicable for replacing greater defects (up to 10 cm2), however, the structure of the tissue is not the preferred hyaline-cartilage 20 structure, i.e. the orientation of the collagen filaments does not show the original cartilage structure.
Object of the present invention is therefore to provide a solution to eliminate the problems outlined above.
SUMMARY OF THE INVENTION
According to the invention articular cartilages are provided, which are made of pure cartilage and have incisions on the surface facing the bone.
The distance between the incisions may be of 0,1 - 1 mm, and the incisions are parallel with each other or are of different directions. They preferably have a depth leaving an intact layer of at least 50pm thickness.
According to a preferred embodiment, cartilage cells, first of all hyaline cells taken from joint cartilages are seeded on the surface provided with incisions.
The method according to the invention comprises the step of collecting cartilage from joints, wherein pure cartilage is collected without bone, and incisions are made on the surface of the cartilage intended to face the bone and a distance of 0,1 - 1 mm is left between the incisions, meanwhile an intact layer of at least 50pm thickness is left at the outer side of the cartilage.
According to the method, cartilage cells, preferably hyaline cells taken from joint cartilages are seeded on the surface intended to face the bone. It may be ad-vantageous if the articular cartilage is fresh frozen until use.
For harvesting articular cartilage, a device may be applied comprising handle and cutting blade, wherein the cutting blade is curvilinear and is provided with spacer elements.
The distance between the cutting blade and the spacer elements is preferably 0,1 - 4 mm and the curvature of the edge is adjusted to that of the joint surface.
The device for producing incisions in the articular cartilages comprises a handle and a bridge connected to said handle and being provided with one or more cut-ting blade(s). The thickness of the cutting blades is 0,1 - 0,5 mm, and the dis-tance between the cutting blades is 0,1 - 1 mm.
The cutting blades may be arranged on discs or on plates and may be provided with adjustable spacer elements.
During the method for applying the articular cartilage - if it is not seeded with cells - microfracturing is performed first at the cartilage defect and than the ar-ticular cartilage is fixed. If the articular cartilage is provided with cartilage cells, it is directly fixed at the cartilage defect.
The articular cartilage may be fixed by thin surgical yarn stitches or fibrin glue. It is also possible that the articular cartilage is fixed by small pieces of surgical yarn or small anchors introduced through the bone.
The invention is based on the recognition that thin cartilage allografts of great surfaces are optimal for the replacement of defected joint cartilages, and the efficiency of their use may be improved if the side intended to face the bone is provided with incisions, and preferably with cartilage cells as well. It is also rec-ognized, that these cells transplanted into the matrix have the optimal structure if they are applied to a matrix gathered from a cadaver and cleared, preferably completely, from cells. A device for harvesting articular cartilage and another device for producing incisions in articular cartilages have been developed for this purpose.
BRIEF DESCRIPTION OF THE DRAWING
Further details of the invention will be set forth below in conjunction with the drawing where Figure 1. is a schematic view of a first embodiment of the device accord-ing to the invention for harvesting articular cartilage, Figure 2. is a schematic view of a second embodiment of the device for harvesting articular cartilage, Figure 3. shows the steps of harvesting sterile articular cartilage, Figure 4. is a schematic view of a first embodiment of the device accord-ing to the invention for producing incisions in articular cartilages, Figure 5. is a schematic view of a second embodiment of the device for producing incisions in articular cartilage, Figure 6. is an enlarged top view of a preferred embodiment of an articu-lar cartilage according to the invention, Figure 7. is section VII - VII of Figure 6, Figure 8. is the cross section of an articular cartilage provided with carti-lage cells, after implanting and Figure 9. is the cross section of an articular cartilage without transplanted cells, after implanting.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Turning to Figure 1, a device for harvesting articular cartilage 1 comprises a handle 2 provided with a sharp, curvilinear cutting blade 4 fixed in a bridge 3.
The curvature of the cutting blade 4 is adjusted to that of the joint surface to be harvested. At the ends of the cutting blade 4, there are spacer elements 5.
The distance t between the edges of the spacer elements 5 and the edge of the cut-ting blade 4 defines the depth of harvesting, i.e. the distance from the bone/cartilage border (tidemark). This distance is in this case 0,5 mm. The dis-tance T between the edges of the spacer elements 5 defines the width of the harvesting.
Figure 2. illustrates another embodiment of the device for harvesting articular cartilage 1 according to the invention. This device also comprises a handle 2 5 with a sharp, curvilinear cutting blade 4 fixed thereon. Blade 4 is provided with a spacer element 5, too. This element is in this embodiment a support plate. The distance t between the edge of the spacer element 5 and the edge of the blade 4 is in this case 0,5 mm, but can go up to 4 mm, if needed.
The thickness of the blade 4 of the device 1 according to the invention for har-vesting articular cartilage ranges preferably from 0,1 to 0,5 mm, and cartilages of rather big surfaces (6 - 10 cm2) can be harvested therewith. The steps of har-vesting are shown in Figures 3a - 3d.
Before implantation, the harvested articular cartilage should be provided with incisions according to the invention, said incisions providing an indentation on the side of the cartilage facing the bone. The distances between the incisions should be very small: 0,1 - 1 mm. A device 6 for producing such incisions is shown in Figure 4 (the illustration is schematic and the proportions are not real).
The device 6 comprises a handle 2 provided with a bridge 3 on one end, and cutting blades 4 arranged in the bridge. The thickness of the cutting blades 4 is 0,2 mm according to this embodiment, and the distances between them is 0,4 mm.
Figure 5. shows another embodiment of the device 6 for producing incisions (the illustration is schematic and not scaled). Here, the cutting blades 4 in the bridge 3 are discs arranged on a rod 7. The discs are fixed (in other embodiments they may be arranged rotatably) on the rod and the rod is provided with a drive 8 (preferably an electric motor). The depth of the cuts can be adjusted by legs slidably arranged on the bridge 3. The legs can be fixed at the desired height with slots 10 and nuts 11.
Other embodiments of the device 6 for producing incisions may be applied as well. One of them may resemble to an egg cutter device: it may have a base and then the handle 2 provided with a bridge 3 on one end, and cutting blades 4 ar-ranged in the bridge is formed as a cutting arm tiltably connected to said base.
According to the method, cartilage cells, preferably hyaline cells taken from joint cartilages are seeded on the surface intended to face the bone. It may be ad-vantageous if the articular cartilage is fresh frozen until use.
For harvesting articular cartilage, a device may be applied comprising handle and cutting blade, wherein the cutting blade is curvilinear and is provided with spacer elements.
The distance between the cutting blade and the spacer elements is preferably 0,1 - 4 mm and the curvature of the edge is adjusted to that of the joint surface.
The device for producing incisions in the articular cartilages comprises a handle and a bridge connected to said handle and being provided with one or more cut-ting blade(s). The thickness of the cutting blades is 0,1 - 0,5 mm, and the dis-tance between the cutting blades is 0,1 - 1 mm.
The cutting blades may be arranged on discs or on plates and may be provided with adjustable spacer elements.
During the method for applying the articular cartilage - if it is not seeded with cells - microfracturing is performed first at the cartilage defect and than the ar-ticular cartilage is fixed. If the articular cartilage is provided with cartilage cells, it is directly fixed at the cartilage defect.
The articular cartilage may be fixed by thin surgical yarn stitches or fibrin glue. It is also possible that the articular cartilage is fixed by small pieces of surgical yarn or small anchors introduced through the bone.
The invention is based on the recognition that thin cartilage allografts of great surfaces are optimal for the replacement of defected joint cartilages, and the efficiency of their use may be improved if the side intended to face the bone is provided with incisions, and preferably with cartilage cells as well. It is also rec-ognized, that these cells transplanted into the matrix have the optimal structure if they are applied to a matrix gathered from a cadaver and cleared, preferably completely, from cells. A device for harvesting articular cartilage and another device for producing incisions in articular cartilages have been developed for this purpose.
BRIEF DESCRIPTION OF THE DRAWING
Further details of the invention will be set forth below in conjunction with the drawing where Figure 1. is a schematic view of a first embodiment of the device accord-ing to the invention for harvesting articular cartilage, Figure 2. is a schematic view of a second embodiment of the device for harvesting articular cartilage, Figure 3. shows the steps of harvesting sterile articular cartilage, Figure 4. is a schematic view of a first embodiment of the device accord-ing to the invention for producing incisions in articular cartilages, Figure 5. is a schematic view of a second embodiment of the device for producing incisions in articular cartilage, Figure 6. is an enlarged top view of a preferred embodiment of an articu-lar cartilage according to the invention, Figure 7. is section VII - VII of Figure 6, Figure 8. is the cross section of an articular cartilage provided with carti-lage cells, after implanting and Figure 9. is the cross section of an articular cartilage without transplanted cells, after implanting.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Turning to Figure 1, a device for harvesting articular cartilage 1 comprises a handle 2 provided with a sharp, curvilinear cutting blade 4 fixed in a bridge 3.
The curvature of the cutting blade 4 is adjusted to that of the joint surface to be harvested. At the ends of the cutting blade 4, there are spacer elements 5.
The distance t between the edges of the spacer elements 5 and the edge of the cut-ting blade 4 defines the depth of harvesting, i.e. the distance from the bone/cartilage border (tidemark). This distance is in this case 0,5 mm. The dis-tance T between the edges of the spacer elements 5 defines the width of the harvesting.
Figure 2. illustrates another embodiment of the device for harvesting articular cartilage 1 according to the invention. This device also comprises a handle 2 5 with a sharp, curvilinear cutting blade 4 fixed thereon. Blade 4 is provided with a spacer element 5, too. This element is in this embodiment a support plate. The distance t between the edge of the spacer element 5 and the edge of the blade 4 is in this case 0,5 mm, but can go up to 4 mm, if needed.
The thickness of the blade 4 of the device 1 according to the invention for har-vesting articular cartilage ranges preferably from 0,1 to 0,5 mm, and cartilages of rather big surfaces (6 - 10 cm2) can be harvested therewith. The steps of har-vesting are shown in Figures 3a - 3d.
Before implantation, the harvested articular cartilage should be provided with incisions according to the invention, said incisions providing an indentation on the side of the cartilage facing the bone. The distances between the incisions should be very small: 0,1 - 1 mm. A device 6 for producing such incisions is shown in Figure 4 (the illustration is schematic and the proportions are not real).
The device 6 comprises a handle 2 provided with a bridge 3 on one end, and cutting blades 4 arranged in the bridge. The thickness of the cutting blades 4 is 0,2 mm according to this embodiment, and the distances between them is 0,4 mm.
Figure 5. shows another embodiment of the device 6 for producing incisions (the illustration is schematic and not scaled). Here, the cutting blades 4 in the bridge 3 are discs arranged on a rod 7. The discs are fixed (in other embodiments they may be arranged rotatably) on the rod and the rod is provided with a drive 8 (preferably an electric motor). The depth of the cuts can be adjusted by legs slidably arranged on the bridge 3. The legs can be fixed at the desired height with slots 10 and nuts 11.
Other embodiments of the device 6 for producing incisions may be applied as well. One of them may resemble to an egg cutter device: it may have a base and then the handle 2 provided with a bridge 3 on one end, and cutting blades 4 ar-ranged in the bridge is formed as a cutting arm tiltably connected to said base.
The depth of the incisions can be adjusted by changing the position of the cut-ting blades 4 with respect to the legs 9 of the bridge 3.
For preparing the incisions, cutting arm is opened, a cartilage is arranged on the upper surface of the base and then the cutting arm is turned down, until legs butt on base.
An articular cartilage obtained in the above way is illustrated in Figures 6 and 7, wherein Fig 6. is a top view and Fig 7. is a cross section of the cartilage.
Inci-sions 12 produced with one embodiment of device 6 have a depth to leave an intact layer of cartilage. The minimum thickness v of that layer is 50 pm, but may go up to 1000 pm. The value of v for the embodiment shown in Figures 7 and 8 is 100 pm. The incisions 12 are parallel with each other, but any other pattern may be used. The distances d between the incisions 12 may range from 0,1 to 1 mm, it is 0,6 mm for the embodiment shown in Figures 6 and 7.
EXAMPLES
Example 1.
Several hundred milligrams of hyaline cartilage was collected with arthroscopy for repairing the cartilage damage of a young sportsman. The collected cartilage was delivered to a cell culturing laboratory.
After having obtained the required number of cells, they were suspended, poured onto the side of the matrix provided with incision, and left for properly sedimenting.
The cartilage matrix had been harvested in sterile conditions from the knee joint of a cadaver, long before the operation, with the device shown in Figure 1.
The matrix with a surface of 2 x 3 cm had been provided with incisions on the side facing the bone, with the device shown in Figure 5. The incisions had been made in two perpendicular directions, wherein the distances between the inci-sions were 0,5 mm and the thickness of the intact collagen layer was 90 pm.
The matrix had than been provided with a sterile packing and stored on a tem-perature of - 80 C.
The cartilage matrix obtained from a cadaver and prepared in the above outlined way was implanted via miniarthrotomy knee operation, as shown in Figure 9. In the exposed knee joint, the damaged cartilage part was removed with a sharp spoon, up to the intact cartilage and a quadratic recipient cavity was prepared in the cleared surface. The graft 14 provided with cells 13 was cut to fit in the cav-ity and implanted in the appropriate position. It was then connected to the edge of the intact cartilage layer with small stitches. At last, the implant was glued around (sealing) with fibrin glue.
Example 2.
A patient of middle age had ankle complaints. As the result of an examination, it was found that he had focal cartilage defect on the upper surface of her talus. It was decided to perform cartilage substitution by cartilage cell transplantation, therefore bone marrow stem cells were collected for culturing (in cases, when it is not possible, joint cartilage particles may be collected for obtaining cells). The collected cells were delivered to a cell culturing laboratory.
Prior to the operation, cartilage sample had been harvested in sterile conditions from the knee joint of a cadaver, with the device shown in Figure 2. The carti-lage had been processed with incisions on the side facing the bone, with the device shown in Figure 5. The incisions had been made in parallel directions, wherein the distances between the incisions were 0,8 mm and the thickness of the intact layer was 120 pm.
The multiplied cells were centrifuged to the graft provided with incisions, to be captured in the incisions and were fixed therein with glue.
The cartilage had than been provided with a sterile packing and stored in fluid nitrogen on a temperature of - 160 C until the day of the operation, when it was sent to the operating room.
After having exposed the ankle joint, the cartilage defect of the talus was cleared, the bone below was cleaned and the graft prepared and cut to proper size and form in advance was implanted in place of the cartilage deficiency.
For fixing, fibrin glue was applied, without stitching, on the bottom and the sides of the implant. Thereafter, the joint was covered and a rehabilitation protocol of 6 weeks has been carried out with proper fractional load.
Example 3.
During arthroscopy of a women of middle age it was found that she had small cartilage deficiency on the knee joint. Therefore, at the same time, following a small joint exposure, the region of the cartilage deficiency has been cleared up to the healthy cartilage.
One week before the operation sound articular cartilage had been harvested in sterile conditions from the shoulder joint of a cadaver, with the device shown in Figure 2. The cartilage had been provided with incisions on the side facing the bone. The incisions had been made in parallel directions, wherein the distances between the incisions were 0,1 mm and the thickness of the intact layer was pm.
The cartilage had than been stored for one week in sterile conditions, without freezing, on +4 C, until the day of the operation.
The graft was delivered to the surgeon together with the living cells therein, for operation. A hole was made in the bone below the cartilage (microfracture) and the graft 14, after having been cut to proper size and form, was fixed in the re-gion of the cartilage deficiency, the surface provided with incisions facing the bone. For fixing the graft, small anchors 16 were introduced through the bone.
In this case, bone marrow cells 17 could flow to the incisions 12 through the hole (not shown) in the bone, and these cells produced the cellular body of the articu-lar cartilage by conversion to cartilage cells. The cells surviving in the cartilage also helped the cartilage to stick to the subchondral bone.
The drawing and the examples show, that the devices according to the invention are simple, the use of them is safe, and they enable to prepare articular carti-lages of far better quality, than the ones used up to now.
The articular cartilages according to the invention offer the advantage with re-spect to the state of art, that the incisions considerably improve the incorporation of the cells cultured in laboratory or deriving from bone marrow. A further advan-tage is that the incisions enhance the flexibility of the cartilage and, in this way, the use is more simple and safe.
For preparing the incisions, cutting arm is opened, a cartilage is arranged on the upper surface of the base and then the cutting arm is turned down, until legs butt on base.
An articular cartilage obtained in the above way is illustrated in Figures 6 and 7, wherein Fig 6. is a top view and Fig 7. is a cross section of the cartilage.
Inci-sions 12 produced with one embodiment of device 6 have a depth to leave an intact layer of cartilage. The minimum thickness v of that layer is 50 pm, but may go up to 1000 pm. The value of v for the embodiment shown in Figures 7 and 8 is 100 pm. The incisions 12 are parallel with each other, but any other pattern may be used. The distances d between the incisions 12 may range from 0,1 to 1 mm, it is 0,6 mm for the embodiment shown in Figures 6 and 7.
EXAMPLES
Example 1.
Several hundred milligrams of hyaline cartilage was collected with arthroscopy for repairing the cartilage damage of a young sportsman. The collected cartilage was delivered to a cell culturing laboratory.
After having obtained the required number of cells, they were suspended, poured onto the side of the matrix provided with incision, and left for properly sedimenting.
The cartilage matrix had been harvested in sterile conditions from the knee joint of a cadaver, long before the operation, with the device shown in Figure 1.
The matrix with a surface of 2 x 3 cm had been provided with incisions on the side facing the bone, with the device shown in Figure 5. The incisions had been made in two perpendicular directions, wherein the distances between the inci-sions were 0,5 mm and the thickness of the intact collagen layer was 90 pm.
The matrix had than been provided with a sterile packing and stored on a tem-perature of - 80 C.
The cartilage matrix obtained from a cadaver and prepared in the above outlined way was implanted via miniarthrotomy knee operation, as shown in Figure 9. In the exposed knee joint, the damaged cartilage part was removed with a sharp spoon, up to the intact cartilage and a quadratic recipient cavity was prepared in the cleared surface. The graft 14 provided with cells 13 was cut to fit in the cav-ity and implanted in the appropriate position. It was then connected to the edge of the intact cartilage layer with small stitches. At last, the implant was glued around (sealing) with fibrin glue.
Example 2.
A patient of middle age had ankle complaints. As the result of an examination, it was found that he had focal cartilage defect on the upper surface of her talus. It was decided to perform cartilage substitution by cartilage cell transplantation, therefore bone marrow stem cells were collected for culturing (in cases, when it is not possible, joint cartilage particles may be collected for obtaining cells). The collected cells were delivered to a cell culturing laboratory.
Prior to the operation, cartilage sample had been harvested in sterile conditions from the knee joint of a cadaver, with the device shown in Figure 2. The carti-lage had been processed with incisions on the side facing the bone, with the device shown in Figure 5. The incisions had been made in parallel directions, wherein the distances between the incisions were 0,8 mm and the thickness of the intact layer was 120 pm.
The multiplied cells were centrifuged to the graft provided with incisions, to be captured in the incisions and were fixed therein with glue.
The cartilage had than been provided with a sterile packing and stored in fluid nitrogen on a temperature of - 160 C until the day of the operation, when it was sent to the operating room.
After having exposed the ankle joint, the cartilage defect of the talus was cleared, the bone below was cleaned and the graft prepared and cut to proper size and form in advance was implanted in place of the cartilage deficiency.
For fixing, fibrin glue was applied, without stitching, on the bottom and the sides of the implant. Thereafter, the joint was covered and a rehabilitation protocol of 6 weeks has been carried out with proper fractional load.
Example 3.
During arthroscopy of a women of middle age it was found that she had small cartilage deficiency on the knee joint. Therefore, at the same time, following a small joint exposure, the region of the cartilage deficiency has been cleared up to the healthy cartilage.
One week before the operation sound articular cartilage had been harvested in sterile conditions from the shoulder joint of a cadaver, with the device shown in Figure 2. The cartilage had been provided with incisions on the side facing the bone. The incisions had been made in parallel directions, wherein the distances between the incisions were 0,1 mm and the thickness of the intact layer was pm.
The cartilage had than been stored for one week in sterile conditions, without freezing, on +4 C, until the day of the operation.
The graft was delivered to the surgeon together with the living cells therein, for operation. A hole was made in the bone below the cartilage (microfracture) and the graft 14, after having been cut to proper size and form, was fixed in the re-gion of the cartilage deficiency, the surface provided with incisions facing the bone. For fixing the graft, small anchors 16 were introduced through the bone.
In this case, bone marrow cells 17 could flow to the incisions 12 through the hole (not shown) in the bone, and these cells produced the cellular body of the articu-lar cartilage by conversion to cartilage cells. The cells surviving in the cartilage also helped the cartilage to stick to the subchondral bone.
The drawing and the examples show, that the devices according to the invention are simple, the use of them is safe, and they enable to prepare articular carti-lages of far better quality, than the ones used up to now.
The articular cartilages according to the invention offer the advantage with re-spect to the state of art, that the incisions considerably improve the incorporation of the cells cultured in laboratory or deriving from bone marrow. A further advan-tage is that the incisions enhance the flexibility of the cartilage and, in this way, the use is more simple and safe.
Claims (30)
1. Articular cartilage for repairing cartilage defects, characterized in that it is made of pure cartilage and is provided with incisions (12) on the surface facing the bone.
2. Articular cartilage as claimed in claim 1, characterized in that there is a dis-tance of 0,1 - 1 mm between the incisions (12).
3. Articular cartilage as claimed in claim 1 or 2, characterized in that the inci-sions (12) are parallel with each other.
4. Articular cartilage as claimed in claim 1 or 2, characterized in that the inci-sions (12) are of different directions.
5. Articular cartilage as claimed in any of claims 1 to 4, characterized in that the incisions (12) have a depth leaving an intact layer (v) of at least 50µm thickness.
6. Articular cartilage as claimed in any of claims 1 to5, characterized in that cartilage cells are seeded on the surface provided with incisions (12).
7. Articular cartilage as claimed in claim 6, characterized in that the cartilage cells are hyaline cells taken from joint cartilages.
8. Method for producing articular cartilage for repairing cartilage defects com-prising the step of collecting cartilage from joints, characterized in that pure cartilage is collected without bone, and incisions are made on the surface of the cartilage intended to face the bone.
9. The method as claimed in claim 8, characterized in that a distance of 0,1 -1 mm is left between the incisions (12).
10. The method as claimed in claim 8, characterized in that an intact layer (v) of at least 50µm thickness is left at the outer side of the cartilage.
11. The method as claimed in any of claims 8 to10, characterized in that carti-lage cells are seeded on the surface intended to face the bone.
12. The method as claimed in claim 8, characterized in that hyaline cells are taken from joint cartilages for arranging them on the surface intended to face the bone.
13. The method as claimed in any of claims 8 to11, characterized in that the articular cartilage is fresh frozen until use.
14. Device for harvesting articular cartilage, comprising handle and cutting blade, characterized in that the cutting blade (4) is curvilinear and is pro-vided with spacer elements (5).
15. The device as claimed in claim 14, characterized in that the distance (t) between the cutting blade (4) and the spacer elements (5) is 0,1 - 4 mm.
16. The device as claimed in claim 14, characterized in that the curvature of the cutting blade (4) conforms to that of the joint surface.
17. Device for producing incisions in articular cartilages, characterized in that it comprises handle (2) and a bridge (3) connected to said handle (2) and being provided with one or more cutting blade(s) (4).
18. The device as claimed in claim 17, characterized in that the thickness of the cutting blades (4) is 0,1 - 0,5 mm.
19. The device as claimed in claim 17 or 18, characterized in that the distance between the cutting blades (4) is 0,1 - 0,5 mm.
20. The device as claimed in any of claims 17 to 19, characterized in that the cutting blades (4) are on discs.
21. The device as claimed in any of claims 17 to 19, characterized in that the cutting blades (4) are on plates.
22. The device as claimed in any of claims 17 to 21, characterized in that it is provided with spacer elements (5).
23. The device as claimed in claim 22, characterized in that the spacer ele-ments (5) are adjustable supports (9).
24. The device as claimed in any of claims 17 to 21, characterized in that the handle (2) and the bridge (3) connected to said handle (2) are in the form of a cutting arm tiltably connected to a base.
25. Method for applying the articular cartilage as claimed in any of claims 1 to 5, for repairing cartilage defects, characterized in that microfracturing is performed first at the cartilage defect and than the articular cartilage is fixed.
26. Method for applying the articular cartilage as claimed in claim 6 or 7, for repairing cartilage defects, characterized in that the articular cartilage pro-vided with cartilage cells is directly fixed at the cartilage defect.
27. The method as claimed in claim 25 or 26, characterized in that the articular cartilage is fixed by thin surgical yarn stitches.
28. The method as claimed in claim 25 or 26, characterized in that the articular cartilage is fixed by fibrin glue.
29. The method as claimed in claim 25 or 26, characterized in that the articular cartilage is fixed by small pieces of surgical yarn introduced through the bone.
30. The method as claimed in claim 25 or 26, characterized in that the articular cartilage is fixed by small anchors introduced through the bone.
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
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HU0700524A HUP0700524A2 (en) | 2007-08-10 | 2007-08-10 | Cartilage allograft for replacement of cartilage damages, and process and accessories for producing thereof |
HUP0700524 | 2007-08-10 | ||
PCT/HU2008/000095 WO2009022191A2 (en) | 2007-08-10 | 2008-08-01 | Articular cartilage, device and method for repairing cartilage defects |
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CA2699005A1 true CA2699005A1 (en) | 2009-02-19 |
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CA2699005A Abandoned CA2699005A1 (en) | 2007-08-10 | 2008-08-01 | Articular cartilage, device and method for repairing cartilage defects |
Country Status (6)
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US (1) | US20100211173A1 (en) |
EP (1) | EP2194927A2 (en) |
AU (1) | AU2008288225A1 (en) |
CA (1) | CA2699005A1 (en) |
HU (1) | HUP0700524A2 (en) |
WO (1) | WO2009022191A2 (en) |
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EP2455040B1 (en) | 2010-11-17 | 2015-03-04 | Arthrex, Inc. | Adjustable suture-button construct for knotless stabilization of cranial cruciate deficient ligament stifle |
EP3527144B1 (en) | 2010-11-17 | 2023-12-13 | Arthrex Inc | Adjustable suture-button construct for ankle syndesmosis repair |
US9301745B2 (en) | 2011-07-21 | 2016-04-05 | Arthrex, Inc. | Knotless suture constructs |
US9332979B2 (en) | 2011-07-22 | 2016-05-10 | Arthrex, Inc. | Tensionable knotless acromioclavicular repairs and constructs |
US9107653B2 (en) | 2011-09-22 | 2015-08-18 | Arthrex, Inc. | Tensionable knotless anchors with splice and methods of tissue repair |
US10245016B2 (en) | 2011-10-12 | 2019-04-02 | Arthrex, Inc. | Adjustable self-locking loop constructs for tissue repairs and reconstructions |
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US20130338792A1 (en) * | 2012-06-15 | 2013-12-19 | Arthrex, Inc. | Implantation of micronized allograft tissue over a microfractured defect |
US9737292B2 (en) | 2012-06-22 | 2017-08-22 | Arthrex, Inc. | Knotless suture anchors and methods of tissue repair |
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AU2013342255B2 (en) | 2012-11-08 | 2017-05-04 | Smith & Nephew, Inc. | Methods and compositions suitable for improved reattachment of detached cartilage to subchondral bone |
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2007
- 2007-08-10 HU HU0700524A patent/HUP0700524A2/en unknown
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2008
- 2008-08-01 CA CA2699005A patent/CA2699005A1/en not_active Abandoned
- 2008-08-01 US US12/674,772 patent/US20100211173A1/en not_active Abandoned
- 2008-08-01 EP EP08788813A patent/EP2194927A2/en not_active Withdrawn
- 2008-08-01 AU AU2008288225A patent/AU2008288225A1/en not_active Abandoned
- 2008-08-01 WO PCT/HU2008/000095 patent/WO2009022191A2/en active Application Filing
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HUP0700524A2 (en) | 2010-01-28 |
AU2008288225A1 (en) | 2009-02-19 |
EP2194927A2 (en) | 2010-06-16 |
WO2009022191A2 (en) | 2009-02-19 |
HU0700524D0 (en) | 2007-10-29 |
US20100211173A1 (en) | 2010-08-19 |
WO2009022191A3 (en) | 2009-04-16 |
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