K Number
K122048
Device Name
COLLAGEN TENDON SHEET-D
Date Cleared
2013-01-08

(180 days)

Product Code
Regulation Number
878.3300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Collagen Tendon Sheet-D is indicated for the management and protection of tendon injuries in which there has been no substantial loss of tendon tissue.
Device Description
Collagen Tendon Sheet-D is a resorbable type I collagen matrix that provides a layer of collagen over injured tendons. Collagen Tendon Sheet-D is designed to provide a layer between the tendon and the surrounding tissue. When hydrated, Collagen Tendon Sheet-D is an easy-to-use, soft, pliable, nonfriable, porous collagen sheet. Collagen Tendon Sheet-D is provided sterile, non-pyrogenic, for single use only, in a variety of sizes, in double peel packages.
More Information

Not Found

No
The device description and performance studies focus on the material properties and biocompatibility of a collagen sheet, with no mention of AI or ML technologies.

Yes.
The device is indicated for the management and protection of tendon injuries, which describes a therapeutic purpose.

No
The device description and intended use indicate that Collagen Tendon Sheet-D is a resorbable collagen matrix for managing and protecting tendon injuries, not for diagnosis. It provides a physical layer rather than collecting or analyzing data for diagnostic purposes.

No

The device description clearly states it is a "resorbable type I collagen matrix" and a "collagen sheet," indicating it is a physical, material-based device, not software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for the "management and protection of tendon injuries." This describes a therapeutic or protective function within the body, not a diagnostic test performed on samples taken from the body.
  • Device Description: The description details a "resorbable type I collagen matrix" that is applied directly to injured tendons. This is a physical implant or barrier, not a reagent or instrument used to analyze biological samples.
  • Lack of IVD Characteristics: There is no mention of analyzing blood, urine, tissue, or any other biological sample to diagnose a condition or provide information about a patient's health status. The device's function is purely mechanical and biological support for tissue repair.

Therefore, Collagen Tendon Sheet-D is a medical device, but it falls under a different category than In Vitro Diagnostics.

N/A

Intended Use / Indications for Use

Collagen Tendon Sheet-D is indicated for the management and protection of tendon injuries in which there has been no substantial loss of tendon tissue.

Product codes (comma separated list FDA assigned to the subject device)

FTM, OWY

Device Description

Collagen Tendon Sheet-D is a resorbable type I collagen matrix that provides a layer of collagen over injured tendons. Collagen Tendon Sheet-D is designed to provide a layer between the tendon and the surrounding tissue. When hydrated, Collagen Tendon Sheet-D is an easy-touse, soft, pliable, nonfriable, porous collagen sheet. Collagen Tendon Sheet-D is provided sterile, non-pyrogenic, for single use only, in a variety of sizes, in double peel packages.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Prescription Use

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Collagen Tendon Sheet-D has been evaluated in a number of in vitro and in vivo tests to assess its safety/biocompatibility, including: cytotoxicity (agarose overlay, liquid and extract methods), tto ourotyplooompanisms reactivity, systemic toxicity, hemolysis, genotoxicity (bacterial and Schildtion, intraductions routing) , and muscle implantation tissue response tests. The device passed all applicable FDA Blue Book Memorandum G95-1 and ISO 10993-1 testing for the biological evaluation of medical devices.

Mechanical characterization included density, strength, stiffness and tear resistance to demonstrate substantial equivalence. Testing was conducted in accordance with FDA's Guidance for the Preparation of a Premarket Notification for a Surgical Mesh.

The results of the in vitro product characterization studies, and in vitro and in vivo biocompatibility studies, demonstrate that Collagen Tendon Sheet-D is substantially equivalent to the predicate device.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Passed all applicable FDA Blue Book Memorandum G95-1 and ISO 10993-1 testing for the biological evaluation of medical devices.

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K112423

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 878.3300 Surgical mesh.

(a)
Identification. Surgical mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Examples of surgical mesh are metallic and polymeric mesh for hernia repair, and acetabular and cement restrictor mesh used during orthopedic surgery.(b)
Classification. Class II.

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K122048

Image /page/0/Picture/1 description: The image shows the logo for Rotation Medical. The logo consists of the word "rotation" in a bold, sans-serif font, with the word "MEDICAL" in a smaller, sans-serif font underneath. Above the word "rotation" is a semi-circle of circles.

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510(k) Summary

JAN 0 8 2013

:

Applicant Information

Applicant Name: Applicant Address:

Telephone: Fax: Contact Person: Rotation Medical, Inc. 15350 25th Avenue North, Suite 100 Plymouth, MN 55447 763-746-7502 763-746-7501 Jeff Sims Vice President, Clinical Programs and Regulatory Affairs January 7, 2013

Date Prepared:

Name of Device

Device Common Name: Device Trade Name: -Device Classification Name: Tendon Protector Collagen Tendon Sheet-D Mesh, Surgical 878.3300 Class II FTM

Legally Marketed Devices to Which Substantial Equivalence is Claimed

Predicate Device(s):

Collagen Tendon Sheet, K112423 Rotation Medical, Inc.

Description of the Device

Collagen Tendon Sheet-D is a resorbable type I collagen matrix that provides a layer of collagen over injured tendons. Collagen Tendon Sheet-D is designed to provide a layer between the tendon and the surrounding tissue. When hydrated, Collagen Tendon Sheet-D is an easy-touse, soft, pliable, nonfriable, porous collagen sheet. Collagen Tendon Sheet-D is provided sterile, non-pyrogenic, for single use only, in a variety of sizes, in double peel packages.

Intended Use

Collagen Tendon Sheet is indicated for the management and protection of tendon injuries in which there has been no substantial loss of tendon tissue.

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K122048

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Image /page/1/Picture/1 description: The image shows the logo for Rotation Medical. The logo consists of the word "rotation" in a stylized font with a line underneath it. Below the word "rotation" is the word "MEDICAL" in a smaller, sans-serif font. Above the word "rotation" is a semi-circle made of circles.

Summary/Comparison of Technical Characteristics

Collagen Tendon Sheet-D is the same product as its predicate Collagen Tendon Sheet (K112423) in all regards excepting the addition of a small amount of FD&C Blue #2 on the perimeter of the upper surface to provide contrast with surrounding tissue during fixation.

Collagen Tendon Sheet-D has been evaluated in a number of in vitro and in vivo tests to assess its safety/biocompatibility, including: cytotoxicity (agarose overlay, liquid and extract methods), tto ourotyplooompanisms reactivity, systemic toxicity, hemolysis, genotoxicity (bacterial and Schildtion, intraductions routing) , and muscle implantation tissue response tests. The device passed all applicable FDA Blue Book Memorandum G95-1 and ISO 10993-1 testing for the biological evaluation of medical devices.

Collagen Tendon Sheet-D and its predicate share base material that has been characterized for chemical composition and purity using SDS-PAGE analysis, collagen typing, residual testing and viral inactivation (four appropriate viruses selected for assessment). Mechanical characterization included density, strength, stiffness and tear resistance to demonstrate substantial equivalence. Testing was conducted in accordance with FDA's Guidance for the Preparation of a Premarket Notification for a Surgical Mesh.

Conclusion of Non-clinical Studies

The results of the in vitro product characterization studies, and in vitro and in vivo biocompatibility studies, demonstrate that Collagen Tendon Sheet-D is substantially equivalent to the predicate device.

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Image /page/2/Picture/0 description: The image shows the seal of the Department of Health & Human Services - USA. The seal is circular, with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. In the center of the seal is an abstract image of an eagle with its wings spread.

DEPARTMENT OF HEALTH & HUMAN SERVICES

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

Rotation Medical, Incorporated % Mr. Jeff Sims Vice President, Clinical Programs and Regulatory Affairs 15350 25th Avenue North, Suite 100 Plymouth, Minnesota 55447

Re: K122048

Trade/Device Name: Collagen Tendon Sheet-D Regulation Number: 21 CFR 878.3300 Regulation Name: Surgical mesh Regulatory Class: Class II Product Code: FTM. OWY Dated: December 06, 2012 Received: December 11, 2012

January 8, 2013

Dear Mr. Sims:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced aboye 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 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

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Page 2 - Mr. Jeff Sims

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/ucm] 15809.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,

Peter D. Rumm -S

Mark N. Melkerson Acting Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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K12-2048

Confidential Rotation Medical, Inc.

Indications for Use

510(k) Number (if known):

Device Name: _ Collagen Tendon Sheet-D

Indications for Use:

Collagen Tendon Sheet-D is indicated for the management and protection of tendon injuries in which there has been no substantial loss of tendon tissue.

Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE – CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Daniel Kime for MXM
(Division Sign-Off)

Division of Sure

510(k) Numb