Prevent Tendon Adhesion Research Articles

Operative treatment of flexor pollicis longus tendon with Krackow suture, functional results: Preliminary results

Surgical treatment of the injuried flexor tensons is the important part of hand surgery. Tendon adhesions, ruptures, joint contcatures-stifness are only one part of the problem one is faced during the tendon treatment. In spite of improvement in surgical technique and suture material, the end result of sutured flexor tendons still represent a serious problem. To present of operative treatment of flexor pollicis longus injury with Krakow suture technique. All patients are treated in the first 48 hours after the accident. The regional anesthesia was performed with use of turniquet. Beside spare debridement, the reconstruction of digital nerves was done. All patients started with active and pasive movements-excercises on the first postoperative day. Follow-up was from 6 to 24 months. In evaluation of functional recovery the grip strenght, pinch strenght, range of movements of interphalangeal and metacarpophalangeal joiht and DASH score were used. In the last two years there were 30 patients, 25 males (83.33%) and 5 females (16.66%). Mean age was 39.8 years, ranged from 17 to 65 years. According to mechanism of injury the patients were divided in two groups: one with sharp and other with wider zone of injury. Concomitant digital nerve lesions was noticed in 15 patients (50%). the Krackow sutrue allowed early rehabilitation, which prevent tendon adhesions, enabled faster and better functional recovery.

Effectiveness of MicroRNA in Down-Regulation of TGF-β Gene Expression in Digital Flexor Tendons of Chickens: In Vitro and In Vivo Study

Transforming growth factor (TGF)-beta is considered to be responsible for the formation of scars such as adhesions around healing digital flexor tendons. We proposed to deliver microRNAs (miRNAs) to silence expression of the TGF-beta1 gene and to investigate the effectiveness of miRNAs in down-regulation of the TGF-beta1 gene in vitro and in vivo. We designed and engineered 4 miRNAs according to genetic sequences of chicken TGF-beta1. Four plasmid vectors harboring the respective engineered miRNAs and 1 control vector were constructed. We transfected 30 wells of cultured tenocytes with these vectors and harvested them 48 hours later. The gene expression levels were quantified using real-time polymerase chain reactions. Subsequently, the miRNA that most effectively silenced TGF-beta gene in vitro was tested on 25 chickens in vivo. The miRNA and control vectors were injected into the injured tendons, respectively. At 1 and 6 weeks after surgery, the tendons were analyzed for gene expression and protein production. In both in vitro and in vivo settings, delivery of miRNA to the tendon substantially down-regulated expression of the TGF-beta gene but did not affect expression of the collagen I gene. In the healing tendon, TGF-beta gene expression was significantly down-regulated by 50% to 60% at 1 and 6 weeks. At 6 weeks, the collagen III gene expression was significantly down-regulated by 55% at 6 weeks and the connective tissue growth factor gene was significantly down-regulated by 25%. At 6 weeks, TGF-beta protein was substantially decreased. MicroRNA significantly down-regulates expression of the TGF-beta in vitro and in vivo. Application of miRNA did not down-regulate expression of the collagen I, but downregulated the collagen III gene. Application of miRNA treatment to modulate TGF-beta expression holds great promise in preventing tendon adhesion formation.

Effects of antisense transforming growth factor-β1 gene transfer on the biological activities of ten-don sheath fibroblasts

Objective To investigate the biological activity changes of rabbit tendon sheath fibro-blasts transfected by antisense TGF-β1 gene so as to provide a novel approach to prevention of postopera-tive tendon adhesion. Methods Tendon sheath fibroblasts were isolated from the New Zealand white rabbits and transfected by antisense TGF-β1 gene with Lipofectin. RT-PCR was used to measure mRNA expressions of collagen Ⅰ, collagen Ⅲ and TGF-β1 expressing and Western blot to measure protein ex-pression of collagen Ⅰ in tendon sheath fibroblasts. Results RT-PCR displayed marked decrease of mRNA expressions of collagen Ⅰ, collagen Ⅲ and TGF-β1 in tendon sheath fibroblasts transfected with antisense TGF-β1 gene, with statistical difference compared with untransfected group or blank transfected group (P<0.01). Western blot showed marked decrease of expression of collagen Ⅰ protein in tendon sheath fibroblasts transfected with antisense TGF-β1 gene, with statistical difference compared with un-transfected group or blank transfected group (P<0.01). Conclusions Tendon sheath fibroblasts can successfully transfect antisense transforming growth factor-β1 gene, decrease production of collagen Ⅰ,collagen Ⅲ and TGF-β1 that are factors for tendon adhesion and may play a certain role in prevention of tendon adhesion after tendon injuries. Key words: Tendon injuries; Oligoribonucleotides,antisense; Transforming growth factor beta; Collagen

Clinical Implications of Cerebral Reorganisation after Primary Digital Flexor Tendon Repair

After flexor tendon injury, most attention is given to the quality of the tendon repair and postoperative early passive dynamic mobilisation. Schemes for active mobilisation have been developed to prevent tendon adhesions and joint stiffness. This paper describes five patients to demonstrate the cerebral consequences of immobilisation allowing only passive movements, which implies a prolonged absence of actual motor commands. At the end of such immobilisation, PET imaging revealed reduced blood flow in specific motor areas, associated with temporary loss of efficient motor control. Effective motor control was regained after active flexion exercises which was reflected in normalised cerebral activations. This suggests that temporary, reversible cerebral dysfunction may affect the outcome of flexor tendon injuries.

Experiment study on prevention of tendon adhesion with different types of barriers

Objective To compare the effectiveness of different types of barriers in preyention of tendon adhesion in animal models and provide basis for clinical application. Methods Forfy male white New-Zealand rabbits were randomly divided into 4 groups.with 10 each.The second and third toes of the left hind legs were paired within groups.Flexor tendon of the second toe was transected at the proximal phalanx level and repaired by modified Kessler's procedure.In group A(control group),the wound Was closed directly.In group B1,C1 and D1,sodium hyaluronate,chitosan and bioeolloid was spread around the tenorrhaphy site respectively.In group.A2,B2,C2 and D2,polylactic acid absorbable membrane was wrapped around the tenorrhaphy site after flexor tendon of the thiId toe was cut and repaired.The resuhs were evaluated grossly,histologically and biomechanically 6 weeks later. Resuits The gross and histological appearance demonstrated that tendon adhesion in each experiment group was significantly reduced compared to that of the control group.Tendons in group B1 and C2 had the least adhesion.The sliding distance and ranges of motion were significantly higher in the experimental groups.However there was no significant difference in tensile strength among all the groups(P＞0.05). Conclusion Polylactic acid absorbable membrane,sodium hyaluronate,ehitosan and biocolloid materials can reduce tendon adhesion without affecting the tensile strength.Among those sodium hyaluronate and chitosan plus absorbable membrane fife the most effective. Key words: Tendons; Bioeompatible materials; Animal experimentation; Adhesion

Prevention of peritendinous adhesions using a hyaluronan‐derived hydrogel film following partial‐thickness flexor tendon injury

Peritendinous adhesions are an important complication of flexor tendon injury. Three hyaluronan (HA)-derived biomaterials were evaluated for the reduction of peritendinous adhesions following partial-thickness tendon injury in rabbits. Rabbits (n = 24) were divided into three groups (n = 8 per group), which were used for gross evaluation, histologic assessment, or biomechanical testing. The fourth and third toes from both hindpaws of each rabbit were randomly assigned to one of four treatments: (i) untreated control, (ii) Seprafilm, (iii) Carbylan-SX in situ crosslinked hydrogel, and (iv) preformed Carbylan-SX film. Rabbits were sacrificed at 3 weeks postsurgery and evaluated anatomically, histologically, and mechanically. All materials used reduced adhesions relative to untreated controls for all three evaluations. Both the gross anatomic and histologic results revealed that Carbylan-SX film was statistically superior to Seprafilm and Carbylan-SX gel in preventing tendon adhesion formation. In biomechanical tests, the Carbylan-SX film-treated hindpaws required the least force to pull the tendon from the sheath. This force was statistically indistinguishable from that required to extrude an unoperated tendon (n = 8). Carbylan-SX gel was less effective than Carbylan-SX film but superior to Seprafilm for all evaluations. A crosslinked HA-derived film promoted healing of a flexor tendon injury without the formation of fibrosis at 3 weeks postoperatively.

Degradable collagen membrane integrated with EGF for prevention of tendon adhesion: an experiment study in chicken

目的 观察和探索表皮生长因子(epidermal growth factor,EGF)复合胶原膜在预防鞘管区肌腱粘连、促进肌腱内源性愈合中的作用.方法 将30只10个月龄的雄性leghorn鸡随机分为A、B、C三组,每组10只.将鸡的左侧第三趾造成挤压撕脱伤模型,用改良Kessler法进行缝接.A组:肌腱缝合口包裹EGF复合胶原膜;B组:缝合口包裹单纯的胶原膜;C组:缝合口不做任何处理.4周后取材,右侧第三趾为对照组.对标本进行肉眼观察、生物力学测定、光镜和电镜等观察.结果 A组肌腱粘连程度较轻,肌腱缝合段内的胶原纤维数量多,以粗大的Ⅰ型胶原为主,成纤维细胞数?量少,腱细胞成熟.B组肌腱粘连程度较轻,但肌腱缝合段内的胶原纤维数量少,排列稀疏,以纤细的Ⅲ型胶原为主.C组肌腱与周围组织粘连较严重,肌腱缝合段内的胶原纤维数量较多,排列紊乱,Ⅰ、Ⅲ型胶原交错排列.结论 1.EGF复合胶原膜能起到屏障肌腱外源性愈合、防止肌腱粘连的作用,但同时也明显减慢了肌腱的愈合速度.2.EGF复合可降解胶原膜,同时也加快了肌腱的内源性愈合速度,起到了较理想的防止粘连的效果。

Individualized Rehabilitation Program for Flexor Tendon Repair: From Pyramid to Algorithm

During the past 3 decades, significant advances have been made in the surgery and postoperative rehabilitation of flexor tendon injuries of the hand. Stronger tendon repairs, facilitated by improved suture techniques and stronger suture materials, have driven postoperative rehabilitation programs. These programs are designed to maintain tendon excursion and prevent tendon adhesion through the early application of forces appropriate to maintain tendon gliding while preventing gapping at the repair site. It is postulated that early active mobilization increases tendon excursion, decreases the likelihood of tendon adhesion, and improves function of the repaired tendon. Protocol-driven therapy programs have become the mainstay of flexor tendon rehabilitation. These protocols provide a framework to apply progressively increasing forces to the tendon at specific time intervals. The timelines have been based on the best-available evidence available to therapists and surgeons. Lacking in experimental clinical trials, the best-available evidence to support the supposed tensile strength of repaired tendon at various stages of tendon healing is derived from laboratory experiments. Although these time-based protocols provide a formula for treatment of tendon repairs, they fail to accommodate human and individual variations in response to treatment, and tendon adhesion continues to be a common complication of tendon repair.

Prevention of Tendon Adhesions by the Reconstruction of the Tendon Sheath With Solvent Dehydrated Bovine Pericard: An Experimental Study

The achievement of the kinetic functions of a finger in full range of motion after the injury and the repair of the flexor tendon has been a challenging issue in hand surgery. Several current studies emphasize the importance of the tendon sheath for the healing of the tendon and for the prevention of the adhesive bands and advise primary repair or reconstruction of them. Various biological and synthetic materials have been used for this purpose with different rates of success. In this experimental study, the sheaths of flexor tendons of chicken toe were excised and three groups were observed: group 1, primary sheath not repaired; group 2, sheath repair with autogenous fascia; and group 3, sheath reconstruction with solvent dehydrated bovine pericardium (SDBP). Histopathologic evaluations were performed on the 3rd and 12th weeks to determine the outcome of the repair methods regarding the gliding surfaces of the tendons, adhesion rates, and inflammatory reactions, which are the main issues on the healing of the tendon. The results indicated less formation of adhesions in group 3 compared with groups 1 and 2 (p = 0.001). The results showed that SDBP can be used for the reconstruction of the sheaths successively for the prevention of the adhesive bands in flexor tendon surgery.

The Effectiveness of Polylactic Acid Bioresorbable Film in the Prevention of Adhesion Formation in Tendons

Purpose : To evaluate the effectiveness of a polylactic acid bioresorbable film in the prevention of tendon adhesion after tendon repair. Materials and Methods : Twenty-four adult rabbits (48 cases) were used in this study. In the first (control) group, the flexor tendons of the third toe were cut and a tenorrhaphy was performed. The 2nd group was injected with hyaluronic acid between the tendon and tendon sheath after suturing. The 3rd group underwent an enveloping of the tendon with polylactic acid film, followed by tenorrhaphy. The test animals were euthanized at 1, 2, 3, and 6 weeks after surgery, and the histology and biomechanics were evaluated. Results : Microscopic evaluations revealed fibrosis to be most apparent in group 1, while groups 2 and 3 showed no significant differences. The biomechanical tests, which were carried out using a Universal Testing Machine, revealed that an increase in adhesion strength with time. At 6 weeks after surgery, group 1 exhibited an adhesion strength that was 2.5-3 times greater than that exhibited by groups 2 and 3. Group 2 had a higher adhesion strength than group 3, but this difference was not statistically significant. Conclusion : Increases in granulation tissue and fibrosis during the healing of sutured tendons were observed, and the tested polylactide resorbable film was found to be effective in reducing the level of adhesion formation after tendon repair.

Fractures of metacarpal and phalangeal shafts treated by mini encircling fixator of TiNi shape memory alloy

目的 探讨微型钛镍形状记忆合金环抱器在掌、指骨骨折治疗中的临床应用价值.方法从2000年3月～2003年6月,我们采用微型钛镍形状记忆合金环抱器切开复位内固定治疗掌、指骨骨折18例,其中掌骨22个,指骨6个.术后早期自主功能锻炼.结果所有患者随访4～25个月,均达到骨性愈合,平均6.3周(5～10周),无感染,无骨折再移位,手功能恢复满意.结论微型钛镍形状记忆合金环抱器有其独特的生物力学和材料力学特点,应用于掌指骨骨干骨折的治疗,能获得稳定的内固定,允许手早期的伸屈功能锻炼,有效预防肌腱粘连、关节僵硬,有很高的临床应用价值。

In vivo gene transfer and overexpression of focal adhesion kinase (pp125 FAK) mediated by recombinant adenovirus-induced tendon adhesion formation and epitenon cell change.

Adhesion formation is a frequent complication of tendon injury repair: however, little is known about its mechanisms. The intracellular focal adhesion kinase (FAK)-related signaling pathway may be one of the mechanisms involved in the induction of tendon adhesions. The replication deficient adenovirus containing the FAK gene (pp125 FAK) was constructed and named Adv-Fak. By in vitro transductions with the recombinant virus, overexpression of the FAK protein was documented in transduced cultured primary tendon cells. By in vivo direct injection of Adv-FAK into the space between the tendon and tendon sheath of White Leghorn chickens, FAK gene transfer with overexpression of the FAK protein was detected by immunohistological staining. The morphology of these stained cells changed from the normal flat shape to cuboid. The group with overexpressed adenovirus-mediated FAK had significant adhesion formation, as seen by increased work of flexion (118.197 +/- 29.616), compared with the group with overexpressed adenovirus-mediated beta-galactosidase (67.507 +/- 36.066) (p < 0.0393) and the group with adenovirus-mediated FAK antisense gene transfer (60.357 +/- 48.562) (p < 0.0211). Histological examination of the samples from tendons with Adv-FAK showed fibers between the tendon and tendon sheath; there were no fibers in the cavities of samples of injured tendons infected with Adv-beta gal. Moreover, at the application site of the former tendons, a thick fiber layer without epitenon cells was built up on the outer surface, whereas a thin fiber layer with clear epitenon cells was observed in the tendons to which Adv-beta gal was applied. Our results show that overexpression of FAK can induce tendon adhesion formation in vivo. This indicates that FAK and the FAK-related signaling pathway may be involved in the process of tendon adhesion formation. Understanding the details of this process may help to prevent tendon adhesion and improve healing.