Hyaluronan in flexor tendon repair

Amiel, David; Ishizue, Kenneth K.; Billings, Edmund; Wiig, Monica; Berg, Jerry Vande; Akeson, Wayne H.; Gelberman, Richard H.

doi:10.1016/s0363-5023(89)80085-1

Cited by 119 publications

(66 citation statements)

References 16 publications

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“…29 -31 In 1989, Amiel et al found that hyaluronic acid applied topically at the time of flexor tendon repair decreased adhesions and improved the gliding function of the repaired flexor tendon in a rabbit model. 32 But the encouraging results of HA in animal models have not been confirmed in clinical trials, perhaps because the half-life of HA is short (days), and the healing time in humans is greater than it is in animals (months versus weeks). Momose et al 26 have shown that the gliding resistance of the PL tendons decreased significantly after treatment with either carbodiimide derivatized HA or unmodified HA, compared to saline-treated tendons ( p Ͻ 0.05), and that this effect persisted through 10 cycles.…”

Section: Discussionmentioning

confidence: 99%

Tendon surface modification by chemically modified HA coating after flexor digitorum profundus tendon repair

Yang¹,

Amadio²,

Sun³

et al. 2003

J Biomed Mater Res

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Carbodiimide derivatized HA (cd-HA) is less soluble in water than normal HA, and therefore has an increased tissue residence time. The purpose of this study was to study the effect of cd-HA gel on gliding and repair integrity during simulated repetitive motion of a repaired tendon in vitro. A total of 36 flexor digitorum profundus (FDP) tendons from six adult mongrel dogs were used and divided into three groups of control, simple HA, and cd-HA. The gliding resistance between the FDP and the proximal pulley, FDS, and bone was measured before laceration and after modified Kessler technique repair at 1, 5, 10, 50, 100, 200, 300, 400, and 500 cycles. After gliding testing, failure load, tendon stiffness, and resistance to gap formation were measured. The results showed from the first cycle to the 10th cycle, there were no significant differences in gliding resistance between the three testing groups (p > 0.05). From the 50th cycle onwards, the friction was significantly lower in the cd-HA gel group than in the control group (p < 0.05). Neither breaking strength, nor tendon stiffness, nor resistance to gap formation of the repairs were significantly different between the three groups (p > 0.05).

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Section: Discussionmentioning

confidence: 99%

Tendon surface modification by chemically modified HA coating after flexor digitorum profundus tendon repair

Yang¹,

Amadio²,

Sun³

et al. 2003

J Biomed Mater Res

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“…[8][9][10][11][12] Clinical results, however, have been highly variable. 9,13,14 One of the reasons for this variability may be the short half-life of topically applied hyaluronic acid in tissues.…”

Section: Introductionmentioning

confidence: 99%

Optimization of surface modifications of extrasynovial tendon to improve its gliding ability in a canine model in vitro

et al. 2006

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Previous studies have shown that the carboxyl groups in hyaluronic acid (HA) could be activated by 1-ethy 1-3-[3-dimethylaminopropyl] carbodiimide hydrochloride (EDC)/N-hydroxysuccinimide (NHS) to form intermediate O-acylisoureas, which can chemically bind to exposed amino groups on the tendon surface, leading to improved gliding ability. However, the optimal ratio and concentrations of the components in this chemical mixture were not investigated. The purpose of this study was to optimize the constituents of this tissue engineering approach to tendon surface modification, to reduce friction and improve durability. Peroneus longus (PL) tendons (n ¼ 40) were harvested from adult mongrel dogs along with the A2 pulley obtained from the ipsilateral hind paw. After the gliding resistance of the normal PL tendon was measured, the tendons were treated under varying concentrations of HA (0.5, 1, and 2%) and EDC/NHS (0.05, 0.25, and 1%) mixed with a 10% gelatin. Tendon friction was measured for 1000 cycles of simulated flexion/extension motion. Following testing, the residual HA on the tendon surface was evaluated by immunohistochemisty. The gliding resistance of the untreated PL tendons had a mean value of 0.087 AE 0.021 N. After surface treatment, there was no significant difference in friction due to HA concentration alone, but the concentration of EDC/NHS and the interaction between HA concentration and EDC/NHS concentration had a significant effect on friction. Regardless of HA concentration, the friction after 1000 cycles was significantly decreased in preparations which included a 1% concentration of EDC/ NHS. The tendons with lower gliding resistance presented a smoother surface on light microscopy and maintained more residual HA on the tendon surface. By varying the relative concentrations of HA, EDC, and NHS it is possible to optimize the effect of surface treatment on friction and durability in a canine extrasynovial tendon in vitro. ß

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“…1 Accordingly, the importance of HA during early stages of repair processes at joints has been investigated several times, [1][2][3][4][5][6] but typically in connection with flexor tendons, the Achilles tendon, the knee, or ligaments. [2][3][4]6 We know of no report directly concerning HA in an experimental model of healing in rotator cuff tears.…”

Section: Introductionmentioning

confidence: 99%

“…7 Postulated mechanisms of benefit mostly have focused on the viscosity of HA causing improvement of sliding properties or preventing adhesions. [2][3][4]6 Wiig and Abrahamsson 8 examined the effect of HA on cell proliferation and matrix production using rabbit deep flexor tendons, but the molecular pharmacology of HA in damaged rotator cuff tissues has not yet been investigated. We have studied the repair process in the rotator cuff of a nonweight-bearing joint by examining an avian acute model.…”

Section: Introductionmentioning

confidence: 99%

Molecular effects of sodium hyaluronate on the healing of avian supracoracoid tendon tear: According to in situ hybridization and real‐time polymerase chain reaction

Shimpuku¹,

Hamada²,

Handa³

et al. 2006

Journal Orthopaedic Research

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Hyluronic acid (HA) on tissue healing has been controversial. We examined the molecular pharmacology of HA injection at the suture site in an acute model of supracoracoid tendon laceration using chickens, an injury of a nonweight-bearing joint considered similar to the human shoulder. Expression of mRNAs encoding a I (I) and aI (III) procollagens was localized using in situ hybridization (ISH). Intensities of mRNA expression for a I (I) and a I (III) procollagens, transforming growth factor-b1 (TGF-b1), basic fibroblast growth factor (bFGF), and insulin-like growth factor (IGF) were determined by quantitative reverse transcription-polymerase chain reaction (RT-PCR). Histologically, chickens with HA injection (HA group) showed early restoration of continuity at the laceration site than saline-injection controls (saline-injection group). By ISH, the expression rate of cells at the lesion site that contained a I (I) and a I (III) procollagen mRNAs were somewhat higher in the HA group than in the saline-injection group. By RT-PCR, the HA-and saline-injection groups showed no significant difference in expression of a I (I) and a I (III) procollagen mRNA between weeks 1 and 6. The saline -injection group exhibited significant decrease in TGF-b1 expression between weeks 1 and 3, and in bFGF expression between weeks 1 and 2; however, the HA group showed no such decrease. As for IGF, no difference was appreciable in both groups between weeks 1 and 6. A single injection of HA could cause earlier restoration of continuity at the lacerated site of the supracoracoid tendon. ß

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Hyaluronan in flexor tendon repair

Cited by 119 publications

References 16 publications

Tendon surface modification by chemically modified HA coating after flexor digitorum profundus tendon repair

Tendon surface modification by chemically modified HA coating after flexor digitorum profundus tendon repair

Optimization of surface modifications of extrasynovial tendon to improve its gliding ability in a canine model in vitro

Molecular effects of sodium hyaluronate on the healing of avian supracoracoid tendon tear: According to in situ hybridization and real‐time polymerase chain reaction

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