Surface modification counteracts adverse effects associated with immobilization after flexor tendon repair

Zhao, Chunfeng; Sun, Yu; Jay, Gregory D.; Moran, Steven L.; An, Kai Nan; Amadio, Peter C.

doi:10.1002/jor.22177

Cited by 13 publications

(12 citation statements)

References 44 publications

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“…Second, we did not test either the cell-based therapy or surface modification alone. However, some studies have shown that bone marrow stromal cells do increase tendon healing capacity [8,10,15], and others have shown that surface modification decreases tendon adhesions [14,40]. Therefore, the purposes of our study were to investigate the effects of combining these treatments on postoperative adhesion formation and tendon healing.…”

Section: Discussionmentioning

confidence: 99%

CORR® ORS Richard A. Brand Award for Outstanding Orthopaedic Research: Engineering Flexor Tendon Repair With Lubricant, Cells, and Cytokines in a Canine Model

Zhao

Ozasa

Reisdorf

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Adhesions and poor healing are complications of flexor tendon repair. Questions/purposes The purpose of this study was to investigate a tissue engineering approach to improve functional outcomes after flexor tendon repair in a canine model. Methods Flexor digitorum profundus tendons were lacerated and repaired in 60 dogs that were followed for 10, 21, or 42 days. One randomly selected repair from either the second or fifth digit in one paw in each dog was treated with carbodiimide-derivatized hyaluronic acid, gelatin, and lubricin plus autologous bone marrow stromal cells stimulated with growth and differentiation factor 5; control repair tendons were not treated. Digits were analyzed by adhesion score, work of flexion, tendon-pulley friction, failure force, and histology.

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Section: Discussionmentioning

confidence: 99%

CORR® ORS Richard A. Brand Award for Outstanding Orthopaedic Research: Engineering Flexor Tendon Repair With Lubricant, Cells, and Cytokines in a Canine Model

Zhao

Ozasa

Reisdorf

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…The toes were operated under sterile conditions and tourniquet control using elastic bandages. A zigzag incision was made in the plantar skin between the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints, which is equivalent to zone 2 in the human hand 60 61 . Through a 1.0-cm long longitudinal incision through the tendon sheath, a transverse cut of the FDP tendon was made with a sharp scalpel at the level about 1.0 cm distal to the PIP joint with the toe in extension.…”

Section: Methodsmentioning

confidence: 99%

Basic FGF or VEGF gene therapy corrects insufficiency in the intrinsic healing capacity of tendons

Tang

Cao

et al. 2016

Sci Rep

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Tendon injury during limb motion is common. Damaged tendons heal poorly and frequently undergo unpredictable ruptures or impaired motion due to insufficient innate healing capacity. By basic fibroblast growth factor (bFGF) or vascular endothelial growth factor (VEGF) gene therapy via adeno-associated viral type-2 (AAV2) vector to produce supernormal amount of bFGF or VEGF intrinsically in the tendon, we effectively corrected the insufficiency of the tendon healing capacity. This therapeutic approach (1) resulted in substantial amelioration of the low growth factor activity with significant increases in bFGF or VEGF from weeks 4 to 6 in the treated tendons (p < 0.05 or p < 0.01), (2) significantly promoted production of type I collagen and other extracellular molecules (p < 0.01) and accelerated cellular proliferation, and (3) significantly increased tendon strength by 68–91% from week 2 after AAV2-bFGF treatment and by 82–210% from week 3 after AAV2-VEGF compared with that of the controls (p < 0.05 or p < 0.01). Moreover, the transgene expression dissipated after healing was complete. These findings show that the gene transfers provide an optimistic solution to the insufficiencies of the intrinsic healing capacity of the tendon and offers an effective therapeutic possibility for patients with tendon disunion.

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“…Although the healing strength of the tendon itself was quite low compared to the force measured in in vivo tendon repair studies,[53, 54] this is the strength of the healing tissue alone without any suture to supplement the strength. The healing strength of MDSCs with GDF-5 group was about twice as high as the strength of the repaired tendons without added cells or with BMSCs alone at 2 and 4 weeks.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of the Effects of Growth and Differentiation Factor 5 on Muscle-Derived Stem Cells and Bone Marrow Stromal Cells in an In Vitro Tendon Healing Model

Ozasa¹,

Gingery²,

Thoreson³

et al. 2014

The Journal of Hand Surgery

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Purpose To investigate the ability of muscle derived stem cells (MDSCs) supplemented with growth and differentiation factor-5 (GDF-5) to improve tendon healing in comparison to bone marrow stromal cells (BMSCs), in an in vitro tendon culture model. Methods Eighty canine flexor digitorum profundus tendons were assigned into 5 groups: 1) repaired tendon without gel patch interposition (no cell group), 2) with BMSC seeded gel patch interposition (BMSC group), 3) with MDSC seeded gel patch interposition (MDSC group), 4) with GDF-5 treated BMSC seeded gel patch interposition (BMSC+GDF-5 group), and 5) with GDF-5 treated MDSC seeded gel patch interposition (MDSC+GDF-5 group). After culturing for 2 or 4 weeks, the failure strength of the healing tendons was measured. The tendons were also evaluated histologically. Results The failure strength of the repaired tendon in the MDSC+GDF-5 group was significantly higher than that of the no cell and BMSC groups. The stiffness of the repaired tendons in the MDSC+GDF-5 group was significantly higher than that of the no cell group. Histologically, the implanted cells became incorporated into the original tendon in all 4 cell-seeded groups. Conclusion Interposition of a multi-layered GDF-5 and MDSC-seeded collagen gel patch at the repair site enhanced tendon healing compared to a similar patch using BMSC. However, this increase in vitro was relatively small. In the clinical setting, differences between MDSC and BMSC may not be substantially different, and it remains to be shown that such methods might enhance the results of an uncomplicated tendon repair clinically. Clinical Relevance MDSC implantation and administration of GDF-5 may improve the outcome of tendon repair.

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Surface modification counteracts adverse effects associated with immobilization after flexor tendon repair

Cited by 13 publications

References 44 publications

CORR® ORS Richard A. Brand Award for Outstanding Orthopaedic Research: Engineering Flexor Tendon Repair With Lubricant, Cells, and Cytokines in a Canine Model

CORR® ORS Richard A. Brand Award for Outstanding Orthopaedic Research: Engineering Flexor Tendon Repair With Lubricant, Cells, and Cytokines in a Canine Model

Basic FGF or VEGF gene therapy corrects insufficiency in the intrinsic healing capacity of tendons

A Comparative Study of the Effects of Growth and Differentiation Factor 5 on Muscle-Derived Stem Cells and Bone Marrow Stromal Cells in an In Vitro Tendon Healing Model

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