Abstract
Peritendinous adhesions are a frequent occurrence following tenolysis and present a major clinical challenge regarding prevention and management, with no recovery assured from conservative or surgical approaches. Herein, we investigated the effectiveness of Hyaloglide®, a hyaluronan gel-based product with a novel autocross-linked technology, in a rabbit model affected by tenolysis on the flexor digitorum communis tendon (FDC). A 1.5-cm-long scrubbing of the tendon surface was performed bilaterally to induce peritendinous adhesion on FDC of 30 animals with subsequent application of Hyaloglide® on the surrounding injured area, in one randomly chosen tendon. The contralateral tendon was treated with saline solution as the control. We sacrificed the rabbit models after 45 days of surgery and quantitatively assessed the generation of peritendinous adherence and regeneration of the tendon sheaths using histological (hematossyline-eosine, masson’s trichromic), histomorphometrical (Tang score, Soslowsky Svesson, and Cook score), light electron microscopic, and gene expression investigations. Four rabbits were devoted to biomechanical analysis. Peritendinous adhesions were limited in Hyaloglide®-treated tendons; moreover, well-regenerated tendon sheaths were observed conversely to untreated tendons presenting with extensive areas of adhesions on the tendon surface. Histomorphometrical analysis revealed an adhesion score (Tang score) significantly better in the treated group (p = 0.001 *) compared to the control group. Moreover, the Soslowsky, Svensson, and Cook score parameters revealed a significantly improved regeneration for fiber structure, cellularity, and vascularity in the treated group (p = 0.001 *). No differences were reported for cartilaginous formation (p = 0.08). Gene expression analysis showed a significant increase in collagen type I expression in the treated group compared to the control group, while metalloprotease 1 and 9 were significantly increased in the control group. Biomechanical analysis did not show significant differences in both groups. Hyaloglide® treatment was safe and well-tolerated, generating improved tissue status. Local application of Hyaloglide® prevents adhesion formation after tenolysis and promotes normal healing with regeneration of the synovial sheath in a rabbit model.
Highlights
Tendons are a histologic high-tensile-strength band of dense fibrous connective tissue that connects muscles and bones and enable joint movement [1] by transmitting the force developed in the muscle to the bone
Adhesion formation following tendon repair and/or tenolysis in the area between the tendon and the surrounding tissue is a critical issue for the surgeon [3,4,5]
We reported fewer peritendinous adhesions in the Hyaloglide® -treated samples and clearly noted well-regenerated synovial sheaths, including parallel collagen fibers and an organized architecture, devoid of an overlapping fibrous architecture
Summary
Tendons are a histologic high-tensile-strength band of dense fibrous connective tissue that connects muscles and bones and enable joint movement [1] by transmitting the force developed in the muscle to the bone. Tendons are equipped with a coverage, so-called peritendinous synovial sheaths [2], which facilitate their movement and protect them from the friction of surrounding tissue and organs. Adhesion formation following tendon repair and/or tenolysis in the area between the tendon and the surrounding tissue is a critical issue for the surgeon [3,4,5]. Tendon injury will initially provide an inflammatory response, but developing adhesions and scar tissue will subsequently inhibit the gliding movement of the tendon [6,7]. The prevention of peritendinous adhesions post tenolysis has been investigated using numerous techniques, with an objective to separate the recovering tendon from the surrounding wound area with an intent to decrease inflammation and subsequent scar tissue formation around the surface of the tendon, reducing the formation of adhesions. Should neither inhibit the synovial sheath of the tendon to naturally regenerate nor should it interfere with its repair mechanism [8]
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