title: Surface treatment of flexor tendon autografts with carbodiimide-derivatized hyaluronic Acid. An in vivo canine model.
abstract: BACKGROUND
  Clinical and experimental studies have demonstrated that restrictive adhesions and poor digital motion are common complications after extrasynovial tendon grafting in an intrasynovial environment. The purpose of this study was to test the hypothesis that surface modification of an extrasynovial tendon with use of a carbodiimide-derivatized hyaluronic acid-gelatin polymer (cd-HA) improves gliding ability and digital function after tendon grafting in a canine model in vivo.
  
  
  METHODS
  The peroneus longus tendons from both hindpaws of twenty-four dogs were harvested and transplanted to replace the flexor digitorum profundus tendons in the second and fifth digits of one forepaw. Prior to grafting, one of the peroneus longus tendons was coated with cd-HA, which consists of 1% hyaluronic acid, 10% gelatin, 0.25% 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC), and 0.25% N-hydroxysuccinimide (NHS), while the other was immersed in saline solution only. Eight dogs were killed at one, three, and six weeks. Digital normalized work of flexion, tendon gliding resistance, and hyaluronic acid quantification (with the hyaluronic acid-binding-protein staining technique) were the outcome measures.
  
  
  RESULTS
  The normalized work of flexion of the tendons treated with cd-HA was significantly lower than that of the saline-solution-treated controls at each time-point (p < 0.05). The gliding resistance of the cd-HA group was significantly lower than that of the saline-solution group at three and six weeks (p < 0.05). The ratio between the intensity of staining of the cd-HA-treated tendons with that of the saline-solution-treated controls was significantly greater at time-0 than at three or six weeks (p < 0.05), but there was no significant difference between time-0 and one-week values.
  
  
  CONCLUSIONS
  Treating the surface of an extrasynovial tendon autograft with a carbodiimide-derivatized hyaluronic acid-gelatin polymer decreases digital work of flexion and tendon gliding resistance in this flexor tendon graft model in vivo.
  
  
  CONCLUSIONS
  cd-HA gelatin may provide surgeons with a new and useful method to improve the quality of tendon graft surgery.
authors.affiliation: Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. zhaoc@mayo.edu
authors.forename: Chunfeng
authors.initials: C
authors.lastname: Zhao
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: Sun
authors.forename: Peter C
authors.initials: PC
authors.lastname: Amadio
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Anke M
authors.initials: AM
authors.lastname: Ettema
authors.forename: Kai-Nan
authors.initials: KN
authors.lastname: An
mesh_terms: D000818:Animals; D004285:Dogs; D005022:Ethyldimethylaminopropyl Carbodiimide; D005552:Forelimb; D006614:Hindlimb; D006820:Hyaluronic Acid; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000637:transplantation*; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control; D046509:Tissue Culture Techniques; D016378:Tissue Transplantation / Q000009:adverse effects / Q000379:methods*; D014034:Toes / Q000503:physiopathology; D014182:Transplantation, Autologous
chemical_list: D006820:Hyaluronic Acid; D005022:Ethyldimethylaminopropyl Carbodiimide