Self‐Healing Hydrogel Embodied with Macrophage‐Regulation and Responsive‐Gene‐Silencing Properties for Synergistic Prevention of Peritendinous Adhesion

Abstract

Antiadhesion barriers such as films and hydrogels used to wrap repaired tendons are important for preventing the formation of adhesion tissue after tendon surgery. However, sliding of the tendon can compress the adjacent hydrogel barrier and cause it to rupture, which may then lead to unexpected inflammation. Here, a self‐healing and deformable hyaluronic acid (HA) hydrogel is constructed as a peritendinous antiadhesion barrier. Matrix metalloproteinase‐2 (MMP‐2)‐degradable gelatin‐methacryloyl (GelMA) microspheres (MSs) encapsulated with Smad3‐siRNA nanoparticles are entrapped within the HA hydrogel to inhibit fibroblast proliferation and prevent peritendinous adhesion. GelMA MSs are responsively degraded by upregulation of MMP‐2, achieving on‐demand release of siRNA nanoparticles. Silencing effect of Smad3‐siRNA nanoparticles is around 75% toward targeted gene. Furthermore, the self‐healing hydrogel shows relatively attenuated inflammation compared to non‐healing hydrogel. The mean adhesion scores of composite barrier group are 1.67 ± 0.51 and 2.17 ± 0.75 by macroscopic and histological evaluation, respectively. The proposed self‐healing hydrogel antiadhesion barrier with MMP‐2‐responsive drug release behavior is highly effective for decreasing inflammation and inhibiting tendon adhesion. Therefore, this research provides a new strategy for the development of safe and effective antiadhesion barriers.

Disulfiram Suppressed Peritendinous Fibrosis Through Inhibiting Macrophage Accumulation and Its Pro-inflammatory Properties in Tendon Bone Healing

“…Infiltration of macrophages to cause tendon–bone damage has recently been increasingly associated with peritendinous adhesion ( Cai et al, 2021 ). In an in vitro study, M-CSF-induced BMDMs displayed an increased F4/80 staining in the TI mice than in the control.…”

Novel use of close-wedge osteotomy and monorail external fixator in the treatment of chronic Monteggia fracture

“…[ 9 , 10 , 12 , 31 ] The repair of the remnant of annular ligament or autograft transplantation, including triceps tendon, palmaris longus and forearm fascia, was performed in these studies, and complication rate of lost ROM of forearm, narrowing of the radial neck and its necrosis is eliminating in recent years. [ 19 , 32 - 36 ]…”

“…[9,10,12,31] The repair of the remnant of annular ligament or autograft transplantation, including triceps tendon, palmaris longus and forearm fascia, was performed in these studies, and complication rate of lost ROM of forearm, narrowing of the radial neck and its necrosis is eliminating in recent years. [19,[32][33][34][35][36] Other researchers, applying either immediate or gradual correction of the deformities, did not chose ALR to lower the incidence of open reconstructionrelated complications. [16,19,37] In the current study, we only performed joint debridement in patients with severely limited preoperative ROM of forearm to deliberate forearm pronation and supination, as the remnant of annular ligament was difficult to recognize after years of TSI and might even go atrophy.…”

Severe spaghetti wrist injury: Should we expand the terminology from wrist to proximal forearm?

“…Besides, much poorer outcomes of opposition (25.0% fair) and intrinsic muscle (25.0% fair) function were more common in the forearm group, due to a more proximal level of motor and sensory neuron injury. Decreased grip strength was observed in the forearm group compared to the wrist group, which was probably due to inflammatory peritendinous adhesion and muscle belly atrophy of disuse due to immobilization before ceasing the splint,[ 20 - 22 ] Luckily, all severed arteries reached proper patency which confirmed blood supply for the distal part of the injured limb. Although average DASH score was slightly lower than expected in both groups and severe complications were seen as two patients even required arthrodesis of elbow or wrist, the overall subjective outcomes of these patients were satisfactory, since the surgical management and rehabilitation agreed with the tradition of limb salvage against amputation.…”