IMPLANTABLE MESH FOR MUSCULOSKELETAL TRAUMA, ORTHOPEDIC RECONSTRUCTION AND SOFT TISSUE REPAIR
Biocompatible mesh materials are employed to make implants for repairing or replacing a bone or for soft tissue repair. The mesh materials can be comprised of bioabsorbable materials, non-bioabsorbable materials or bioabsorbable and non-bioabsorbable materials. Pharmaceutical actives, bone growth enhancers and the like can be combined with the implants.
1. Field of the Invention
The present invention relates to biocompatible mesh materials that are formed into implantable structures for treatment of musculoskeletal trauma, orthopedic reconstruction and soft tissue applications.
2. The Related Art
Biocompatible mesh materials have traditionally been used in soft tissue surgery. But these materials have been largely ignored for skeletal repair, due in part to their flexibility and lack of strength. For example, U.S. Pat. No. 3,463,158 describes polyglycolic acid materials which are used to make absorbable and partially absorbable woven devices which are said to be useful in the repair of hernias, arteries and veins.
More rigid hardware devices made from fenestrated shells are described in U.S. Patent Application Pub. No. 2005/0015154. These devices are said to enhance tissue integration so that the device becomes permanently affixed to the tissue.
There are many musculoskeletal trauma and orthopedic reconstruction needs that are not effectively met by current technology either because the materials of construction are too rigid or too flexible for their designated applications. The devices of the present invention provide a significant improvement over the current technology by employing mesh materials in a non-traditional manner and/or by employing certain new mesh materials and modified mesh materials in medical applications.
SUMMARY OF THE INVENTIONThe implantable devices of the present invention employ meshes comprised of bioabsorbable materials or non-bioabsorbable materials or a combination of bioabsorbable and non-bioabsorbable materials. Each device is made in the form of a structure having the strength and other physical characteristics necessary to carry out its intended purpose. The meshes can be employed alone to form implantable devices or they can be combined with other and different meshes and/or non-mesh materials to form implantable devices. The devices also can be combined with pharmaceutical agents, bone growth enhancers and the like.
Mesh materials, which can be used in the present invention, can take numerous forms. They can be woven, knitted, braided or knotted, or an arrangement of interlocking links (such as the links of the type found in jewelry or chain link fencing) or other interlocking, intertwined or interwoven constructions and the terms “mesh” or “mesh materials” as used herein are intended to include these various forms and constructions.
The figures illustrate mesh materials employed in the invention and embodiments of the invention employing the mesh materials. The figures may not be drawn to scale.
The invention has to do with implantable devices made from mesh materials. One or more than one type of mesh material can be used in an implantable device of the invention. And the mesh material can be combined with non-mesh materials such as rods, tubes, solid sheets, perforated sheets, fillers and other materials of various shapes, forms and compositions to make a composite implant structure having sufficient strength to carry out its intended purpose. The implantable devices of the invention can be used to repair or replace a bone or a joint or reattach a tendon, muscle or cartilage. Novel mesh structures for soft tissue repair are also described.
In the simplest structure, a woven implantable mesh consists of two sets of strands crossed over and under each other in a simple alternating pattern as shown in
Many other woven mesh configurations are possible, however. Decreasing the spacing between the strands can produce a denser, less permeable mesh with smaller voids 4 as shown in
The mesh can also be woven with a variable spacing between strands. This can occur along one axis or along both as shown in
A loosely woven mesh can be created by alternating pairs of strands in each direction as shown in
All of the above examples show the strands essentially parallel to the edges of the sheet of mesh, but this too can be varied as shown in
By varying the fibers or strands in each direction, the material properties can be changed uniformly as shown in
Numerous other constructions can be used to make the mesh materials of the present invention as will be apparent to those skilled in the art based upon the disclosures herein. Some examples are provided in
The strand materials can come from any of the classes of biocompatible implant materials; metallics, bioresorbable polymers and non-resorbable polymers. In addition, organic materials such as collagen are suitable in some applications. The strands can have various physical structures. For example, they can be monofilament or thread or yarn structures. They can be braided or they can be hollow tubular structures and the hollow tubular structures can have a cross-section which is round, oval, square, rectangular, triangular or of any other closed geometric shape, including irregular shapes. If the hollow strands are porous or biodegradable, they can be filled with medication or bone growth substances to provide a timed release at the surgical site. A surgical mesh which incorporates a timed release of antibiotics is particularly attractive in abdominal wall or hernia repair.
Many of the previous examples show a woven mesh in a flat configuration but this is just the starting point for mesh implants. In a flat woven configuration, the individual strands can shift relative to each other to provide maximum flexibility. In other applications it might be desirable to constrain the strands to create a more rigid construction. This can be accomplished in several ways. One method is to sinter the woven mesh. Sintering is the process of fusing adjacent structures by heating them just below the melting point of the material. At this temperature the strands will soften and fuse together where they contact one another. Pressure may be used in addition to heat alone.
If this same process is applied to mesh 9 shown in
Another method of constraining the strands in a mesh is to fill the interstices between the strands with another biocompatible material thereby locking the strands in their relative positions. This also serves to combine the properties of the mesh material and the filler. In this manner, the mesh structure can act as a reinforcing element for the filler resulting in a composite material having properties superior to either material alone. Suitable filling materials include resorbable polymers, hydrogels, collagen as well as non-resorbable polymers. If this material is bioresorbable, then the gradual degradation of the bioresorbable component will alter the overall mechanical properties of the filled mesh over time. If the filling material is non-resorbable, then the mechanical properties will remain unchanged after implantation. A filling material that softens at a relatively low temperature (like most bioresorbable polymers) also provides the advantage of allowing the mesh to be shaped intraoperatively. In surgery, it is often necessary to contour an implant to match the patient's anatomy and have the implant maintain the new contour while providing support to the tissue. Most polymer based meshes can be contoured but have the tendency to spring back to their original shape. Filling the mesh with a material that softens at a low temperature allows the implant to be heated in the operating room, contoured to fit the patient and then, after cooling, it maintains that form because the filler locks the strands in their new positions.
Implantable meshes can also be comprised of at least two sheets of mesh optionally adhered to one another, for example, laminated together or adhered to one another at predetermined discreet points of contact such as at points 32a and 32b in
In another embodiment, a multilayer construction can have only the edges (i.e., the perimeter) sintered, filled or both. The center section remains flexible. An example is shown in
Implantable mesh products can be produced in shapes other than flat sheets.
Mesh may be fabricated in tubular form by weaving, knitting or braiding processes. (See
Flattened tubular mesh could be made by weaving, braiding or knitting to produce a flat, hollow cable or strap which additionally can be combined with many other components to form implantable medical devices.
A section of mesh 44, sealed at one end can form a packet for containing medication and this can be used in the manner described in U.S. Pat. No. 6,916,483. The mesh structure permits body fluids to act upon the contents yet will contain them in a volume for implantation at a desired location in the body or in another implant.
In a multi-component tubular mesh construction, the members can also be designed to be moveable relative to one another as shown in FIGS. 14C through 14D-3.
Flattened tubular mesh can also be used as an outer covering for a bone plate. The addition of this outer mesh cover can add strength, stiffness, tissue ingrowth properties, the ability to deliver medication, etc.
Other bone plate embodiments are illustrated in
Tubular mesh structures may also be created by rolling up sheets of mesh. These can be single sheets, laminated sheets, sintered sheets or filled sheets or any combination thereof. A shaped core can be used in the process and this core may become part of the implant or may only be used for a portion of the fabrication process. This core can be solid, tubular or shaped, and it can be comprised of any implant materials known in the art. The core can be a composite of various implant materials and it may also take the form of a partial core if required. It is also possible to roll the mesh sheets with no core. Afterwards the rolled construct can be formed into a final cross-sectional shape using heat and/or pressure, adhesives, filling material, any flowable material that can be hardened by curing, etc. The orientation of the mesh strands relative to the rolling direction can be varied to produce different mechanical properties of the finished tubular form. Similarly, the orientation of the rolling direction relative to the edge of the sheet can greatly influence the mechanical properties of the finished tubular form.
More complex three-dimensional shapes can be formed by compacting the implantable mesh, similar to wadding up a piece of paper to throw in the trash. This can be done with single sheets, laminated sheets, rolled sheets, sintered sheets or filled sheets of mesh, or any combination thereof. Once the mesh is compacted into the desired shape, it can be locked in place by sintering and/or filling the strands. While a hip stem is illustrated, obviously this process could be used to produce a wide range of implants including bone plates, screws, rods, etc. The resulting three-dimensional structure of a compressed, sintered mesh (
Implantable mesh can be combined with other components to form a complete implant.
The mesh material also can be perforated. The perforation process can be combined with heat to fuse the perforated edges to prevent fraying or loosening of the fibers or strands.
Mesh structures provide a means of producing surgical and orthopedic implants with enhanced properties. They represent a method of combining a wide range of existing implant materials in new ways to maximize their advantages and minimize their individual limitations. Strands of various materials can be interwoven at the mesh level. Various fabrication methods (e.g., weaving, knitting, braiding and perforating) can create mesh with a wide range of physical properties. Layers of different mesh can be laminated together to produce a hybrid implant material with properties precisely tailored to the clinical indication. These mesh structures can be further reinforced by sintering the strands to prevent movement and/or by encapsulating them in another material. In this manner, an implant can be made with properties not found in the current selection of biomaterials. Implants for fracture fixation could be made with the required initial strength but also with the ability to partially or completely resorb preventing stress shielding, minimizing the amount of residual foreign material in the patient and reducing the number of second (removal) surgeries. Reconstructive implants could be made with internal structures similar to cancellous bone, thus offering a better combination of strength, resiliency and reduced weight. Surgical meshes for muscle, ligament or tendon repair and/or reattachment to bone can be wholly or partially resorbable and offer the ability to deliver antibiotics or other medications to the local surgical site. The exposed surfaces of implants could be designed either to encourage or discourage the ingrowth of hard or soft tissues. The net result is a new class of biomaterials with enhanced mechanical and biological properties.
Claims
1. An orthopedic implant comprised of a mesh material shaped in the form of a structure for repairing or replacing a bone or a joint, the structure having sufficient strength to repair or replace the bone or joint.
2. The orthopedic implant of claim 1 wherein the mesh material is comprised of at least two different strand structures having the same or different compositions.
3. The orthopedic implant of claim 2 wherein said at least two different strand structures are selected from the group consisting of monofilament, braided, yarns, threads, hollow tubes, flat strips, solid ovals, hollow ovals and solid rounds.
4. The orthopedic implant of claim 2 wherein said compositions are selected from the group consisting of resorbable materials, non-resorbable materials and resorbable and non-resorbable materials.
5. The orthopedic implant of claim 1 further comprising at least one additional mesh material overlaying and adjacent to at least a portion of the structure.
6. The orthopedic implant of claim 1 wherein the mesh materials are comprised of strands having interstices therebetween.
7. The orthopedic implant of claim 6 further comprising medication contained within at least some of the interstices.
8. The orthopedic implant of claim 6 wherein at least some of the interstices are filled with a biocompatible material.
9. The orthopedic implant of claim 8 further comprising medication contained within at least some of the interstices.
10. The orthopedic implant of claim 8 further comprising medication contained within at least some of the biocompatible material.
11. The orthopedic implant of claim 6 wherein at least some of the strands are tubular strands.
12. The orthopedic implant of claim 11 further comprising medication within the tubular strands.
13. The orthopedic implant of claim 1 wherein the mesh material is tubular and has a proximal end and a distal end.
14. The orthopedic implant of claim 13 wherein the mesh material is woven, braided or knitted.
15. The orthopedic implant of claim 13 comprising at least two tubular woven mesh materials, each having a proximal end and a distal end.
16. The orthopedic implant claim 15 wherein said at least two tubular woven mesh materials are coaxial.
17. The orthopedic implant of claim 16 wherein said at least two tubular woven mesh materials are coaxially movable relative to one another.
18. The orthopedic implant of claim 13 wherein one of the proximal end and/or the distal end is closed.
19. The orthopedic implant of claim 13 wherein the proximal end and the distal end are open and further comprising an elongate strap inserted in the proximal open end of the tubular mesh material and optionally extending through the distal open end, the strap and mesh material being moveable relative to one another.
20. The orthopedic implant of claim 19 wherein the strap is comprised of a mesh material.
21. The orthopedic implant of claim 13 wherein the proximal end and the distal end are open and further comprising an elongate strap having a first end and a second end, the first end of the elongate strap being inserted into the proximal open end of the tubular mesh material and extending through a first opening disposed along a side portion of the tubular mesh material and the second end of the elongate strap being inserted into the distal open end of the tubular mesh material and extending through said first opening or a second opening disposed along a side portion of the tubular mesh material.
22. The orthopedic implant of claim 21 wherein the strap is comprised of a mesh material.
23. The orthopedic implant of claim 21 further comprising a bracket disposed between the proximal end and the distal end for affixing the implant to a bone.
24. The orthopedic implant of claim 21 further comprising a fastener affixed to one end of the elongate strap.
25. The orthopedic implant of claim 13 wherein the tubular mesh material is flattened.
26. The orthopedic implant of claim 25 further comprising a bone plate wherein the flattened tubular mesh material is affixed as a covering over at least a portion of the bone plate.
27. The orthopedic implant of claim 26 wherein the flattened tubular mesh material is at least partially fused to the bone plate.
28. The orthopedic implant of claim 1 comprising a bone plate having a top surface and a bottom surface and a mesh material laminated to the top surface or the bottom surface or both the top surface and the bottom surface.
29. The orthopedic implant of claim 1 comprising a first flattened tubular mesh material, a second flattened tubular mesh material coaxially disposed within the first flattened tubular mesh material and a core strip coaxially disposed within the second flattened tubular mesh material, the core strip comprising a solid or a mesh material.
30. The orthopedic implant of claim 29 wherein a portion of the first flattened tubular mesh material is cut away to form a pocket.
31. The orthopedic implant of claim 1 wherein the mesh material is comprised of at least one mesh sheet wrapped around an optionally removable core.
32. The orthopedic implant of claim 31 wherein the core is solid, tubular or shaped.
33. The orthopedic implant of claim 1 wherein the mesh material is comprised of at least one rolled mesh sheet.
34. The orthopedic implant of claim 33 wherein the at least one rolled mesh sheet is pre-cut or pre-shaped.
35. The orthopedic implant of claim 33 wherein the at least one rolled mesh sheet has a proximal end and a distal end and is rolled in parallel with an axis.
36. The orthopedic implant of claim 35 which is rolled upon itself from the proximal end and/or the distal end in a direction along the axis and perpendicular thereto.
37. The orthopedic implant of claim 33 wherein the mesh material is diagonally rolled and optionally shaped.
38. The orthopedic implant of claim 33 wherein the mesh material is pre-cut or pre-shaped.
39. The orthopedic implant of claim 33 wherein the at least one rolled mesh sheet is shaped by heat, pressure or heat and pressure.
40. The orthopedic implant of claim 1 having the structure of a bone plate comprised of a solid material and a mesh material affixed to the solid material.
41. The orthopedic implant of claim 1 having the structure of a bone plate comprised of at least one mesh material.
42. The orthopedic implant of claim 1 further comprising at least one perforation in the mesh material.
43. The orthopedic implant of claim 1 comprising at least two sheets of the mesh material.
44. The orthopedic implant of claim 43 wherein said at least two sheets are the same or different.
45. The orthopedic implant of claim 44 wherein said at least two sheets are adhered to one another.
46. The orthopedic implant of claim 44 wherein said at least two sheets have a common perimeter and said at least two sheets are adhered to one another at the perimeter.
47. The orthopedic implant of claim 44 wherein said at least two sheets are adhered to one another at discreet points of contact.
48. The orthopedic implant of claim 44 wherein the mesh materials are comprised of strands having interstices therebetween and at least some of the interstices are filled with a biocompatible material or medication or a biocompatible material and medication.
49. An implant device comprising a mesh material shaped in the form of a structure for orthopedic, musculoskeletal or soft tissue repair, the mesh material having multiple strands, the strands crossing each other at points of contact with one another wherein at least some of the strands are affixed to others at the points of contact.
50. The implant device of claim 49 wherein some of the strands are affixed to others by adhesive, fusion or knots.
51. The implant device of claim 49 wherein the mesh material is compacted.
52. The implant device of claim 49 comprised of more than one mesh material.
53. The implant device of claim 52 wherein at least one mesh material is compacted.
54. The implant device of claim 49 wherein the mesh material is comprised of one or more than one higher melting point strand and one or more than one lower melting point strand, at least the lower melting point strand or strands having at least one point of contact and said lower melting point strand or strands is fused at each point of contact.
55. A method of making an implant device comprising a mesh material shaped in the form of a structure for orthopedic, musculoskeletal or soft tissue repair comprising affixing to one another at points of contact with one another strands of a mesh material having multiple strands, the strands crossing each other at points of contact with one another.
56. The method of claim 55 wherein the implant device is comprised of more than one mesh material.
57. An implant device comprising a mesh material shaped in the form of a structure for orthopedic, musculoskeletal or soft tissue repair, the mesh having multiple strands and interstices between the strands, at least some of the interstices being filled with a biocompatible material or medication or a biocompatible material and medication.
58. The implant device of claim 57 comprised of more than one mesh material.
59. A method of making an implant device comprising a mesh material shaped in the form of a structure for orthopedic, musculoskeletal or soft tissue repair comprising filling with a biocompatible material or medication or a biocompatible material and medication at least some interstices in a mesh having multiple strands and interstices between the strands.
60. The method of claim 59 wherein the implant device is comprised of more than one mesh material.
61. An orthopedic implant device comprising a rolled up or compacted mesh material shaped in the form of a structure for repairing or replacing a bone or a joint.
62. The orthopedic implant device of claim 61 wherein the rolled up or compacted mesh material is overlayed with one or more layers of a mesh material which is the same as or different from the rolled up or compacted mesh material.
63. The orthopedic implant device of claim 61 wherein the mesh material is a filled mesh material.
64. A method of contouring the orthopedic implant device of claim 61 comprising heating the device and reshaping it to a new contour that fits a patient's anatomy wherein the device maintains the new contour upon cooling.
65. An implant device comprising a mesh material for orthopedic, musculoskeletal or soft tissue repair, the mesh material having a flat central section with two opposing ends, the flat central section tapering at each opposing end to a cable, rope or strap comprised of the mesh material.
66. A method of making an implant device comprising a rolled up or compacted mesh material shaped in the form of a structure for repairing or replacing a bone or a joint comprising rolling up a mesh material to make a rolled-up perform or compacting a mesh material to make a compacted preform and subjecting the rolled-up or compacted preform to heat and/or pressure in order to shape it into the implant device.
67. The method of claim 66 wherein the mesh material is a filled mesh material.
68. An orthopedic implant device comprising a core wrapped with multiple layers of a mesh material and shaped in the form of a structure for repairing or replacing a bone or a joint.
69. A method of making an implant device comprising a mesh material shaped in the form of a structure for repairing or replacing a bone or a joint comprising wrapping a core with multiple layers of a mesh material to make a wrapped core and subjecting the wrapped core to heat and/or pressure in order to shape it into the implant device.
70. A method of contouring an orthopedic implant device having a contour that can be reshaped upon heating and being comprised of a mesh material or mesh materials, optionally in combination with non-mesh materials, comprising heating the device and shaping it to a new contour that fits a patient's anatomy wherein the device maintains the new contour upon cooling.
71. The orthopedic implant of claim 45 wherein the mesh materials are comprised of strands having interstices therebetween and at least some of the interstices are filled with a biocompatible material or medication or a biocompatible material and medication.
72. The orthopedic implant of claim 46 wherein the mesh materials are comprised of strands having interstices therebetween and at least some of the interstices are filled with a biocompatible material or medication or a biocompatible material and medication.
73. The orthopedic implant of claim 47 wherein the mesh materials are comprised of strands having interstices therebetween and at least some of the interstices are filled with a biocompatible material or medication or a biocompatible material and medication.
Type: Application
Filed: Jul 18, 2007
Publication Date: Jan 22, 2009
Inventors: James D. Ralph (Bethlehem, PA), Thomas N. Troxell (Pottstown, PA), Mark Michels (Glen Mills, PA)
Application Number: 11/779,559
International Classification: A61B 17/08 (20060101);