Patent Description:
An osteochondral structure refers to a structure comprising cartilage and bone. Typical osteochondral structures can be found in the thighbone (femur), shinbone (tibia), and kneecap (patella). Such structures fit tightly together and move smoothly because the bone surface is covered with a relatively thick layer of articular (hyaline) cartilage. An (osteo)chondral defect is any type of damage to articular cartilage and optionally to underlying (subchondral) bone. Usually, (osteo)chondral defects appear on specific weight-bearing spots at the ends of the thighbone and shinbone and the back of the kneecap for instance. They may range from roughened cartilage, small bone and cartilage fragments that hinder movement, to complete cartilage loss.

Trauma of joint surfaces is common in young active people practicing sports, or as a sequel to accidents. Lesions may comprise the cartilage layer only, but often the underlying subchondral bone too. Articular cartilage has a very low tendency for healing and the repair tissue is qualitatively inferior to the original tissue. This invariably leads to the formation of osteoarthritis (OA) over the years, which is a major cause of disability and loss of quality of life in elderly people. The standard treatment for this condition is ultimately joint replacement by artificial joints. Whilst clinically effective, the non-biological implants do not last longer than <NUM>-<NUM> years and revision surgery is much less effective and very costly. For this reason, much research is dedicated to developing biological regenerative therapies that would be life-long lasting. However, despite promising in vitro results, until now not a single solution has proven to be more effective than the current standard of care over a longer period in real life conditions.

Because the cartilage layer lacks nerve fibers, patients are often not aware of the severity of the damage. During the final stage, an affected joint consists of bone rubbing against bone, which leads to severe pain and limited mobility. By the time patients seek medical treatment, surgical intervention may be required to alleviate pain and repair the cartilage damage. Implants have been developed for the joint in order to avoid or postpone such surgical interventions. These may be implanted in a bone structure at an early stage of cartilage damage, and may thus be provided for preventive treatment, in order to avoid unnoticed degeneration of the joint.

A number of treatments is available to treat articular cartilage damage in joints, such as the knee, starting with the most conservative, non-invasive options and ending with total joint replacement if the damage has spread throughout the joint. Currently available treatments include anti-inflammatory medications in the early stages. Although these may relieve pain, they have limited effect on arthritis symptoms and further do not repair joint tissue. Cartilage repair methods, such as arthroscopic debridement, attempt to at least delay tissue degeneration. These methods however are only partly effective at repairing soft tissue, and do not restore joint spacing or improve joint stability. Joint replacement (arthroplasty) is considered as a final solution, when all other options to relieve pain and restore mobility have failed or are no longer effective. While joint arthroplasty may be effective, the procedure is extremely invasive, technically challenging and may compromise future treatment options. Cartilage regeneration has also been attempted, more in particular by tissue-engineering technology. The use of cells, genes and growth factors combined with scaffolds plays a fundamental role in the regeneration of functional and viable articular cartilage. All of these approaches are based on stimulating the body's normal healing or repair processes at a cellular level. Many of these compounds are delivered on a variety of carriers or matrices including woven polylactic acid based polymers or collagen fibers. Despite various attempts to regenerate cartilage, a reliable and proven treatment does not currently exist for repairing defects to the articular cartilage.

Another standard of care consists of Microfracture (MFx) for smaller lesions (≤ <NUM><NUM>) and Autologous Chondrocyte Implantation (ACI) for bigger lesions (> <NUM><NUM>). The cartilaginous tissue regenerated with these techniques however is not able to withstand the biomechanical challenges in the joint and starts to degenerate within <NUM> months already. Substantial delay in joint replacement by artificial joints, let alone preventing it, therefore is not possible.

<CIT> discloses a biodegradable osteochondral implant comprising a porous top and a porous bottom section separated by a barrier impermeable to certain agents.

It is an object of the present invention to provide an implant for the replacement and regeneration of biological tissue in the shape of a plug having improved load distribution as well as cartilage regenerating properties. Another aim is to provide such a plug-shaped implant for the replacement and regeneration of an osteochondral structure. Yet another aim is to provide a method for the preparation of the implant. The invention further aims to provide an implant which is able to repair articular cartilage lesions in a durable fashion, and which at least postpones and, preferably, prevents joint replacement by artificial joints.

The above and other aims are provided by an implant according to the invention as defined in claim <NUM>.

With a substantially non-porous material in the context of the present invention is meant a material having a porosity of less than <NUM> %, relative to the total volume of the material, preferably up to <NUM>%, more preferably up to <NUM>%, and more preferably still up to <NUM>% of the total volume of the material. A porous material comprises pores, which are defined as minute openings. The pores may be micropores, having a diameter of less than <NUM>, and may be macropores, having a diameter of greater than <NUM>. The pores may be interconnected, which is preferred, and which means that pores are internally connected or there is continuity between parts or elements. A non-porous material in the context of the present invention does not mean a material that is impermeable to molecules of any size, and some small molecules may indeed be able to pass through the non-porous material. Rather, a non-porous material in the context of the present invention represents a material that is impermeable to synovial fluid and/or blood.

Pore sizes in the porous parts of the implant may be chosen from <NUM>-<NUM> micron, more preferably from <NUM>-<NUM> micron, and most preferably from <NUM>-<NUM> micron.

The materials used in the invented implant are preferably biocompatible, by which is meant that these materials are capable of coexistence with living tissues or organisms without causing harm to them. Further, the implant in accordance with the invention is substantially non-biodegradable and combines cartilage replacement with cartilage regeneration. With a non-biodegradable material in the context of the present invention is meant a material that is not broken down into less complex compounds or compounds having fewer carbon atoms by the environment of the implanted implant. The weight-average molecular weight of a substantially non-biodegradable material is reduced by at most <NUM>%, relative to the original weight-average molecular weight after one year of implantation, more preferably at most <NUM>%, still more preferably at most <NUM>%, and more preferably still at most <NUM>%.

The base section of the plug-shaped implant functions as a bone anchor, whereas the combination of middle and top sections functions as partial replacement for the damaged cartilage and as scaffold for cartilage regeneration. In the plug-shaped implant, the top section refers to the section that is closest to the cartilage phase, when implanted. The base section refers to the section that is furthest from the cartilage phase, when implanted. The middle section is situated in between the top and base sections.

The cross-section of the plug-shaped implant through a horizontal or a vertical plane may have any suitable shape. The cross-section may be circular, square or may be polygonal, such as hexagonal, octagonal, or decagonal. In some embodiments, the plug-shaped implant may be tapered such that it is shaped as a truncated cone structure. Preferably, the implant has a smaller cross-section at the base section than at the top section. The cross-section (or diameter in case of a cylindrical implant) may vary continuously between the base and top section, or may show discontinuities, for instance at the interface between sections.

When the implant has a tapered profile, the angle of the taper is preferably between <NUM>° and <NUM>°. In some embodiments, the taper is between about <NUM>° and <NUM>°, more preferably between <NUM>° and <NUM>°, even more preferably between <NUM>° and <NUM>°. A tapered profile may facilitate insertion of the implant into an osteochondral defect and may further reduce possible damage to host tissue.

A useful embodiment of the invention provides an implant, wherein the base section comprises a core of non-porous polyaryletherketone polymer and a, preferably circumferential, shell of porous polyaryletherketone polymer, wherein the shell has a thickness that is less than <NUM>% of a largest diameter of the base section. Other useful embodiments provide an implant wherein the (circumferential) shell has a thickness of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>% , of less than <NUM>%, or of less than <NUM>% of a largest diameter of the base section. Alternatively, the cross-sectional area of the (circumferential) shell covers at most <NUM>% of a largest cross-sectional area of the base section. Other useful embodiments provide an implant wherein the cross-sectional area of the circumferential shell is less than <NUM>%, less than <NUM>%, less than <NUM>%, less than <NUM>%, less than <NUM>%, less than <NUM>%, less than <NUM>% , or less than <NUM>% of a largest cross-sectional area of the base section.

Another embodiment of the invention provides an implant, wherein the base section extends between a top surface and a bottom surface, and comprises a layer of porous polyaryletherketone polymer, wherein the layer is adjacent to the top surface and has a thickness that is less than <NUM>% of a largest height of the base section, and wherein pores of the polyaryletherketone polymer in the layer comprise a biocompatible elastomeric material that is the same as the material of the middle section, preferably all pores. In other embodiments, the layer that is adjacent to the top surface has a thickness of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, or of less than <NUM>% of a largest height of the base section. All the above embodiments may improve the adhesion of the middle section (and top section) to the base section to varying degrees. At the same time, the mechanical properties of the base section, and the support offered by the base section to the implant, remain at an adequate level.

In another embodiment of the invention, the top surface of the base section of the implant comprises irregularities or undulations. Irregularities may for instance comprise ridges having a saw-toothed shape. Undulations may be irregular or regular, such as those having a sinusoidal shape.

Another useful embodiment relates to an implant, wherein the base section comprises a centrally located cavity that comprises a biocompatible elastomeric material. Such a cavity may further improve the adhesion of the middle section (and top section) to the base section. The cavity may be cylindrical, or its cross-section may be square, or polygonal. The walls of the cavity may also be provided with irregularities or undulations, or may comprise sections of a larger cross-sectional area than its average cross-sectional area. Several of such cavity sections may be provided at different heights of the base section to form mechanical locking structures.

A preferred embodiment of the invention provides an implant, wherein the base section comprises a non-porous polyaryletherketone polymer, and, more preferably, wherein the base section in combination comprises the central cavity.

In order to further improve the adhesion between the base section and the middle (and top) section, an embodiment of the invention provides an implant, wherein the base section further comprises a phosphate mineral comprising an apatite, more preferably a hydroxylapatite, a fluorapatite and/or a chlorapatite, most preferably a hydroxylapatite. The phosphate mineral may be provided at an outer surface of the base section, or may be provided within pores of the base section.

Yet another embodiment provides an implant, wherein the base section comprises an outer surface having irregularities or undulations. Such outer surface irregularities may for instance comprise ridges having a saw-toothed shape, for instance extending circumferentially over (part of) the outer surface of the base section. Undulations may be irregular or regular, such as those having a sinusoidal shape. The undulations may likewise extend circumferentially over (part of) the outer surface of the base section. Irregularities and undulations may be provided by casting the materials in a suitably profiled mold, or, alternatively, may be provided by mechanical machining, for instance by rotary milling of a molded implant.

The polyaryletherketone (PAEK) polymer of the base section comprises a semi-crystalline thermoplastic polymer containing alternately ketone (R-CO-R) and ether groups (R-O-R). The linking group R between the functional groups comprises a <NUM>,<NUM>-substituted aryl group. The PAEK polymer used in the base section may inter alia comprise PEK (polyetherketone), PEEK (polyetheretherketone), PEKK (polyetherketoneketone), PEEKK (polyetheretherketoneketone) and PEKEKK (polyetherketoneetherketoneketone). Due to its excellent resistance to hydrolysis, the polyaryletherketone polymer of the base section is advantageously used in the invented implant. It does not break down when sterilized, nor when implanted in the body for an extended time. It also turns out to bond particularly well to the elastomeric material of the middle and top sections. The polyaryletherketone polymer of the base section may be used as such, or, in an embodiment, may comprise a reinforcing material selected from the group consisting of fibrous or particulate polymers and/or metals.

According to the invention, the material of the middle and top section comprises the same thermoplastic elastomeric material. By this is meant that at least its building blocks are chemically the same. As mentioned herein below, some physical properties may differ, for instance their weight averaged molecular weight. In a particularly suitable embodiment, the thermoplastic elastomeric material comprises a linear block copolymer comprising urethane and urea groups, and is substantially free of an added peptide compound having cartilage regenerative properties. It has surprisingly been found that the implant of the invention is able to regenerate cartilage tissue, thus avoiding the use of any functional compound exhibiting cartilage regenerative properties. In particular, it has been found that the implant according to this embodiment does not need the use of peptides, for instance those comprising an RGD-sequence. These compounds have been said to enable binding integrin's and thereby stimulating cell adhesion. Preferably, the thermoplastic elastomeric material is substantially free of any added compound having cartilage regenerative properties.

The thermoplastic elastomeric material of the implant according to an embodiment of the invention comprises a linear block (or segmented) copolymer. Such a copolymer comprises 'hard' crystallized blocks of polyurethane and/or polyurea segments, and may also comprise 'hard' crystallized blocks of polyester and/or polyamide between 'soft' blocks. At room temperature, the low melting 'soft' blocks may be incompatible with the high melting 'hard' blocks, which induces phase separation by crystallization or liquid-liquid demixing. These copolymers exhibit reversible physical crosslinks that originate from crystallization of the 'hard' blocks of the segmented copolymer. The thermoplastic elastomers may be formed into any shape at higher temperatures, more in particular at temperatures above the melting point of the 'hard' blocks. On the other hand, the thermoplastic elastomers provide mechanical stability and elastic properties at low temperatures, i.e. at typical body temperatures. This makes these materials particularly suitable as replacement material for human or animal cartilage.

In another preferred embodiment of the invented implant, the thermoplastic elastomeric material further comprises carbonate groups. This embodiment has proven to be beneficial in that its mechanical properties are well adapted to the mechanical properties of human or animal cartilage. Surprisingly, regeneration of cartilage is improved when using this embodiment in an implanted implant.

A particularly preferred embodiment of the invention provides an implant, wherein the thermoplastic elastomeric material comprises a poly-urethane-bisurea-alkylenecarbonate, more preferably a poly-urethane-bisurea-hexylenecarbonate.

The constituents of the thermoplastic elastomer may generally comprise three building blocks: a long-chain diol, for example with a polyether, polyester or polycarbonate backbone, a bifunctional di-isocyanate, and, finally, a chain extender, such as water, another (sometimes short-chain) diol, or a diamine. The latter chain extender is preferred since this leads to bisurea units in the thermoplastic elastomer.

An embodiment of the implant wherein the thermoplastic elastomeric material is aliphatic is preferred. This means that all building blocks of the thermoplastic elastomer are devoid of aromatic groups and contain aliphatic groups only. The thermoplastic elastomer of the invention may be prepared in a one pot procedure, in which a long-chain diol is first reacted with an excess of a di-isocyanate to form an isocyanate-functionalized prepolymer.

The latter is subsequently reacted with a chain extender, such as the preferred diamine, which results in the formation of a higher molecular weight thermoplastic elastomeric polymer containing urethane groups. If a diamine is used as the chain extender, the thermoplastic elastomer will also contain bisurea groups, which is preferred.

The synthetic procedure to prepare the thermoplastic elastomers may lead to a distribution in the 'hard' block lengths. As a result, the phase separation of these block copolymers may be incomplete, in that part of the 'hard' blocks, in particular the shorter ones, are dissolved in the soft phase, causing an increase in the glass transition temperature. This is less desired for the low temperature flexibility and elasticity of the thermoplastic elastomeric material of the top and middle sections. The polydispersity in 'hard' blocks shows as a broad melting range, and a rubbery plateau in dynamic mechanical thermal analysis (DMTA) that is dependent on temperature. Preferred embodiments therefore comprise elastomeric block copolymers containing 'hard' blocks of substantially uniform length. These may be prepared by fractionation of a mixture of 'hard' block oligomers, and subsequent copolymerization of the uniform 'hard' block oligomers of a specific length (or length variation) with the prepolymer, mentioned above.

Although the thermoplastic elastomers may be prepared by a chain extension reaction of an isocyanate-functionalized prepolymer with a diamine, they may also be prepared by a chain extension reaction of an amine-functionalized prepolymer with a di-isocyanate. Examples of suitable, commercially available diamines and di-isocyanates include alkylene diamines and/or di-isocyanates, arylene diamines and/or di-isocyanates. Amine-functionalized prepolymers are also commercially available, or can be prepared from (readily available) hydroxy functionalized prepolymers by cyanoethylation followed by reduction of the cyano-groups, by Gabriel synthesis (halogenation or tosylation followed by modification with phthalimide, and finally formation of the primary amine by deprotection of the phthalimide group) or by other methods that are known in the art. Isocyanate-functionalized prepolymers can be prepared by reaction of hydroxy functionalized prepolymers with di-isocyanates, such as for example isophorone di-isocyanate (IPDI), <NUM>,<NUM>-diisocyanato butane, <NUM>,<NUM>-diisocyanato hexane or <NUM>,<NUM>'-methylene bis(phenyl isocyanate). Alternatively, isocyanate-functionalized prepolymers can be prepared from amine-functionalized prepolymers, for example by reaction with di-tert-butyl tricarbonate. Hydroxy-functionalized prepolymers of molecular weights typically ranging from about <NUM>/mol to about <NUM>/mol of all sorts of compositions are also advantageously used. Examples include prepolymers of polyether's, such as polyethylene glycols, polypropylene glycols, poly(ethylene-co-propylene) glycols and poly(tetrahydrofuran), polyesters, such as poly(caprolactone)s or polyadipates, polycarbonates, polyolefins, hydrogenated polyolefins such as poly(ethylene-butylene)s, and the like. Polycarbonates are preferred.

The implant is preferably used without any means of attachment and remains in the osteochondral structure by its geometry and the surrounding tissue structure. The implant may be used in the knee, but may also be used for other joints, such as a temporal-mandibular joint, an ankle, a hip, a shoulder, and the like.

The thermoplastic elastomer used in the top and middle sections of the implant is particularly advantageous since it allows adapting its mechanical properties to those of human and animal cartilage. In an embodiment of the invention, an implant may be provided wherein the elastomeric material of the middle section has an elastic modulus at room temperature of less than <NUM> MPa, more preferably of less than <NUM> MPa, of less than <NUM> MPa, of less than <NUM> MPa, of less than <NUM> MPa, of less than <NUM> MPa, of less than <NUM> MPa, or of less than <NUM> MPa.

In the context of the present application, room temperature is meant to be a temperature in the range of <NUM>-<NUM>, more preferably <NUM>.

Likewise, preferred embodiments of the implant comprise a top section wherein the porous elastomeric material of the top section has an elastic modulus at room temperature of less than <NUM>% of the elastic modulus of the elastomeric material of the middle section, more preferably of less than <NUM>%, even more preferably of between <NUM>-<NUM>%, even more preferably of between <NUM>-<NUM>%, and most preferably of between <NUM>-<NUM>% of the elastic modulus of the elastomeric material of the middle section. Such a reduced elastic modulus may be achieved by modifying the porosity of the material of the middle section, or by modifying physical properties of the material in the middle section through changing its weight average molecular weight for instance.

The porosity of the elastomeric material of the top section may be chosen within a broad range. Preferred porosities of the elastomeric material of the top section are selected from <NUM>-<NUM>% by volume, more preferably from <NUM>-<NUM>% by volume, even more preferably from <NUM>-<NUM>% by volume, and most preferably from <NUM>-<NUM>% by volume.

A useful embodiment of the invention provides an implant, wherein the middle section comprises a core of non-porous elastomeric material and a, preferably circumferential, shell of porous elastomeric material, wherein the shell has a thickness that is less than <NUM>% of a largest diameter of the middle section. Other useful embodiments provide an implant wherein the (circumferential) shell has a thickness of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>%, of less than <NUM>% , of less than <NUM>%, or of less than <NUM>% of a largest diameter of the middle section. The largest diameter is for instance appropriate in an embodiment wherein the plug-shaped implant is tapered and has circular cross-sections. Alternatively, the cross-sectional area of the (circumferential) shell covers at most <NUM>% of a largest cross-sectional area of the middle section. Other useful embodiments provide an implant wherein the cross-sectional area of the (circumferential) shell is less than <NUM>%, less than <NUM>%, less than <NUM>%, less than <NUM>%, less than <NUM>%, less than <NUM>%, less than <NUM>%, or less than <NUM>% of a largest cross-sectional area of the middle section. The largest cross-sectional area is for instance appropriate in an embodiment wherein the plug-shaped implant is tapered.

Embodiments having the above-disclosed preferred combinations of mechanical properties of the top and middle section tend to promote regeneration of cartilage. This is believed to be due to a favorable stress (re)distribution of the osteochondral structure including the implant during (dynamic) loading.

The height of the plug-shaped implant may be chosen according to the specific application in the body. Heights may vary from <NUM> to <NUM> for instance. According to a useful embodiment of the invention, an implant is provided wherein a height of the base section, a height of the non-porous middle section, and a height of the porous top section are selected such that a top surface of the implant comes to lie below a top surface of cartilage present on an osteochondral structure when implanted, preferably over a distance of between <NUM> - <NUM>. This embodiment promotes growing cartilage tissue into, but also onto the top section, whereby a strong fixation is built between the top section and the newly formed cartilage. It has turned out that cartilage cells from the host cartilage have a strong affinity for the segmented elastomer of the top section, and therefore are prone to colonize the surface thereof to produce new hyaline cartilage tissue on top of the implant.

Another embodiment provides an implant wherein a height of the base section, a height of the non-porous middle section, and a height of the porous top section are selected such that a bottom surface of the middle section comes to lie about level with a bottom surface of cartilage present on an osteochondral structure when implanted.

Yet another embodiment of the invention provides a top section, a top surface of which is slightly curved. Preferred radii of curvature of the top surface of the top section in a sagittal plane are selected to range from <NUM> - <NUM>, more preferably from <NUM> - <NUM>, even more preferably from <NUM> - <NUM>, even more preferably from <NUM> - <NUM>, even more preferably from <NUM> - <NUM>, and most preferably from <NUM> - <NUM>. This embodiment may regenerate a new cartilage layer on the top surface of the top section of the implant of about equal thickness across the top surface. The result may be a radius of a top surface of the regenerated cartilage that is about the same as the radius of the surrounding native cartilage layer next to the implant, thereby showing a continuity in radius. The top surface of the top section of the implant may also be curved in a medial-lateral plane, preferably with a radius of curvature with the ranges disclosed above for the sagittal plane. In a practical embodiment, the top surface of the top section of the implant has a radius of curvature that is equal in the sagittal and the medial-lateral plane. This embodiment thus comprises a spherical top surface.

Another aspect of the invention provides a method for the preparation of the implant as defined in claim <NUM>.

Another embodiment of the invention provides a method wherein after step b) the mold is opened and additional granules of the thermoplastic elastomeric material are added to the mold, and step b) is repeated. The amount of material added in the two-step embodiment of the method may be chosen within wide ranges. Increasingly good results are obtained when the ratio between the first addition and the second addition of granules of the thermoplastic elastomeric material is selected from <NUM>:<NUM> to <NUM>:<NUM>, more preferably from <NUM>:<NUM> to <NUM>:<NUM>, and most preferably from <NUM>:<NUM> to <NUM>:<NUM>.

Another embodiment of the invention provides a method wherein the heating temperature of step b) is between <NUM> and <NUM>, more preferably between <NUM> and <NUM>, and most preferably between <NUM> and <NUM>. Preferred pressures at all cited temperature ranges are between <NUM> and <NUM> GPa, and more preferably between <NUM> and <NUM> GPa.

The invention will now be further elucidated by the following figures and examples, without however being limited thereto. In the figures:.

Referring to <FIG>, a side view of an embodiment of an exemplary implant according to the present invention is shown. The implant <NUM> in the shape of a plug comprises a base section <NUM>, configured for anchoring in bone tissue, a middle section <NUM> configured for replacing cartilage tissue, and a top section <NUM> configured for growing cartilage tissue onto and into. The middle section <NUM> and top section <NUM> comprise the same thermoplastic elastomeric material. The thermoplastic elastomeric material in this embodiment comprises a poly-urethane-bisurea-hexylenecarbonate, the preparation and properties whereof will be elucidated further below. The top section <NUM> however comprises poly-urethane-bisurea-hexylenecarbonate in porous from, whereas the middle section <NUM> comprises the same poly-urethane-bisurea-hexylenecarbonate without any pores. The base section <NUM> comprises a non-porous polyaryletherketone polymer, which, in the embodiment shown is a non-porous PEKK polymer. The implant <NUM> is cylindrical and has a diameter <NUM> of <NUM>. The height <NUM> of the base section <NUM>, the height <NUM> of the middle section <NUM>, and the height <NUM> of the top section <NUM> add up to a total height of <NUM>.

<FIG> schematically represents a side view of another embodiment of an implant according to the present invention. The embodied implant <NUM> in the shape of a plug again comprises a base section <NUM>, configured for anchoring in bone tissue, a middle section <NUM> configured for replacing cartilage tissue, and a top section <NUM> configured for growing cartilage tissue onto and into. The middle section <NUM> and top section <NUM> comprise the same poly-urethane-bisurea-hexylenecarbonate material, which is porous in the top section <NUM>, and non-porous in the middle section <NUM>. The base section <NUM> comprises a substantially non-porous PEKK polymer with a porosity of less than <NUM> %, relative to the total volume of the PEKK polymer. The base section <NUM> of this embodiment in particular comprises a core <NUM> of non-porous PEKK polymer and a circumferential shell <NUM> of porous PEKK polymer. The shell <NUM> has a thickness <NUM> of about <NUM>% of the diameter <NUM> of the base section <NUM> (and implant <NUM>). The base section <NUM> further extends between a top surface <NUM> and a bottom surface <NUM>, and comprises a layer <NUM> of porous PEKK polymer, which layer <NUM> is adjacent to the top surface <NUM> and has a thickness <NUM> of about <NUM>% of the height <NUM> of the base section <NUM>. The pores of the PEKK polymer in the layer <NUM> comprise the biocompatible poly-urethane-bisurea-hexylenecarbonate which originates from the middle section <NUM> and has infiltrated the pores of the PEKK polymer in the layer <NUM> during manufacturing. A method for manufacturing the implant will be elucidated further below. As with the embodiment of <FIG>, the implant <NUM> is cylindrical and has a diameter <NUM> of <NUM>. The height <NUM> of the base section <NUM>, the height <NUM> of the middle section <NUM>, and the height <NUM> of the top section <NUM> add up to a total height of <NUM>.

<FIG> schematically represents a side view of yet another embodiment of an implant according to the present invention. The embodied implant <NUM> in the shape of a plug again comprises a base section <NUM>, configured for anchoring in bone tissue, a middle section <NUM> configured for replacing cartilage tissue, and a top section <NUM> configured for growing cartilage tissue onto and into. The middle section <NUM> and top section <NUM> comprise the same poly-urethane-bisurea-hexylenecarbonate material, which is porous in the top section <NUM>, and substantially non-porous in the middle section <NUM>. The base section <NUM> comprises a substantially non-porous PEKK polymer with a porosity of less than <NUM> %, relative to the total volume of the PEKK polymer. The base section <NUM> of this embodiment in particular extends between a top surface <NUM> and a bottom surface <NUM>, and comprises a layer <NUM> of porous PEKK polymer, which layer <NUM> is adjacent to the top surface <NUM> and has a thickness <NUM> of about <NUM>% of the height <NUM> of the base section <NUM>. The pores of the PEKK polymer in the layer <NUM> comprise the biocompatible poly-urethane-bisurea-hexylenecarbonate which originates from the middle section <NUM> and has infiltrated the pores of the PEKK polymer in the layer <NUM> during manufacturing. The middle section <NUM> of this embodiment in particular comprises a core <NUM> of non-porous poly-urethane-bisurea-hexylenecarbonate polymer and a circumferential shell <NUM> of porous poly-urethane-bisurea-hexylenecarbonate polymer. The shell <NUM> has a thickness <NUM> of about <NUM>% of the diameter <NUM> of the middle section <NUM> (and implant <NUM>). The base section <NUM> further extends between a top surface <NUM> and a bottom surface <NUM>, and comprises a layer <NUM> of porous PEKK polymer, which layer <NUM> is adjacent to the top surface <NUM> and has a thickness <NUM> of about <NUM>% of the height <NUM> of the base section <NUM>. The dimensions and shape are the same as in the embodiments of <FIG>.

<FIG> schematically represents a side view of yet another embodiment of an implant according to the present invention. The embodied implant <NUM> in the shape of a plug corresponds to the one shown in <FIG>. In addition, the middle section <NUM> of this embodiment now has a circumferential shell <NUM> of porous poly-urethane-bisurea-hexylenecarbonate polymer having a thickness <NUM> of about <NUM>% of the diameter <NUM> of the middle section <NUM> (and implant <NUM>). Further, the base section <NUM> comprises a layer <NUM> of porous PEKK polymer, which layer <NUM> is adjacent to the top surface <NUM> and has a thickness <NUM> of about <NUM>% of the height <NUM> of the base section <NUM>. The pores of the PEKK polymer in the layer <NUM> comprise the biocompatible poly-urethane-bisurea-hexylenecarbonate which originates from the middle section <NUM> and has infiltrated the pores of the PEKK polymer in the layer <NUM> during manufacturing. The base section <NUM> further comprises a core <NUM> of non-porous PEKK polymer and a circumferential shell <NUM> of porous PEKK polymer. The shell <NUM> has a thickness <NUM> of about <NUM>% of the diameter <NUM> of the base section <NUM> (and implant <NUM>). Finally, the base section <NUM> also comprises a layer <NUM> of porous PEKK polymer, which layer <NUM> is adjacent to the bottom surface <NUM> and has a thickness <NUM> of about <NUM>% of the height <NUM> of the base section <NUM>. The dimensions and shape are the same as in the embodiments of <FIG>.

Please note that in <FIG> the circumferential shells (<NUM>, <NUM>) are shown in cross-section to show their respective thicknesses (<NUM>, <NUM>). In a side view, they would extend over the complete diameter <NUM> of the implant <NUM>.

Referring to <FIG>, a side view of another embodiment of the implant according to the present invention is shown. The implant <NUM> in the shape of a plug comprises the same materials and sections as shown in <FIG>. The dimensions of the implant of <FIG> are the same as those of the implant of <FIG> with one exception. Instead of having a flat top surface <NUM> of the top section <NUM> (and the implant <NUM>), as in <FIG>, the top surface 41a of the top section <NUM> is spherical with a radius of curvature R of about <NUM> (not drawn to scale).

Referring to <FIG>, a side view of another embodiment of the implant according to the present invention is shown. The implant <NUM> in the shape of a plug comprises the same materials and sections as shown in <FIG>. The dimensions of the implant of <FIG> are the same as those of the implant of <FIG> with one exception. Instead of having a flat top surface <NUM> of the top section <NUM>, as in <FIG>, the top surface 41a of the top section <NUM> is spherical with a radius of curvature R of about <NUM> (not drawn to scale). Referring to <FIG>, a side view of another embodiment of the implant according to the present invention is shown. The implant <NUM> in the shape of a plug comprises the same materials and sections as shown in <FIG>. The dimensions of the implant of <FIG> are the same as those of the implant of <FIG> with one exception. Instead of having a flat top surface <NUM> of the top section <NUM>, as in <FIG>, the top surface 41a of the top section <NUM> is spherical with a radius of curvature R of about <NUM> (not drawn to scale).

Referring to <FIG>, a side view of another embodiment of the implant according to the present invention is shown. The implant <NUM> in the shape of a plug comprises the same materials and sections as shown in <FIG>. The dimensions of the implant of <FIG> are the same as those of the implant of <FIG> with one exception. Instead of having a flat top surface <NUM> of the top section <NUM>, as in <FIG>, the top surface 41a of the top section <NUM> is spherical with a radius of curvature R of about <NUM> (not drawn to scale).

Again note that in <FIG> the circumferential shells (<NUM>, <NUM>) are shown in cross-section to show their respective thicknesses (<NUM>, <NUM>). In a side view, they would extend over the complete diameter <NUM> of the implant <NUM> (not drawn to scale).

Referring to <FIG>, an embodiment of a base section <NUM> of the invented implant <NUM> is schematically shown. The base section <NUM> shown is essentially cylindrical-shaped with a diameter <NUM>, and a height <NUM>. The top surface <NUM> of the base section has a circumferential flat rim part <NUM> that gradually extends into a centrally located cavity <NUM>. The cavity <NUM> is provided with locking parts <NUM> that have a larger diameter than the diameter of the cavity <NUM>. A shown in detail in <FIG>, the locking parts <NUM> of the cavity <NUM> are disk-shaped whereby the outer rim of the disk makes an angle <NUM> with the longitudinal direction <NUM> of the base section <NUM> of between <NUM>° and <NUM>°, more preferably between <NUM>° and <NUM>°. The cavity <NUM> (and parts <NUM>) during manufacturing of the implant fills with part of the biocompatible elastomeric material to provide an adequate locking of the middle section <NUM> to the base section <NUM>. As discussed above, the base section <NUM> comprises a PEKK polymer which may be non-porous or substantially non-porous, the latter embodiment including the examples disclosed above. The base section <NUM> is further seen to comprise an outer surface having irregularities or undulations. In the present embodiment, these comprise circumferential ridges <NUM> which, in cross-section, are saw-tooth-shaped, as shown in detail in <FIG>. The angle <NUM> under which the saw-tooth flanks extend with respect to the transverse direction <NUM> of the base section <NUM>, is preferably between <NUM>° and <NUM>°, more preferably between <NUM>° and <NUM>°.

The aliphatic poly-urethane-urea-hexylene carbonate biomaterial of the middle section <NUM> and the top section <NUM> was manufactured as follows (with reference to <FIG>). Poly(hexylene carbonate) diol (<NUM>, <NUM> mmol) was weighed in a <NUM> <NUM>-necked flask and dried by heating to <NUM> overnight under vacuum, after which it was allowed to cool to room temperature. Under an argon atmosphere, <NUM>,<NUM>-diisocyanatohexane (<NUM>, <NUM> mmol), DMAc (<NUM>) and a drop of Sn(II)bis(<NUM>-ethylhexanoate) were added, after which the mixture was heated and stirred for <NUM> hours upon which the viscosity increased. The mixture was allowed to cool to room temperature, was diluted with DMAc (<NUM>) and a solution of <NUM>,<NUM>-diaminohexane (<NUM>, <NUM> mmol) in DMAc (<NUM>) was added at once under thorough mixing. A gel was immediately formed upon addition and mixing. The mixture was further diluted with DMAc (<NUM>) and was heated in an oil bath of <NUM> to acquire a homogeneous viscous slurry. After cooling to room temperature, the mixture was precipitated in a water/brine mixture (<NUM> water + <NUM> saturated brine) to yield a soft white material. This material was cut into smaller pieces and was stirred in a <NUM>:<NUM> mixture of methanol and water (<NUM>) for <NUM> hours. After decanting the supernatant, the resulting solid was stirred in a <NUM>:<NUM> mixture of methanol and water (<NUM>) for <NUM> hours. Decanting of supernatant, stirring in a <NUM>:<NUM> mixture of methanol and water (<NUM>) for <NUM> hours, decanting of the supernatant, and drying of the solid at <NUM> in vacuo yielded a flexible, tough elastomeric polymer.

<NUM>H NMR spectroscopy was performed on the resulting polymer, using a Varian <NUM>, a Varian <NUM>, or a <NUM> Bruker spectrometer at <NUM>. DSC was performed using a Q2000 machine (TA Instruments). Heating scan rates of <NUM>/min and <NUM>/min were used for the assessment of the melting temperature (Tm) and the glass transition temperature (Tg), respectively. The Tm was determined by the peak melting temperature and the Tg was determined from the inflection point.

All reagents, chemicals, materials, and solvents were obtained from commercial sources and were used without further purification. The used poly(hexylene carbonate) diol had an average molecular weight of approximately <NUM>/mol. <FIG> and <FIG> show the <NUM>H NMR spectrum and DSC thermograms of the obtained polymer, respectively. The <NUM>H NMR spectrum results may be summarized as follows: <NUM>H NMR (<NUM>, HFIP-d2): δ = <NUM> (m, n*<NUM>, n - <NUM>), <NUM> (m, <NUM>), <NUM> (m, <NUM>), <NUM>-<NUM> (multiple signals for aliphatic CH2 methylenes) ppm. The average molecular weight of the repeating hard/soft block sections is about <NUM> kDa. The DSC results may be summarized as follows: DSC (<NUM>/min, <FIG>): Tm (top) = <NUM> (soft block melt); DSC (<NUM>/min, <FIG>): Tg = -<NUM>. No second melting point for the hard block was observed up to <NUM>. However, in a final heating run up to <NUM> at <NUM>/min (<FIG>), a small and broad melting transition was observed at ca. In the DSC-diagrams, the endothermic melting peaks are plotted downwards, whereas the exothermic crystallizations are plotted upwards.

The non-porous aliphatic poly-urethane-urea-hexylene carbonate biomaterial had an elastic modulus according to ASTM D638 of <NUM> ± <NUM> MPa.

The implant <NUM> was manufactured by attaching the top and middle sections (<NUM>, <NUM>) to a PEKK base section <NUM> which serves as bone anchor. In a method according to an embodiment of the invention, PEKK bone anchors were capped with the poly-urethane-urea-hexylene carbonate biomaterial by pressing small granules of the aliphatic polycarbonate polymer on top of and into the PEKK anchors. For this purpose, a custom press setup was used. Various temperatures (<NUM> to about <NUM>), compressive forces (<NUM> kN to about <NUM> kN) and methods have been tested. The best results were obtained using a two-step procedure, employing a temperature of <NUM> and using a compressive force of <NUM> kN (<NUM> tons, or <NUM>; corresponding to a pressure of <NUM> GPa). Lower temperatures than <NUM> seemed to give less homogenously pressed poly-urethane-urea-hexylene carbonate biomaterial layers (sections <NUM> and <NUM>), while higher temperatures are less desired as the urea groups in the poly-urethane-urea-hexylene carbonate biomaterial may then degrade to some extent. In the first step, ca. <NUM> of the polymer <NUM> was pressed onto and into the PEKK bone anchor for <NUM> minutes, while in the second step, ca. <NUM> of polymer <NUM> was added to the setup and the sample was pressed for another <NUM> minutes under the same conditions (<NUM> and <NUM> kN). The samples were subsequently removed from the compression setup and were then allowed to cool. After the second pressing step, the surface of the poly-urethane-urea-hexylene carbonate biomaterial layer (sections <NUM> and <NUM>) on top of the base section <NUM> seemed to be substantially flat. The biomaterial was almost transparent and colorless. The edges of the biomaterial showed some fringes or frays, and these were removed using a scalpel.

A central hole (<NUM>, <NUM>) of the base section <NUM> was about <NUM> deep and about <NUM> in diameter. The hole was substantially filled with the poly-urethane-urea-hexylene carbonate biomaterial, and the attachment of the biomaterial to the PEKK base section <NUM> seemed quite strong and robust. Removing the biomaterial from the PEKK base section by force, or loosening the connection at the PEKK-biomaterial interfaces, proved practically impossible. All used equipment and accessories that were intended to come into contact with the PEKK base section <NUM> and/or with the elastomeric biomaterial were rinsed with ethanol or isopropanol and were thereafter dried. After pressing, and cutting the frays, the PEKK-biomaterial plug implant was rinsed with isopropanol and dried. The plugs may also be produced in a sterilized environment, if needed.

As assessed by measuring, the PEKK base section was <NUM> in diameter and <NUM> tall (a height of <NUM>). The central cavity in the base section was about <NUM> in diameter and about <NUM> deep. The elastomeric biomaterial (the aliphatic polycarbonate) positioned onto the PEKK base section was about <NUM> in diameter and about <NUM> high. Accordingly, the total PEKK-biomaterial plug implant was about <NUM> tall.

The top section <NUM> was provided with pores by drilling holes in it with an average diameter of <NUM> micron, to a final porosity of <NUM> vol. The porous aliphatic poly-urethane-urea-hexylene carbonate biomaterial of the top section <NUM> had an elastic modulus according to ASTM D638 of <NUM> ± <NUM> MPa.

The implant <NUM> may be implanted into an osteochondral defect <NUM> as shown in <FIG>. In a typical method, a cartilage defect extending into the subchondral bone (<FIG>) is drilled out and a plug-shaped implant <NUM> is implanted into the drilled hole under some pressure (`press fit'), as shown in <FIG>. Bone then grows onto, and in some embodiments into, the PEKK base section <NUM>, anchoring the implant <NUM>. Surrounding native cartilage <NUM> grows onto a top side <NUM> of the top section <NUM> and new cartilage 5a is generated on top of the implant <NUM>, as shown in <FIG>. As is also shown in <FIG>, the height <NUM> of the base section <NUM>, the height <NUM> of the non-porous middle section <NUM>, and the height <NUM> of the porous top section <NUM> are selected such that a top surface <NUM> of the implant <NUM> comes to lie below a top surface <NUM> of cartilage <NUM> present on an osteochondral structure (<NUM>, <NUM>) when implanted, preferably over a distance <NUM> of between <NUM> - <NUM>. In the present case, this distance was about <NUM>. The osteochondral structure (<NUM>, <NUM>) comprises subchondral bone <NUM> and a cartilage layer <NUM> on top of it. A synovial cavity <NUM> is generally also present.

As also shown in <FIG>, the height <NUM> of the base section <NUM>, the height <NUM> of the non-porous middle section <NUM>, and the height <NUM> of the porous top section <NUM> are selected such that a bottom surface <NUM> of the middle section <NUM> (or top surface <NUM> of the base section <NUM>) comes to lie about level with a bottom surface <NUM> of the cartilage layer <NUM> of the osteochondral structure (<NUM>, <NUM>) when implanted.

Finally, the implant according to the embodiment shown in <FIG> may also be implanted into an osteochondral defect <NUM> as shown in <FIG>. Due to a spherical top surface 41a of the top layer <NUM>, this embodiment may regenerate a new cartilage layer 5a on the top surface 41a of the top section <NUM> of the implant <NUM> of about equal thickness across the top surface 41a. The result may be a radius of a top surface <NUM> of the regenerated cartilage 5a that is about the same as the radius of the surrounding native cartilage layer <NUM> next to the implant, thereby showing a continuity in radius.

Claim 1:
An implant (<NUM>) for the replacement and regeneration of biological tissue in the shape of a plug, comprising a base section (<NUM>) configured for anchoring in bone tissue, a middle section (<NUM>) configured for replacing cartilage tissue, and a top section (<NUM>) configured for growing cartilage tissue onto and into, wherein the middle (<NUM>) and top section (<NUM>) comprise the same thermoplastic elastomeric material, which is porous in the top section (<NUM>), and non-porous in the middle section (<NUM>), characterized in that the base section (<NUM>) comprises a substantially non-porous polyaryletherketone polymer with a porosity of less than <NUM> %, relative to the total volume of the polyaryletherketone polymer.