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

Abstract

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).

Lubricin surface modification improves tendon gliding after tendon repair in a canine model in vitro

“…Tendon surface modifications using gelatin and hyaluronic acid have been developed to reduce the gliding resistance of both tendon graft and repaired tendon. 27,28,30 Here we investigate the effect of adding lubricin to these formulations.…”

“…22,25 A number of abnormalities in the function of tendons within tenosynovial sheaths, and tendon adhesion formation, have also been described in CACP syndrome, suggesting that lubricin is an important element necessary for normal tendon function. 25 Previous studies have looked at the effect of hyaluronic acid and gelatin on the gliding resistance 14,26-28 and outcome of tendon repairs. 29-33 The purpose of the current study was to investigate the effect of the addition of lubricin to existing tendon surface modifications on the gliding resistance of repaired flexor tendon after 1,000 cycles of tendon motion in a canine model in vitro.…”

Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid<sbt aid="1047845">An in Vivo Canine Model</sbt>

“…This modification of hyaluronic acid is believed to decrease water solubility, increase binding strength, and therefore increase tissue residence time 40 . Recent reports on carbodiimide-modified hyaluronic acid combined with gelatin on the surface of extrasynovial tendons noted decreased gliding resistance between the tendon and its pulley system during repeated flexion-extension motion over 500 cycles in a canine model in vitro 41,42 . The purpose of the current study was to investigate whether such a modified extrasynovial tendon, treated with cd-HA, would show improved performance in vivo, as demonstrated by increased tendon gliding ability, decreased digital work of flexion, and reduced adhesion formation.…”

The Use of Hyaluronic Acid after Tendon Surgery and in Tendinopathies

“…Other authors have supposed that adhesions could be reduced with more stable HA derivatives and HA could be fixed to the tendon surface, and its removal could be minimized [8–10, 19, 20]. Several HA derivatives have been evaluated.…”

“…The carbodiimide-derivatized HA (cd-HA) is less soluble in water than normal HA and therefore has an increased tissue residence time [19, 20]. Preliminary experiments, performed on intact tendon grafts in vitro , showed that the preparation improved gliding and that the effect was increased when gelatin was added [8].…”