K Number
K112267
Manufacturer
Date Cleared
2011-10-20

(73 days)

Product Code
Regulation Number
882.5275
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Neurolac® nerve guide is indicated for the reconstruction of a peripheral nerve discontinuity up to 20 mm in patients who have sustained a complete division of a nerve.

Device Description

Neurolac® is designed to be a flexible and transparent resorbable poly(DL-lactide- co-e-caprolactone) tube to provide a protective environment for peripheral nerve reqeneration after injury and to create a conduit to quide axonal growth across a nerve gap. Neurolac® nerve guides are provided sterile in Tyvek pouch packages and retainer in a variety of sizes. The modification in this submission concerns a line extension to the predicate devices with a thinner wall thickness.

AI/ML Overview

The provided document describes a 510(k) submission for a line extension to the Neurolac® Nerve guide, with the modification being a thinner wall thickness. The study is an in vitro comparison of the new thinner-walled device to the predicate device (K032115).

Here's a breakdown of the acceptance criteria and study as requested, based on the provided text:

1. Table of Acceptance Criteria and Reported Device Performance

The document does not explicitly state "acceptance criteria" with numerical targets for each property. Instead, it demonstrates comparability to the predicate device. The implicit acceptance criterion is that the thinner-walled Neurolac nerve guides perform equivalently to the current cleared Neurolac nerve guides.

PropertyImplicit Acceptance Criteria / TargetReported Device Performance (Neurolac with 37% wall thickness reduction)
Dimensional ChangesComparable to Cleared Neurolac
Inner diameterLumen maintained till week 10-11Lumen maintained till week 10-11
Outer diameterGradual increaseGradual increase
Wall thicknessGradual increase in outward directionGradual increase in outward direction
Weight ChangesComparable to Cleared Neurolac
Swelling (water uptake)Stable in initial weeks, then gradual increaseStable in initial weeks and then gradual increase
Weight lossAfter week 10-11After week 10-11
AnalysisComparable to Cleared Neurolac
NMR (degradation products)After week 12After week 12
DSC (Tg)Gradual decrease in TgGradual decrease in Tg
Intrinsic ViscositySlow and gradual decreaseSlow and gradual decrease
Mechanical PropertiesComparable to Cleared Neurolac
Mechanical propertiesStable for initial 10-11 weeksStable for initial 10-11 weeks
Flexural propertiesStable for initial 10-11 weeksStable for initial 10-11 weeks
Compression propertiesStable for initial 10-11 weeksStable for initial 10-11 weeks
SuturabilityNot explicitly defined as "comparable" but notable improvementEasy suturing (compared to "Difficult suturing" for cleared device)

2. Sample Size Used for the Test Set and the Data Provenance

The document does not specify the sample size for the in vitro tests.
The data provenance is presented as in vitro testing, not explicitly stating country of origin, though the submitter is based in The Netherlands. It is a retrospective comparison as it compares to an already cleared predicate device.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and the Qualifications of Those Experts

Not applicable. This is an in vitro test for material properties and device performance, not a study requiring expert clinical assessment for ground truth.

4. Adjudication Method for the Test Set

Not applicable. This is an in vitro test for material properties and device performance.

5. If a Multi Reader Multi Case (MRMC) Comparative Effectiveness Study was Done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

Not applicable. This is not an AI/imaging device.

6. If a Standalone (i.e. algorithm only without human-in-the-loop performance) was Done

Not applicable. This is not an algorithm/software device. The performance data presented are for the physical device itself.

7. The Type of Ground Truth Used

The "ground truth" here is the established performance characteristics of the predicate device (Neurolac nerve guides K032115), against which the new thinner-walled device is compared. This is based on previously established performance data for the predicate and fundamental material science.

8. The Sample Size for the Training Set

Not applicable. There is no concept of a "training set" in this type of in vitro device comparison study. The study focuses on demonstrating comparability to a predicate device.

9. How the Ground Truth for the Training Set Was Established

Not applicable, as there is no training set mentioned or implied. The "ground truth" for comparison is the documented performance of the predicate device, which would have been established through its own preclinical studies and regulatory clearance process.

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OCT 2 0 2011

K112267
page 1/3
Special 510(k) Summary of Safety and EffectivenessLine extension to Neurolac nerve guide
Submitter:Polyganics BVRozenburglaan 15A9727 DL GroningenThe Netherlandswww.polyganics.com
Contact Person:Betty IJmker.Manager Regulatory AffairsTel : +31 50 588 6598Fax : +31 50 588 6599E-mail : ijmker@polyganics.com
Date Prepared:20 September 2011
GeneralProvisions:Trade Name: Neurolac® Nerve guide
Common Name: Nerve guide
Classification Name: Nerve Cuff, 21 CFR 882.5275
Device Classification: Class II
Predicate Device:• Neurolac Polyganics BV K032115
PerformanceStandardsFor the Nerve Cuff performance, the FDA, under section 514 of the Food, Drug andCosmetic Act, has not established standards.
Indications forUseThe Neurolac® nerve guide is indicated for the reconstruction of a peripheral nervediscontinuity up to 20 mm in patients who have sustained a complete division of anerve.

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Device Neurolac® is designed to be a flexible and transparent resorbable poly(DL-lactide-Description co-e-caprolactone) tube to provide a protective environment for peripheral nerve reqeneration after injury and to create a conduit to quide axonal growth across a nerve gap.

Neurolac® nerve guides are provided sterile in Tyvek pouch packages and retainer in a variety of sizes.

The modification in this submission concerns a line extension to the predicate devices with a thinner wall thickness.

In vitro testing for this line extension demonstrated that the technological Performance Data: characteristics and performance criteria of the additional thinner-walled Neurolac nerve guides are comparable to the current cleared Neurolac nerve guides and that they can perform in a manner equivalent to Neurolac devices currently on the market for the same intended use. The results of the in vitro testing are summarized below:

PropertiesCleared Neurolac nerveguidesNeurolac with 37%wall thickness reduction
DimensionalchangesInnerdiameterLumen maintained tillweek 10-11Lumen maintained tillweek 10-11
OuterdiameterGradual increaseGradual increase
WallthicknessGradual increase inoutward directionGradual increase inoutward direction
WeightchangesSwelling(wateruptake)Stable in initial weeks andthen gradual increaseStable in initial weeksand then gradualincrease
Weight lossAfter week 10-11After week 10-11
AnalysisNMRDegradation prodcutsafter week 12Degradation productsafter week 12
DSCGradual decrease in TgGradual decrease in Tg
IntrinsicViscositySlow and gradualdecreaseSlow and gradualdecrease
MechanicalpropertiesStable for initial 10-11weeksStable for initial 10-11weeks
FlexuralpropertiesStable for initial 10-11weeksStable for initial 10-11weeks
CompressionpropertiesStable for initial 10-11weeksStable for initial 10-11weeks
SuturabilitytestingDifficult suturingEasy suturing

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page 3/3

Summary of Substantial Equivalence The design, materials, fundamental technology and intended use (safety and efficacy) featured with the Neurolac® Nerve Guide are substantially equivalent to those featured with the following cleared device: Neurolac nerve guides (K032115; Polyganics BV). The basis for equivalence is demonstrated by the comparisons in the following table:

Neurolac nerve guidethinner-walls (thissubmission)Neurolac nerve guide(K032115)
Intended useReconstruction of aperipheral nervediscontinuity up to 20 mm inpatients who havesustained a completedivision of a nerve.Reconstruction of aperipheral nerve discontinuityup to 20 mm in patients whohave sustained a completedivision of a nerve.
Materialpoly(DL-lactide-co-ε-caprolactone)poly(DL-lactide-co-ε-caprolactone)
DesignTubeTube
Sizes1.5 - 3mm ID3cm length1.5 - 3mm ID3cm length
SterilizationEtOEtO
Shelf-life42 months42 months
PackagingSingle use, polycar-bonatetray, single tyvek pouch,cardboard box.Single use, polycar-bonatetray, single tyvek pouch,cardboard box.

Differences between the devices do not raise any significant issues of safety and effectiveness.

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Image /page/3/Picture/1 description: The image shows the seal of the Department of Health & Human Services - USA. The seal features an abstract eagle design with three curved lines representing the eagle's body and wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the eagle.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

OCT 2 0 2011

Polyganics BV c/o Betty IJmker Manager Regulatory Affairs Rozenburglaan 15A 9727 DL Groningen The Netherlands

Re: K112267

Trade/Device Name: Neurolac Nerve Guide Regulation Number: 21 CFR 882.5275 Regulation Name: Nerve Cuff Regulatory Class: II Product Code: JXI Dated: September 20, 2011 Received: September 23, 2011

Dear Ms. Ijmker:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA), You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21

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Page 2 - Ms. Betty IJmker

CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours.

Luke Riving

Malvina B. Eydelman, M.D. Director Division of Ophthalmic, Neurological, and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use Statement

510(k) K112267 Number

Neurolac® nerve guide Device Name

: : !

Indications The Neurolac nerve guide is indicated for the reconstruction of a peripheral nerve discontinuity up to 20 mm in patients who have sustained a complete for Use division of a nerve.

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use x (Per 21 CFR 801. 109)

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Over-The-Counter Use_

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OR

(Division Sign-Off) Division of Ophthalmic, Neurological and Ear, Nose and Throat Devices

510(k) Number K112267

§ 882.5275 Nerve cuff.

(a)
Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue) and for capping the end of the nerve to prevent the formation of neuroma (tumors).(b)
Classification. Class II (performance standards).