The effects of biological lubricating molecules on flexor tendon reconstruction in a canine allograft model in vivo.
BACKGROUND
Using allograft is an attractive alternative for flexor tendon reconstruction because of the lack of donor-site morbidity, and better matching to the intrasynovial environment. The purpose of this study was to use biological lubricant molecules to modify the graft surface to decrease adhesions and improve digit function.


METHODS
Twenty-eight flexor digitorum profundus tendons from the second and fifth digits of 14 dogs were lacerated and repaired to create a model with repair failure and scar digit for tendon reconstruction. Six weeks after the initial operation, the tendons were reconstructed with flexor digitorum profundus allograft tendons obtained from canine cadavers. One graft tendon in each dog was treated with saline as a control and the other was treated with carbodiimide-derivatized hyaluronic acid and gelatin plus lubricin. Six weeks postoperatively, digit function, graft mechanics, and biology were analyzed.


RESULTS
Allograft tendons treated with carbodiimide-derivatized hyaluronic acid-lubricin had decreased adhesions at the proximal tendon/graft repair and within the flexor sheath, improved digit function, and increased graft gliding ability. The treatment also reduced the strength at the distal tendon-to-bone repair, but the distal attachment rupture rate was similar for both graft types. Histologic evaluation showed that viable cells migrated to the allograft, but these were limited to the tendon surface.


CONCLUSIONS
Carbodiimide-derivatized hyaluronic acid-lubricin treatment of tendon allograft improves digit functional outcomes after flexor tendon reconstruction. However, delayed bone-to-tendon healing should be a caution. Furthermore, the cell infiltration into the allograft tendon substance should be a target for future studies, to shorten the allograft self-regeneration period.
Rochester, Minn.; and Providence, R.I. From the Biomechanics & Tendon and Soft Tissue Biology Laboratories, Mayo Clinic; and Brown University.
Chunfeng
C
Zhao
Zhuang
Z
Wei
Ramona L
RL
Reisdorf
Andrew R
AR
Thoreson
Gregory D
GD
Jay
Steven L
SL
Moran
Kai-Nan
KN
An
Peter C
PC
Amadio
D000818:Animals; D002234:Carbodiimides / Q000494:pharmacology; D004285:Dogs; D005552:Forelimb / Q000601:surgery; D005780:Gelatin / Q000494:pharmacology; D006023:Glycoproteins / Q000494:pharmacology*; D006820:Hyaluronic Acid / Q000494:pharmacology*; D022125:Lacerations / Q000601:surgery; D023421:Models, Animal; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function / Q000187:drug effects; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000601:surgery / Q000637:transplantation*; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control*; D014184:Transplantation, Homologous; D014945:Wound Healing / Q000187:drug effects; D000099158:Proteoglycan 4
D002234:Carbodiimides; D005780:Gelatin; D006023:Glycoproteins; D006820:Hyaluronic Acid; D000099158:Proteoglycan 4