Prevention of Peritendinous Adhesion Formation After the Flexor Tendon Surgery in Rabbits

Fatemi, Mohammad Javad; Shirani, Shahram; Sobhani, Roohollah; Lebaschi, Amir; Gharegozlou, Mohammad Javad; Bagheri, Tooran; Pedram, Mir Sepehr; Isfeedvajani, Mohsen Saberi; Araghi, Shirin; Fatemi, Mohammad Ali

doi:10.1097/sap.0000000000001169

Cited by 17 publications

(6 citation statements)

References 38 publications

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“…Tendon adhesion mostly occurs after tendon surgery and joint immobilization. Several mechanisms have been implicated in the modulation of adhesion formation, including the regulation of the TGF-β signaling pathway, oxidative stress, and the inflammatory response [ 3 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two pathways are considered to participate in tendon repair. The intrinsic repair pathway involves the internal repair function of tenocytes, the extrinsic repair process involves the invasion of cells from the outside of tendon and finally promotes the formation of adhesion [ 3 , 4 ]. As the pathophysiological mechanism of tendon adhesion is not clear, the prevention and treatment of tendon adhesion is still facing challenges.…”

Section: Introductionmentioning

confidence: 99%

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Quercetin reduces tendon adhesion in rat through suppression of oxidative stress

Liang

Zhang

et al. 2020

BMC Musculoskelet Disord

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Background Tendon adhesion is one of the most common clinical problems, which poses a considerable challenge to orthopedics doctors. Quercetin (QUE) as a popular drug at present, it has various biological functions, including anti-inflammatory, anti-ischemic, anti-peroxidation, and antioxidant. The purpose of this study was to investigate the effect of quercetin on tendon adhesion and whether quercetin can inhibit oxidative stress. Method Thirty-six rats were randomly divided into three groups, including control group, low QUE (50 mg/kg/day) group, and high QUE (100 mg/kg/day) group. After 1 week, the levels of SOD, MDA and GPx were measured. The degree of tendon adhesion was assessed by macroscopic evaluation and histological evaluation. After 4 weeks. Besides, the pharmacological toxicity of quercetin to main organs were evaluated by histological analysis. Results The extent of superoxide dismutase (SOD) and glutathione peroxidase (GPx) of tendon tissue in high QUE group was significantly higher than those of low QUE group and control group. And the extent of malondialdehyde (MDA) of tendon tissue in high QUE group was significantly lower than that of low QUE group and control group. By macroscopic evaluation and histological analysis, the extent of tendon adhesion in high QUE group was lower than low QUE group and control group. However, there were no significant changes of the major organs through histological analysis. Conclusions Quercetin may be a good and safe strategy in preventing tendon adhesion. But further clinical research is needed before its recommendation in the prevention and treatment of tendon adhesion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quercetin reduces tendon adhesion in rat through suppression of oxidative stress

Liang

Zhang

et al. 2020

BMC Musculoskelet Disord

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“…In an experimental study using local interferon-α, interferon-β and 5-fluorouracil, 5-fluorouracil was shown to prevent adhesion with anti-inflammatory effect. [ 28 ] In another study, local vitamin E analogue was shown to reduce postoperative adhesion by antioxidant and antifibrotic effects in an experimental chicken model with flexor digitorum profundus tendon injury. [ 12 ] Reduced postoperative adhesion was shown in another study where collagen-elastin matrix was used to prevent postoperative adhesion in an experimental rabbit model undergoing flexor tendon repair.…”

Section: Discussionmentioning

confidence: 99%

Does methylene blue reduce adhesion during the healing process after tendon repair?

et al. 2020

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This study aims to biomechanically and histopathologically investigate the effects of methylene blue (MB) on preventing postoperative adhesion in chickens undergoing fullthickness flexor tendon incision. Materials and methods: This study was performed between June 2017 and June 2018 on Hubbard JA 57 type chickens (age, 6 months; weight, 2.2±0.3 kg). Sixty-four tendons were studied in 32 chickens, including 16 in the control group and 16 in the experimental group. The second and third finger flexor digitorum profundus tendons of the left foot of each chicken were repaired primarily after a full-thickness incision approximately 1 cm proximal to the distal adhesion area. In the control (n=32) and experimental groups (n=32), 0.25 mL of normal saline and 0.25 mL of 1% MB solutions were applied locally to the surgical site, respectively. The operated limb was immobilized using a circular cast. 16 chickens were randomly selected in each group and examined at the fourth week, and the remaining 16 chickens were examined at the sixth week. Thirty-two of these tendons were evaluated using the Tang histopathological adhesion classification system, and the other 32 were evaluated with a biomechanical pull system. Results: Adhesion was found to be less in the experimental group compared to the control group at the end of the fourth and sixth weeks both histopathologically and biomechanically. Furthermore, adhesion was significantly less in the experimental group at the end of the sixth week compared to the fourth week both histopathologically and biomechanically. Conclusion: Histopathological and biomechanical results show that MB, which has anti-inflammatory, antiseptic, antimicrobial and antioxidant effects, reduces adhesion during the healing process after tendon repair. We think that local MB application, particularly in surgeries performed after this type of injury, will be beneficial on early rehabilitation and functional results.

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“…Effective inhibition of the formation of peritendinous adhesions is related to the blocking of crucial cellular targets and associated downstream signals in the adhesion formation pathway . However, the mechanisms involved in peritendinous adhesion, especially crucial cellular targets, have not been clarified.…”

Section: Discussionmentioning

confidence: 99%

Gene Silencing via PDA/ERK2‐siRNA‐Mediated Electrospun Fibers for Peritendinous Antiadhesion

Liu

et al. 2018

Advanced Science

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Sustained delivery of small interfering RNA (siRNA) is a challenge in gene silencing for managing gene‐related disorders. Although nanoparticle‐mediated electrospun fibers enable sustainable gene silencing, low efficiency, loss of biological activity, toxicity issues, and complex electrospinning techniques are all bottlenecks of these systems. Preventing peritendinous adhesion is crucial for their successful use, which involves blocking cellular signaling via physical barriers. Here, a multifunctional, yet structurally simple, cationic 2,6‐pyridinedicarboxaldehyde‐polyethylenimine (PDA)‐mediated extracellular signal‐regulated kinase (ERK)2‐siRNA polymeric delivery system is reported, in the form of peritendinous antiadhesion electrospun poly‐l‐lactic acid/hyaluronan membranes (P/H), with the ability to perform sustained release of bioactive siRNA for long‐term prevention of adhesions and ERK2 silencing. After 4 days of culture, the cell area and proliferation rate of chicken embryonic fibroblasts on siRNA+PDA+P/H membrane are significantly less than those on P/H and siRNA+P/H membranes. The in vivo results of average optical density of collagen type III (Col III) and gene expression of ERK2 and its downstream SMAD3 in the siRNA+PDA+P/H group are less than those of P/H and siRNA+P/H groups. Consequently, siRNA+PDA+P/H electrospun membrane can protect the bioactivity of ERK2‐siRNA and release it in a sustained manner. Moreover, adhesion formation is inhibited by reducing fibroblast proliferation and Col III deposition, and downregulating ERK2 and its downstream SMAD3.

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Prevention of Peritendinous Adhesion Formation After the Flexor Tendon Surgery in Rabbits

Abstract: Local application of 5-FU significantly reduced peritendinous adhesion. Local IFN-α and IFN-β had no significant effect on the prevention of peritendinous adhesion formation. The strength of the repair was not affected by these cytokines and 5-FU.

Cited by 17 publications

References 38 publications

Quercetin reduces tendon adhesion in rat through suppression of oxidative stress

Quercetin reduces tendon adhesion in rat through suppression of oxidative stress

Does methylene blue reduce adhesion during the healing process after tendon repair?

Gene Silencing via PDA/ERK2‐siRNA‐Mediated Electrospun Fibers for Peritendinous Antiadhesion

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