Evaluation of a new collagen‐based medical device (ElastiCo®) for the treatment of acute Achilles tendon injury and prevention of peritendinous adhesions: An in vitro biocompatibility and in vivo investigation

Abstract

Tendon healing still represents a challenge for clinicians because it is slow and incomplete. The most injured is the Achilles tendon, and surgery is the therapeutic strategy often adopted because it provides a quicker functional recovery. Peritendinous adhesions are the main complication of surgery with hyperplasia and chemotaxis of fibroblasts. A biomaterial that blocks fibroblast migration, without interfering with the passage of cytokines and growth factors, might be useful. The present study evaluated the biocompatibility of a new Type I collagen‐based scaffold (ElastiCo®) and its ability to promote Achilles tendon healing, inhibiting adhesion formation. After verifying in vitro biocompatibility, physical, and mechanical properties of the scaffold, an in vivo study was performed in 28 rats, operated to induce an acute lesion in both Achilles tendons. One tendon was treated with the suture only and the contralateral one with suture wrapped with ElastiCo® film. After 8 and 16 weeks, it was observed that ElastiCo® reduced internal and external peritendinous adhesions and Collagen III content and increased Collagen I. Elastic modulus increased with both treatments over time. Current results highlighted the clinical translationality of ElastiCo® that could improve the quality of life in patients affected by Achilles tendon lesions surgically treated.

Electrospun tube reduces adhesion in rabbit Achilles tendon 12 weeks post-surgery without PAR-2 overexpression

“…The etiology of adhesion formation roots in the destruction of the basement membrane, a cell-retentive layer on the tendon surface, where cells can exit upon damage and finally lead to an adhesion by deposits of extracellular matrix components 34 . Several anti-adhesion approaches have been developed recently, such as electrospun tubes with hyaluronic acid to address deep flexor tendons ruptures in the sheep model 35 ; collagen-based (ElastiCo) barrier material to inhibit adhesion in the rat AT model 11 or a cellhydrogel fiber composite, mimicking the synovial sheath, promoting the endogenous hyaluronic acid formation, and enhancing the lubricating effect 36 .…”

“…Severe adhesions are reported most frequently for the flexor digitorum profundus (FDP) tendons as well as the flexor digitorum superficialis (FDS) of the hand in zone II, starting from the A1 pulley proximal edge to the distal insertion of FDS 9,10 . Nevertheless, also the Achilles tendon (AT) is often affected by adhesion formation 11 . A leaflet of fascia surrounds the AT, where adhesion may occur during the healing process.…”

Biomimetic Scaffolds for Tendon Tissue Regeneration

“…Veronesi et al wrapped the prepared novel type I collagen scaffold around the sutured Achilles tendon defect in rats. Compared with the control group that only had the defect sutured, the type I collagen content and elastic modulus in the experimental group increased when compared to the control group [ 209 ].…”

Biomaterials for Soft Tissue Repair and Regeneration: A Focus on Italian Research in the Field

“…Membranes based on this material were evaluated in vitro and in vivo on a rat model presenting acute lesion of Achilles’ tendons to verify biocompatibility. The ability to support tendon regeneration and to prevent postsurgical adhesion was confirmed [ 105 ].…”