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Pang S, Wu R, Lv W, Zou J, Li Y, Li Y, Zhang P, Ma X, Wang Y, Liu S. Use of a pH-responsive imatinib mesylate sustained-release hydrogel for the treatment of tendon adhesion by inhibiting PDGFRβ/CLDN1 pathway. Bioact Mater 2024; 38:124-136. [PMID: 38699245 PMCID: PMC11063598 DOI: 10.1016/j.bioactmat.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024] Open
Abstract
Adhesion after tendon injury, which can result in limb movement disorders, is a common clinical complication; however, effective treatment methods are lacking. Hyaluronic acid hydrogels are a new biomedical material used to prevent tendon adhesion owing to their good biocompatibility. In addition, potential drugs that inhibit adhesion formation have gradually been discovered. The anti-adhesion effects of a combination of loaded drugs into hydrogels have become an emerging trend. However, current drug delivery systems usually lack specific regulation of drug release, and the effectiveness of drugs for treating tendon adhesions is mostly flawed. In this study, we identified a new drug, imatinib mesylate (IM), that prevents tendon adhesion and explored its related molecular pathways. In addition, we designed a pH-responsive sustained-release hydrogel for delivery. Using the metal-organic framework ZIF-8 as a drug carrier, we achieved controlled drug release to increase the effective drug dose at the peak of adhesion formation to achieve better therapeutic effects. The results showed that IM blocked the formation of peritendon adhesions by inhibiting the PDGFRβ/ERK/STAT3/CLDN1 pathway. Furthermore, the hydrogel with ZIF-8 exhibited better physical properties and drug release curves than the hydrogel loaded only with drugs, showing better prevention and treatment effects on tendon adhesion.
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Affiliation(s)
- Sa Pang
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Rd, Shanghai, 200233, PR China
| | - Rongpu Wu
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Rd, Shanghai, 200233, PR China
| | - Wenxin Lv
- Center for Advanced Low-dimension Materials, State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry and Chemical Engineering, Donghua University, Shanghai, 201620, PR China
| | - Jian Zou
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Rd, Shanghai, 200233, PR China
| | - Yuange Li
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Rd, Shanghai, 200233, PR China
| | - Yanhao Li
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Rd, Shanghai, 200233, PR China
| | - Peilin Zhang
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Rd, Shanghai, 200233, PR China
| | - Xin Ma
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Rd, Shanghai, 200233, PR China
| | - Yi Wang
- Center for Advanced Low-dimension Materials, State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry and Chemical Engineering, Donghua University, Shanghai, 201620, PR China
| | - Shen Liu
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Rd, Shanghai, 200233, PR China
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Xie X, Xu J, Ding D, Lin J, Han K, Wang C, Wang F, Zhao J, Wang L. Janus Membranes Patch Achieves High-Quality Tendon Repair: Inhibiting Exogenous Healing and Promoting Endogenous Healing. NANO LETTERS 2024; 24:4300-4309. [PMID: 38534038 DOI: 10.1021/acs.nanolett.4c00818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
The imbalance between endogenous and exogenous healing is the fundamental reason for the poor tendon healing. In this study, a Janus patch was developed to promote endogenous healing and inhibit exogenous healing, leading to improved tendon repair. The upper layer of the patch is a poly(dl-lactide-co-glycolide)/polycaprolactone (PLGA/PCL) nanomembrane (PMCP-NM) modified with poly(2-methylacryloxyethyl phosphocholine) (PMPC), which created a lubricated and antifouling surface, preventing cell invasion and mechanical activation. The lower layer is a PLGA/PCL fiber membrane loaded with fibrin (Fb) (Fb-NM), serving as a temporary chemotactic scaffold to regulate the regenerative microenvironment. In vitro, the Janus patch effectively reduced 92.41% cell adhesion and 79.89% motion friction. In vivo, the patch inhibited tendon adhesion through the TGF-β/Smad signaling pathway and promoted tendon maturation. This Janus patch is expected to provide a practical basis and theoretical guidance for high-quality soft tissue repair.
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Affiliation(s)
- Xiaojing Xie
- Key Laboratory of Textile Science & Technology of Ministry of Education College of Textiles, Donghua University, Shanghai 201620, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Danzhi Ding
- Key Laboratory of Textile Science & Technology of Ministry of Education College of Textiles, Donghua University, Shanghai 201620, China
| | - Jing Lin
- Key Laboratory of Textile Science & Technology of Ministry of Education College of Textiles, Donghua University, Shanghai 201620, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Chaorong Wang
- Shanghai Frontier Science Research Center for Advanced Textiles, College of Textiles, Donghua University, Shanghai 201620, China
| | - Fujun Wang
- Shanghai Frontier Science Research Center for Advanced Textiles, College of Textiles, Donghua University, Shanghai 201620, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology of Ministry of Education College of Textiles, Donghua University, Shanghai 201620, China
- Shanghai Frontier Science Research Center for Advanced Textiles, College of Textiles, Donghua University, Shanghai 201620, China
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Liu Z, Zhou H, Li P, Wang Z, Tu T, Ezzi SHA, Kota VG, Hasan Abdulla MHA, Alhaskawi A, Dong Y, Huang Y, Dong M, Su X, Lu H. Fibroblast Activation Protein-Targeted PET/CT With Al 18F-NODA-FAPI-04 for In Vivo Imaging of Tendon Healing in Rat Achilles Tendon Injury Models. Am J Sports Med 2023; 51:3790-3801. [PMID: 37975494 DOI: 10.1177/03635465231208843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Fibroblast activation protein (FAP) has shown high expression in inflammatory responses and fibrosis. HYPOTHESIS We speculated that FAP could serve as a diagnostic and monitoring target in the tendon healing process. STUDY DESIGN Controlled laboratory study. METHODS A total of 72 Sprague-Dawley rats were randomly divided into a tendon crush group and a half-partial tendon laceration group. Four rats in each group were injected with radiotracers weekly for 4 weeks after surgery, with aluminum fluoride-labeled 1,4,7-triazacyclononane-N,N',N″-triacetic acid-conjugated FAP inhibitor (Al18F-NODA-FAPI-04) administered on the first day of each week and 18F-fludeoxyglucose (18F-FDG) on the next day. Small animal positron emission tomography (PET) imaging was performed, and tendon tissue was collected for pathology and quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis each week after surgery. RESULTS One week after surgery, both radiotracers showed signal concentration at the lesion site, which was the highest radioactive uptake observed during 4 weeks postoperatively, consistent with the severity of the lesion. Consistent trends were observed for inflammatory cytokines during qRT-PCR analysis. Additionally, Al18F-NODA-FAPI-04 PET exhibited a more precise lesion pattern, attributed to its high specificity for naive fibroblasts when referring to histological findings. Over time, the uptake of both radiotracers at the injury site gradually decreased, with 18F-FDG experiencing a more rapid decrease than Al18F-NODA-FAPI-04. In the fourth week after surgery, the maximum standardized uptake values of Al18F-NODA-FAPI-04 in the injured lesion almost reverted to the baseline levels, indicating a substantial decrease in naive fibroblasts and inflammatory cells and a reduction in inflammation and fibrosis, especially compared with the first week. Corresponding trends were also revealed in pathological and qRT-PCR results. CONCLUSION Our findings suggest that inflammation is a prominent feature during the early stage of tendon injury. Al18F-NODA-FAPI-04 PET allows accurate localization and provides detailed morphological imaging, enabling continuous monitoring of the healing progress and assessment of injury severity.
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Affiliation(s)
- Zhenfeng Liu
- PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, MMed Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Pengfei Li
- Department of Plastic and Aesthetic Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Zewei Wang
- Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Tian Tu
- Department of Plastic and Aesthetic Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Sohaib Hasan Abdullah Ezzi
- Department of Orthopaedics of the 3rd Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Vishnu Goutham Kota
- Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Mohamed Hasan Abdulla Hasan Abdulla
- Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Yuqiao Huang
- Institute of Translational Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Mengjie Dong
- PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Xinhui Su
- PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
- Investigation performed at The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou, ZheJiang Province, China PR
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Chen S, Cai D, Dong Q, Ma G, Xu C, Bao X, Yuan W, Wu B, Fang B. Silver nanoparticles-decorated extracellular matrix graft: fabrication and tendon reconstruction performance. Biomater Res 2023; 27:85. [PMID: 37710328 PMCID: PMC10503197 DOI: 10.1186/s40824-023-00428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The reconstruction of tendons with large defects requires grafts with high mechanical strength and is often hindered by complications such as infection and adhesion. Hence, grafts combining the advantages of mechanical resilience and antibacterial/antiadhesion activity are highly sought after. METHODS The silver nanoparticles (GA-Ag NPs) synthesized from gallic acid and silver nitrate were attached to a decellularized extracellular matrix (Decellularized Tendon crosslinking GA-AgNPs, DT-Ag). We examined the histological structure, mechanical property, morphology, Zeta potential, cytotoxicity, antibacterial properties, antioxidant and anti-inflammatory properties, and ability of the DT-Ag to treat tendon defects in animals. RESULTS Approximately 108.57 ± 0.94 μg GA-Ag NPs loaded per 50 mg DT, the cross-linked part of GA-Ag NPs was 65.47 ± 0.57%, which provided DT-Ag with long-lasting antibacterial activity. Meanwhile, GA endowed DT-Ag with good antioxidant and anti-inflammatory activities. Additionally, The DT-Ag facilitated M2 macrophage polarization, and suppressed fibrin deposition by hindering fibroblast adhesion. Mormore, the main advantages of DT-Ag, namely its long-lasting antibacterial activity (tested using Escherichia coli and Staphylococcus aureus as models) and the ability to prevent tissue adhesion were confirmed in vivo. CONCLUSION The fabricated multifunctional tendon graft was highly hydrophilic, biocompatible, and mechanically resilient, and concluded to be well suited for dealing with the main complications of surgical tendon reconstruction and has bright application prospects.
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Affiliation(s)
- Sunfang Chen
- Department of Orthopedics, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310000, China
- Department of Orthopedics, the Central Hospital Affiliated to Shaoxing University, Shaoxing, 312030, China
| | - Dan Cai
- Department of Orthopedics, the First People's Hospital of Huzhou, First Affiliated Hospital of Huzhou University, Huzhou, 313000, China
| | - Qi Dong
- Department of Orthopedics, Honghui Hospital, Xi'an Jiao Tong University, Xi'an City, 710054, China
| | - Gaoxiang Ma
- Department of Orthopedics, the Central Hospital Affiliated to Shaoxing University, Shaoxing, 312030, China
| | - Chennan Xu
- Department of Orthopedics, the Central Hospital Affiliated to Shaoxing University, Shaoxing, 312030, China
| | - Xiaogang Bao
- Department of Orthopedics, The Spine Surgical Center, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Wei Yuan
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China.
| | - Bing Wu
- Department of Orthopedics, the Central Hospital Affiliated to Shaoxing University, Shaoxing, 312030, China.
| | - Bin Fang
- Department of Orthopedics, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310000, China.
- Department of Orthopedics, the Central Hospital Affiliated to Shaoxing University, Shaoxing, 312030, China.
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Use of Silicone Tubes as Antiadhesion Devices in a Modified Two-Stage Flexor Tendon Reconstruction in Zone II: A Retrospective Study. J Hand Surg Am 2023; 48:444-451. [PMID: 36863927 DOI: 10.1016/j.jhsa.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/17/2022] [Accepted: 01/04/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE This study aimed to assess the outcome of a modified two-stage flexor tendon reconstruction using silicone tubes as antiadhesion devices while performing simultaneous tendon grafting. METHODS From April 2008 to October 2019, 16 patients (21 fingers) with zone II flexor tendon injuries, who sustained failed tendon repair or neglected tendon laceration, were treated by a modified two-stage flexor tendon reconstruction. The first stage of treatment comprised flexor tendon reconstruction with interposition of silicone tubes to minimize fibrosis and adhesion around the tendon graft; the second stage of treatment comprised silicone tube removal under local anesthesia. RESULTS The patient median age was 38 (range, 22-65) years. After a median follow-up period of 14 (range, 12-84) months, the median total active motion (TAM) of fingers was 220° (range, 150-250°). Excellent and good TAM ratings were identified in 71.4%, 76.2%, and 76.2% according to the Strickland, modified Strickland, and American Society for Surgery of the Hand (ASSH) evaluation systems, respectively. At follow-up, complications included superficial infections in two fingers of one patient whose silicone tube was removed 4 weeks postoperatively. The most common complication was a flexion deformity of the proximal interphalangeal joint (four fingers) and/or distal interphalangeal joint (nine fingers). The rate of failed reconstruction was higher in patients with preoperative stiffness and infection. CONCLUSIONS Silicone tubes are suitable antiadhesion devices, and the modified two-stage flexor tendon reconstruction technique is an alternative procedure with a shorter rehabilitation period for complicated flexor tendon injury, compared with current popular reconstructions. Preoperative stiffness and postoperative infection may compromise the final clinical outcome. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Murray E, Challoumas D, Putti A, Millar N. Effectiveness of Sodium Hyaluronate and ADCON-T/N for the Prevention of Adhesions in Hand Flexor Tendon Surgery: A Systematic Review and Meta-Analysis. J Hand Surg Am 2022; 47:896.e1-896.e20. [PMID: 34509314 DOI: 10.1016/j.jhsa.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/04/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE A common complication after digital flexor tendon repair in the hand is postoperative adhesions that can cause loss of motion and compromise hand function. The aim of this review of relevant published literature was to assess the effectiveness of locally administered sodium hyaluronate or ADCON-T/N for the prevention of adhesions after hand flexor tendon repair. METHODS A literature search was conducted in June 2020 in multiple databases for randomized controlled trials . Our primary outcome was measurement of active finger motion. Follow-up was defined as short-term (< 12 weeks), mid-term (12 weeks to 6 months) and long-term (> 6 months). Mean differences (MD) and standardized mean differences (SMD) of total active motion (TAM) of the interphalangeal joints (IPJs) and active motion of the IPJs separately were calculated where results were meta-analyzed. RESULTS Six randomized controlled trials were included. For ADCON-T/N, no benefits were detected for TAM of the IPJs (MD 1.71 [-21.54, 24.96]) or active motion of the IPJs separately (proximal: MD 4.77 [-4.47, 14]; distal: MD 1.17 [-10.33, 12.66]) in the short-/mid-term. The mid-term benefit in TAM of sodium hyaluronate over standard care (placebo/no treatment) did not reach statistical significance (SMD 0.31 [0, 0.63]); however, a subgroup comparison of repeated administration of sodium hyaluronate versus standard care was both statistically and clinically significant (SMD 0.55 [0.11, 0.98]). CONCLUSIONS Repeated administration of sodium hyaluronate at the tendon repair site may be effective in improving postoperative active finger motion after primary hand flexor tendon repair in the mid-term. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Elspeth Murray
- Department of Trauma & Orthopaedic Surgery, Wishaw General Hospital, Wishaw
| | - Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow; Department of Trauma & Orthopaedic Surgery, Ayr University Hospital, Ayr.
| | - Amit Putti
- Department of Trauma & Orthopaedic Surgery, Forth Valley Royal Hospital, Larbert, UK
| | - Neal Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow
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Advances in the Development of Anti-Adhesive Biomaterials for Tendon Repair Treatment. Tissue Eng Regen Med 2020; 18:1-14. [PMID: 33150560 PMCID: PMC7862451 DOI: 10.1007/s13770-020-00300-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Peritendinous adhesion that simultaneous with tendon healing link the healing tendon to the surrounding tissue. It results in functional disability, and has a significant adverse impact on health as well as social and economic development. Methods: Based on a search in the PubMed and Web of Science database, the research articles were screened by their time, main idea, impact factor index, while the ones with no credibility were excluded. Afterwards, we go through the analysis of the reliability and characteristics of the results were further screened from selected articles. Results: A total of 17 biomaterials used to evaluate the adhesion mechanism and the properties of the material were found. All of these biomaterials contained randomized controlled studies and detailed descriptions of surgical treatment that support the reliability of their results which indicates that biomaterials act as barriers to prevent the formation of adhesion, and most of them exhibit satisfactory biocompatibility, biodegradability or selective permeability. Moreover, a few had certain mechanical strength, anti-inflammatory, or carrier capacities. However, there still existed some defects, such as time, technology, clinical trials, material targeting and different measurement standards which also lowered the reliability of their results. Conclusion: In future, anti-adhesion biomaterials should focus on affordable raw materials with wide sources, and the production process should be simplified, in this way, the versatility and targeting of materials will be improved.
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Iwanaga Y, Morizaki Y, Uehara K, Tanaka S, Sakai T, Saito T. Robust Suture Combination for Rat Flexor Tendon Repair Model. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:354-358. [PMID: 35415525 PMCID: PMC8991537 DOI: 10.1016/j.jhsg.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose We aimed to develop a rat flexor tendon repair model that could be applied to experiments in similar clinical settings. Methods We prepared 3 different combinations of sutures in rat flexor tendons: group A had 3 single peripheral sutures plus a 2-strand core suture; group B had 3 figure-of-eight peripheral sutures alone; and group C had 3 figure-of-eight peripheral sutures plus a 2-strand core suture. We examined the in vitro tensile strength of the repaired tendons by a biomechanical test, the rerupture rate within 3 weeks, and histological findings in vivo. Results Group C displayed the greatest ultimate strength by the mechanical test. The flexor tendons in group C did not rerupture within 3 weeks after surgery, whereas many of those in groups A and B reruptured. Fibrous scar tissue was observed in the gap of the tendon stumps in groups A and B, but not in group C. Conclusions The combination of figure-of-eight peripheral sutures and a 2-strand core suture provided the repaired rat flexor tendon with enough strength to prevent rerupture without cast fixation or immobilization after surgery. Clinical relevance This combination of sutures is useful to reproduce flexor tendon repair similar to that performed in clinical settings and will contribute to various translational experiments in vivo.
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Alimohammadi M, Aghli Y, Fakhraei O, Moradi A, Passandideh-Fard M, Ebrahimzadeh MH, Khademhosseini A, Tamayol A, Mousavi Shaegh SA. Electrospun Nanofibrous Membranes for Preventing Tendon Adhesion. ACS Biomater Sci Eng 2020; 6:4356-4376. [PMID: 33455173 DOI: 10.1021/acsbiomaterials.0c00201] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tendon injuries are frequent, and surgical interventions toward their treatment might result in significant clinical complications. Pretendinous adhesion results in the disruption of the normal gliding mechanism of a damaged tendon, painful movements, and an increased chance of rerupture in the future. To alleviate postsurgical tendon-sheath adhesions, many investigations have been directed toward the development of repair approaches using electrospun nanofiber scaffolds. Such methods mainly take advantage of nanofibrous membranes (NFMs) as physical barriers to prevent or minimize adhesion of a repaired tendon to its surrounding sheath. In addition, these nanofibers can also locally deliver antiadhesion and anti-inflammatory agents to reduce the risk of tendon adhesion. This article reviews recent advances in the design, fabrication, and characterization of nanofibrous membranes developed to serve as (i) biomimetic tendon sheaths and (ii) physical barriers. Various features of the membranes are discussed to present insights for further development of repair methods suitable for clinical practice.
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Affiliation(s)
- Mahdieh Alimohammadi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Mechanical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Yasaman Aghli
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,LadHyx, École Polytechnique, Palaiseau, France
| | - Omid Fakhraei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Ali Khademhosseini
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California 90095, United States of America.,Center for Minimally invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, California 90095, United States of America.,Department of Radiology, University of California-Los Angeles, Los Angeles, California 90095, United States of America.,Department of Chemical and Biomolecular Engineering, University of California-Los Angeles, Los Angeles, California 90095, United States of America.,Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States of America
| | - Ali Tamayol
- University of Connecticut Health Center, Farmington, Connecticut 06030, United States of America
| | - Seyed Ali Mousavi Shaegh
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
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10
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Kikuchi K, Setoyama K, Takada S, Otsuka S, Nakanishi K, Norimatsu K, Tani A, Sakakima H, Kawahara KI, Hosokawa K, Kiyama R, Sumizono M, Tancharoen S, Maruyama I, Hattori G, Morioka M, Tanaka E, Uchikado H. E8002 Inhibits Peripheral Nerve Adhesion by Enhancing Fibrinolysis of l-Ascorbic Acid in a Rat Sciatic Nerve Model. Int J Mol Sci 2020; 21:ijms21113972. [PMID: 32492845 PMCID: PMC7313081 DOI: 10.3390/ijms21113972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/12/2020] [Accepted: 05/31/2020] [Indexed: 12/23/2022] Open
Abstract
Perineural adhesions leading to neuropathy are one of the most undesirable consequences of peripheral nerve surgery. However, there are currently no widely used compounds with anti-adhesive effects in the field of peripheral nerve surgery. E8002 is a novel, anti-adhesive, multi-layer membrane that contains L-ascorbic acid (AA). Here, we investigated the effect and mechanism of E8002 in a rat sciatic nerve adhesion model. A total of 21 rats were used. Six weeks after surgery, macroscopic adhesion scores were significantly lower in the E8002 group (adhesion procedure followed by nerve wrapping with E8002) compared to the E8002 AA(−) group (adhesion procedure followed by nerve wrapping with the E8002 membrane excluding AA) and adhesion group (adhesion procedure but no treatment). Correspondingly, a microscopic examination revealed prominent scar tissue in the E8002 AA(−) and adhesion groups. Furthermore, an in vitro study using human blood samples showed that AA enhanced tissue-type, plasminogen activator-mediated fibrinolysis. Altogether, these results suggest that E8002 may exert an anti-adhesive action via AA and the regulation of fibrinolysis.
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Affiliation(s)
- Kiyoshi Kikuchi
- Division of Brain Science, Department of Physiology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan;
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan; (G.H.); (M.M.)
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima 890-8520, Japan; (S.T.); (S.O.); (K.-i.K.); (I.M.)
- Department of Pharmacology, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand;
| | - Kentaro Setoyama
- Natural Science Center for Research and Education, Division of Laboratory Animal Science, Kagoshima University, Kagoshima 890-8520, Japan;
| | - Seiya Takada
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima 890-8520, Japan; (S.T.); (S.O.); (K.-i.K.); (I.M.)
| | - Shotaro Otsuka
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima 890-8520, Japan; (S.T.); (S.O.); (K.-i.K.); (I.M.)
| | - Kazuki Nakanishi
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (H.S.); (R.K.)
| | - Kosuke Norimatsu
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (H.S.); (R.K.)
| | - Akira Tani
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (H.S.); (R.K.)
| | - Harutoshi Sakakima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (H.S.); (R.K.)
| | - Ko-ichi Kawahara
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima 890-8520, Japan; (S.T.); (S.O.); (K.-i.K.); (I.M.)
- Laboratory of Functional Foods, Department of Biomedical Engineering, Osaka Institute of Technology, Osaka 535-8585, Japan
| | - Kazuya Hosokawa
- Research Institute, Fujimori Kogyo Co., Ltd., 1-10-1 Sachiura, Kanazawa-ku, Yokohama, Kanagawa 236-0003, Japan;
| | - Ryoji Kiyama
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (H.S.); (R.K.)
| | - Megumi Sumizono
- Department of Rehabilitation, Faculty of Nursing and Welfare, Kyushu University of Nursing and Social Welfare, Tamana, Kumamoto 865-0062, Japan;
| | - Salunya Tancharoen
- Department of Pharmacology, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand;
| | - Ikuro Maruyama
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima 890-8520, Japan; (S.T.); (S.O.); (K.-i.K.); (I.M.)
| | - Gohsuke Hattori
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan; (G.H.); (M.M.)
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan; (G.H.); (M.M.)
| | - Eiichiro Tanaka
- Division of Brain Science, Department of Physiology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan;
- Correspondence: (E.T.); (H.U.); Tel.: +81-942-31-7542 (E.T.); +81-92-477-2355 (H.U.); Fax: +81-942-31-7695 (E.T.); +81-92-477-2325 (H.U.)
| | - Hisaaki Uchikado
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan; (G.H.); (M.M.)
- Uchikado Neuro-Spine Clinic, Fukuoka 812-0893, Japan
- Correspondence: (E.T.); (H.U.); Tel.: +81-942-31-7542 (E.T.); +81-92-477-2355 (H.U.); Fax: +81-942-31-7695 (E.T.); +81-92-477-2325 (H.U.)
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11
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Meier Bürgisser G, Evrova O, Calcagni M, Scalera C, Giovanoli P, Buschmann J. Impact of PDGF-BB on cellular distribution and extracellular matrix in the healing rabbit Achilles tendon three weeks post-operation. FEBS Open Bio 2020; 10:327-337. [PMID: 31571428 PMCID: PMC7050259 DOI: 10.1002/2211-5463.12736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 09/12/2019] [Accepted: 09/27/2019] [Indexed: 01/14/2023] Open
Abstract
Current methods for tendon rupture repair suffer from two main drawbacks: insufficient strength and adhesion formation, which lead to rerupture and impaired gliding. A novel polymer tube may help to overcome these problems by allowing growth factor delivery to the wound site and adhesion reduction, and by acting as a physical barrier to the surrounding tissue. In this study, we used a bilayered DegraPol® tube to deliver PDGF-BB to the wound site in a full-transection rabbit Achilles tendon model. We then performed histological and immunohistochemical analysis at 3 weeks postoperation. Sustained delivery of PDGF-BB to the healing Achilles tendon led to a significantly more homogenous cell distribution within the healing tissue. Lower cell densities next to the implant material were determined for +PDGF-BB samples compared to -PDGF-BB. PDGF-BB application increased proteoglycan content and reduced alpha-SMA+ areas, clusters of different sizes, mainly vessels. Finally, PDGF-BB reduced collagens I and III in the extracellular matrix. The sustained delivery of PDGF-BB via an electrospun DegraPol® tube accelerated tendon wound healing by causing a more uniform cell distribution with higher proteoglycan content and less fibrotic tissue. Moreover, the application of this growth factor reduced collagen III and alpha-SMA, indicating a faster and less fibrotic tendon healing.
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Affiliation(s)
| | - Olivera Evrova
- Division of Plastic Surgery and Hand SurgeryUniversity Hospital ZurichSwitzerland
- Laboratory of Applied MechanobiologyETH ZürichSwitzerland
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand SurgeryUniversity Hospital ZurichSwitzerland
| | | | - Pietro Giovanoli
- Division of Plastic Surgery and Hand SurgeryUniversity Hospital ZurichSwitzerland
| | - Johanna Buschmann
- Division of Plastic Surgery and Hand SurgeryUniversity Hospital ZurichSwitzerland
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12
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Capella-Monsonís H, Kelly J, Kearns S, Zeugolis DI. Decellularised porcine peritoneum as a tendon protector sheet. Biomed Mater 2019; 14:044102. [DOI: 10.1088/1748-605x/ab2301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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Capella-Monsonís H, Kearns S, Kelly J, Zeugolis DI. Battling adhesions: from understanding to prevention. BMC Biomed Eng 2019; 1:5. [PMID: 32903353 PMCID: PMC7412649 DOI: 10.1186/s42490-019-0005-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/20/2019] [Indexed: 12/28/2022] Open
Abstract
Adhesions represent a major burden in clinical practice, particularly following abdominal, intrauterine, pericardial and tendon surgical procedures. Adhesions are initiated by a disruption in the epithelial or mesothelial layer of tissue, which leads to fibrin adhesion sites due to the downregulation of fibrinolytic activity and an increase in fibrin deposition. Hence, the metabolic events involved in tissue healing, coagulation, inflammation, fibrinolysis and angiogenesis play a pivotal role in adhesion formation. Understanding these events, their interactions and their influence on the development of post-surgical adhesion is crucial for the development of effective therapies to prevent them. Mechanical barriers, antiadhesive agents and combination thereof are customarily used in the battle against adhesions. Although these systems seem to be effective at reducing adhesions in clinical procedures, their prevention remains still elusive, imposing the need for new antiadhesive strategies.
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Affiliation(s)
- Héctor Capella-Monsonís
- Regenerative, Modular and Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
| | | | - Jack Kelly
- University Hospital Galway, Galway, Ireland
| | - Dimitrios I. Zeugolis
- Regenerative, Modular and Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
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14
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Hsu SH, Dai LG, Hung YM, Dai NT. Evaluation and characterization of waterborne biodegradable polyurethane films for the prevention of tendon postoperative adhesion. Int J Nanomedicine 2018; 13:5485-5497. [PMID: 30271142 PMCID: PMC6149831 DOI: 10.2147/ijn.s169825] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Tendon adhesion is a serious problem and it affects tendon gliding and joint motion. Although recent studies have yielded promising results in developing anti-adhesion materials, there are still many problems. Polycaprolactone (PCL)-based polyurethane (PU) has good mechanical properties and biocompatibility, and it has a potential in anti-adhesion applications. MATERIALS AND METHODS In this study, a series of waterborne biodegradable polyurethane (WBPU) films with different ratios of ionic groups were synthesized. In order to select an effective anti-adhesion film, the WBPU films were cast and characterized for physicochemical properties and biocompatibility. RESULTS All WBPU films were non-cytotoxic in the cell viability test and had suitable physicochemical and mechanical properties based on the measurement of zeta potential, water contact angle, mechanical properties, water absorption, thickness change, and gelatin test. To evaluate the anti-adhesion effect, severely injured tendons of rabbits were sutured with the modified Kessler core suture technique and WBPU films were then wrapped around the tendon. Implantation in rabbits showed that the WBPU film had better anti-adhesion effect than PCL films and the untreated control, and demonstrated no significant difference in the anti-adhesion performance from the commercial product Seprafilm based on gross evaluation, histological analysis, and biomechanical assessment. CONCLUSION Compared to Seprafilm and PCL applied in the tendon anti-adhesion, WBPU had better mechanical properties, low inflammatory reaction, and a proper degradation interval.
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Affiliation(s)
- Shan-Hui Hsu
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Lien-Guo Dai
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Yu-Min Hung
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China,
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15
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Meier Bürgisser G, Calcagni M, Bachmann E, Fessel G, Snedeker JG, Giovanoli P, Buschmann J. Rabbit Achilles tendon full transection model - wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery. Biol Open 2016; 5:1324-33. [PMID: 27635037 PMCID: PMC5051656 DOI: 10.1242/bio.020644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization), or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization), while in the other groups (3 and 12 weeks) a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011), and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points). Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand. Summary: The rabbit Achilles tendon full transection model can be used to study adhesion extent in a controlled way. It also mimics the biomechanics of human hand flexor tendons.
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Affiliation(s)
- Gabriella Meier Bürgisser
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Elias Bachmann
- Uniklinik Balgrist, Department of Orthopedics, Forchstrasse 340, Zurich 8008, Switzerland
| | - Gion Fessel
- Uniklinik Balgrist, Department of Orthopedics, Forchstrasse 340, Zurich 8008, Switzerland
| | - Jess G Snedeker
- Uniklinik Balgrist, Department of Orthopedics, Forchstrasse 340, Zurich 8008, Switzerland Laboratory for Orthopaedic Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ), Rämistrasse 101, Zurich CH-8092, Switzerland
| | - Pietro Giovanoli
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Johanna Buschmann
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
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16
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Chen CH, Chen SH, Shalumon KT, Chen JP. Dual functional core-sheath electrospun hyaluronic acid/polycaprolactone nanofibrous membranes embedded with silver nanoparticles for prevention of peritendinous adhesion. Acta Biomater 2015; 26:225-35. [PMID: 26234491 DOI: 10.1016/j.actbio.2015.07.041] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 01/18/2023]
Abstract
Peritendinous adhesions, one of the common complications after tendon injury and subsequent surgery, could be minimized by directly placing a physical barrier between the injured site and the surrounding tissue. We used silver (Ag) nanoparticles embedded in electrospun hyaluronic acid (HA)/polycaprolactone (PCL) nanofibrous membranes (NFMs) (HA/PCL+Ag NFMs) to prevent peritendinous adhesions and bacterial infection after tendon surgery. HA was used for effective lubrication, and Ag provided antibacterial activity. A dual functional anti-adhesion barrier with core-sheath nanofibrous architecture was made from an HA core solution and a photo-reduced silver nitrate/PCL sheath solution. Polycaprolactone NFMs (PCL NFMs), hyaluronic acid/polycaprolactone core-sheath NFMs (HA/PCL NFMs) and HA/PCL+Ag NFMs with comparable fiber diameters and pore sizes were prepared and analyzed. The microporous structure of NFMs is expected to effectively block the penetration of adhesion-forming fibroblasts during tendon healing. The release of Ag from HA/PCL+Ag NFMs plateaued after 4 days, which confirmed the short-term anti-bacterial effect, and this result was verified with agar diffusion tests. In contrast, the release of HA was extended up to 21 days to simulate the lubrication effect offered by HA in the synovial fluid of the tendon sheath. In vitro cell culture experiments revealed that HA/PCL+Ag NFMs exhibited the highest inhibition of fibroblast attachment and proliferation without significant cytotoxicity due to the synergistic effect of Ag and HA. In vivo studies with a rabbit flexor tendon model further confirmed the efficacy of HA/PCL+Ag NFMs in reducing peritendinous adhesion as determined by gross observation, histology, joint range-of-motion, tendon gliding and biomechanical tests.
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Affiliation(s)
- Chih-Hao Chen
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 333, Taiwan, ROC; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kwei-San, Taoyuan 333, Taiwan, ROC
| | - Shih-Hsien Chen
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 333, Taiwan, ROC
| | - K T Shalumon
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 333, Taiwan, ROC
| | - Jyh-Ping Chen
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 333, Taiwan, ROC.
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