Abstract
Defect of the tendon sheath after tendon injury is a main reason for tendon adhesions, but it is a daunting challenge for the biomimetic substitute of the tendon sheath after injury due to its multi-layer membrane-like structure and complex biologic functions. In this study, a multi-layer membrane with celecoxib-loaded poly(l-lactic acid)-polyethylene glycol (PELA) electrospun fibrous membrane as the outer layer, hyaluronic acid (HA) gel as middle layer, and PELA electrospun fibrous membrane as the inner layer was designed. The anti-adhesion efficacy of this multi-layer membrane was compared with a single-layer use in rabbit flexor digitorum profundus tendon model. The surface morphology showed that both PELA fibers and celecoxib-loaded PELA fibers in multi-layer membrane were uniform in size, randomly arrayed, very porous, and smooth without beads. Multi-layer membrane group had fewer peritendinous adhesions and better gliding than the PELA membrane group and control group in gross and histological observation. The similar mechanical characteristic and collagen expression of tendon repair site in the three groups indicated that the multi-layer membrane did not impair tendon healing. Taken together, our results demonstrated that such a biomimetic multi-layer sheath could be used as a potential strategy in clinics for promoting tendon gliding and preventing adhesion without poor tendon healing.
Highlights
The tendon sheath, which surrounds the tendon in some areas of the hand and foot, is an important structure for tendon gliding and nutrition
From cross-sectional morphology of Figure 1A, we could learn that thicknesses of the multi-layer membrane were 130 μm for the PELA layer and 170 μm for the outer celecoxib-loaded PELA layer
Unloaded PELA membrane resulted in small bundles of fibrous tissues bridging the tendon and the surrounding tissue, but in multi-layer membrane group, few adhesions were observed between the repaired tendon and the surroundings and a spatula could go through under the tendon (Figure 2A)
Summary
The tendon sheath, which surrounds the tendon in some areas of the hand and foot, is an important structure for tendon gliding and nutrition It consists of an outer fibrous sheath and an inner synovial sheath, which are two thin and serous sheets, the parietal and visceral sheets. An ideal substitute for the tendon sheath should mimic the structure of tendon sheath and inhibit invasion of exogenous fibroblasts and perform the biological function of secreting synovial fluid, which can decrease adhesion and facilitate tendon repair. In our previous study, a celecoxib-loaded PELA diblock copolymer fibrous membrane has been fabricated by electrospinning [14]. A multi-layer electrospun membrane-like tendon sheath structure was designed, the outer layer was celecoxib-loaded PELA electrospun fibrous membrane, the inner layer was PELA electrospun fibrous membrane, and HA gel was placed between two layers. Was to evaluate whether this multi-layer electrospun membrane can prevent adhesion by the outer layer and promote tendon gliding and healing by HA and the inner layer
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