Resorbable and non-resorbable augmentation devices for tenorrhaphy of xenografts in extensor tendon deficits: 12 week study

Abstract

Resorbable (poly- l-lactide) and non-resorbable (polyethylene terephathalate) tendon augmentation devices (TAD) in conjunction with a pericardial adhesion barrier, were designed to strengthen tenorrhaphies and were evaluated in an ovine extensor tendon deficit model in a short term study. Fifteen centimetres of tendon were resected and replaced with kangaroo tail tendon xenografts that had been cross-linked with 0.075% glutaraldehyde (GA) at 4 °C for one or seven days. Compared with tenorrhaphies performed with Kessler sutures alone, both types of TAD were more effective at preventing tenorrhaphy dehiscence, and thus maintaining tendon function. Furthermore, tensile strength of TAD tenorrhaphies increased significantly between zero and twelve weeks. For xenografts cross-linked in GA for one day, the tensile strength of tenorrhaphies with the resorbable TAD rose from 38 ± 9 N at time zero, to 116 ± 46 N at twelve weeks, while non-resorbable TAD tenorrhaphy strength at time zero was 42 ± 16 N and 99 ± 27 N at twelve weeks. For xenografts cross-linked with GA for seven days, similar increases in tensile strength of tenorrhaphies, with the two types of TAD were found. As there was no significant difference in mechanical performance or tissue response between the two TAD types in the first 12 weeks, use of the resorbable poly- l-lactide device may be advantageous clinically. Tensile strengths of midsections of the tendon xenograft cross-linked for 7 days was not significantly diminished 12 weeks after implantation and these xenografts were partially remodelled around the periphery. However, the tensile strength of xenografts cross-linked for one day declined significantly between time zero (319 ± 80 N) and twelve weeks (239 ± 92 N), suggesting that this degree of crosslinking was inadequate for maintenance of mechanical strength. Evaluation of the performance of tenorrhaphy augmentation devices with xenografts, over a longer implantation period, is required to further understand their usefulness for reconstruction of traumatic tendon injuries.