Improvement of Flexor Tendon Reconstruction with Carbodiimide-Derivatized Hyaluronic Acid and Gelatin-Modified Intrasynovial Allografts: Study of a Primary Repair Failure Model

Chunfeng Zhao; Yu-Long Sun; Ikeda, Jun; Kirk, Ramona L.; Thoreson, Andrew R.; Moran, Steven L.; Kai-Nan An; Amadio, Peter C.
December 2010
Journal of Bone & Joint Surgery, American Volume;12/1/2010, Vol. 92-A Issue 17, p2817
Academic Journal
Background: Tendon grafts play an important role in flexor tendon reconstruction. This study was an investigation of the effects of surface modification of allograft intrasynovial tendons with carbodiimide-derivatized hyaluronic acid and gelatin in an in vivo canine model. To mimic the actual clinical situation, a novel and clinically relevant model of a failed primary flexor tendon repair was used to evaluate the flexor tendon grafts. Methods: Twenty-eight flexor digitorum profundus tendons from the second and fifth digits of fourteen dogs were lacerated and repaired in zone II in a first-surgery phase. The dogs were allowed free active motion postoperatively. In a second phase, six weeks later, the tendons were reconstructed with use of a flexor digitorum profundus allograft. In each dog, one graft was treated with carbodiimide-derivatized hyaluronic acid and gelatin (the CHG group) and the other was treated with saline solution, as a control. The dogs were restricted from free active motion, but daily therapy was performed beginning on postoperative day 5 and continued until six weeks after the operation, when the animals were killed. The outcomes were evaluated on the basis of digit work of flexion, gliding resistance, healing at the distal attachment, graft cell viability, histological findings, and findings on scanning electron microscopy. Results: In the first phase, all twenty-eight repaired tendons ruptured, with scar and adhesion formation in the repair site. Six weeks after allograft reconstruction, the mean work of flexion was 0.37 and 0.94 N-mm/degree in the CHG group and the saline-solution control group, respectively; these values were significantly different (p < 0.05). The gliding resistance in the CHG group was also significantly less than that in the saline-solution control group (0.18 versus 0.28 N) (p < 0.05), but no difference between groups was observed with regard to the distal tendon-bone pullout strength. Histological analysis showed that tenocytes in the host tendon proliferated and migrated toward the acellular allograft. Conclusions: This primary repair failure model was reproducible and reliable, with a uniform failure pattern, and provides an appropriate and clinically relevant animal model with which to study flexor tendon reconstruction. The surface modification of allografts with carbodiimide-derivatized hyaluronic acid and gelatin improved digital function and tendon gliding ability.


Related Articles

  • Surface Treatment of Flexor Tendon Autograft and Allograft Decreases Adhesion Without an Effect of Graft Cellularity: A Pilot Study. Karabekmez, Furkan; Zhao, Chunfeng // Clinical Orthopaedics & Related Research;Sep2012, Vol. 470 Issue 9, p2522 

    Background: Flexor tendon grafting is often required to reconstruct a failed tendon repair. Previous reports have demonstrated flexor grafts coated with lubricants such as carbodiimide derivatized hyaluronic acid (cd-HA) decrease adhesion formation and improve digit function. However, whether...

  • The Effect of Lubricin on the Gliding Resistance of Mouse Intrasynovial Tendon. Hayashi, Masanori; Zhao, Chunfeng; Thoreson, Andrew R.; Chikenji, Takako; Jay, Gregory D.; An, Kai-Nan; Amadio, Peter C. // PLoS ONE;Dec2013, Vol. 8 Issue 12, p1 

    The purpose of this study was to investigate the role of lubricin on the gliding resistance of intrasynovial tendons by comparing lubricin knockout, heterozygous, and wild type mice. A total of thirty-six deep digital flexor (DDF) tendons in the third digits of each hind paw from eighteen adult...

  • Carbodiimide-Derivatized Hyaluronic Acid Surface Modification of Lyophilized Flexor Tendon. Ikeda, Jun; Chunfeng Zhao; Yu-Long Sun; Kai-Nan An; Amadio, Peter C. // Journal of Bone & Joint Surgery, American Volume;Feb2010, Vol. 92-A Issue 2, p388 

    Background: lntrasynovialgraftsarethe ideal solution to replace defects in intrasynovial flexortendons, but autologous graft sources are rarely available. The purpose of the present study was to test the hypotheses that an intrasynovial tendon prepared with repetitive freeze-thaw cycles and...

  • Evaluation of Biological Properties of Collagen/Hyaluronic Acid Composite Scaffolds. Zeqiang He; Lizhi Xiong // Polymers & Polymer Composites;2013, Vol. 21 Issue 7, p457 

    Porous collagen matrices crosslinked with hyaluronic acid (HA) by 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide (EDC) have been developed as scaffold materials for tissue engineering. The biological properties, including fibroblast proliferation, haemolytic behaviour, micronucleus, acute...

  • Preparation and characterization of nanoparticles based on histidine-hyaluronic acid conjugates as doxorubicin carriers. Wu, Jing-liang; Liu, Chen-guang; Wang, Xiao-lei; Huang, Zhen-hua // Journal of Materials Science: Materials in Medicine;Aug2012, Vol. 23 Issue 8, p1921 

    Histidine-hyaluronic acid (His-HA) conjugates were synthesized using hyaluronic acid (HA) as a hydrophilic segment and histidine (His) as hydrophobic segment by 1-ethyl-3(3-dimethylaminopropyl)carbodiimide (EDC) mediated coupling reactions. The structural characteristics of the His-HA conjugates...

  • ADHESION PREVENTION EFFECTS OF TOLMETIN COMBINED WITH HYALURONIC ACID. Shaojin Wang; Peixue Ling; Yanli He; Tianmin Zhang // Hyaluronan;2002, Vol. 2, p13 

    This study was to investigate the effects of intra-sheath injection of tolmetin sodium plus sodium hyaluronate (Tolmetin-HA) on adhesion formation in chicken flexor tendon model. Seventy-five chickens were divided into three groups. The long flexor tendon of central digit of all chickens was...

  • Preparation and characterization of chitosan/galactosylated hyaluronic acid scaffolds for primary hepatocytes culture. Jinyong Fan; Yi Shang; Yingjin Yuan; Jun Yang // Journal of Materials Science: Materials in Medicine;Jan2010, Vol. 21 Issue 1, p319 

    Hepatocyte-specific three-dimensional tissue-engineeringed scaffold plays an important role for developing bioartificial liver devices. In the present study, galactose moieties were covalently coupled with hyaluronic acid through ethylenediamine. Highly porous sponge composed of chitosan (CS)...

  • Results of flexor tendon repair of the hand by the motion-stable wire suture by Towfigh. Olivier, L.C.; Assenmacher, S.; Kendoff, D.; Schmidt, G.; Towfigh, H.; Schmit-Neuerburg, K.P. // Archives of Orthopaedic & Trauma Surgery;Apr2001, Vol. 121 Issue 4, p212 

    We compared the motion-stable wire suture by Towfigh (MSWST) with a modified Kessler suture (MKS) by following up flexor tendon repairs (MSWST, n = 21/39 digits; MKS, n = 20/31 digits). For MSWST we found 31 (79.5%) “excellent”, 3 (7.7%) “good”, and 5 (12.8%)...

  • Effects of a Lubricin-Containing Compound on the Results of Flexor Tendon Repair in a Canine Model in Vivo. Chunfeng Zhao; Yu-Long Sun; Ramona L. Kirk; Andrew R. Thoreson; Gregory D. Jay; Steven L. Moran; Kai-Nan An; Peter C. Amadio // Journal of Bone & Joint Surgery, American Volume;Jun2010, Vol. 92-A Issue 6, p1453 

    Background: Tendon surface modification with a synthetic biopolymer, carbodiimide–derivatized hyaluronic acid and gelatin with the addition of lubricin (CHL), has been shown to reduce gliding resistance after tendon repair in an in vitro model. The purpose of the study was to investigate...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics