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Reisdorf RL, Liu H, Bi C, Vrieze AM, Moran SL, Amadio PC, Zhao C. Carbodiimide-Derivatized Synovial Fluid for Tendon Graft Coating Improves Long-Term Functional Outcomes of Flexor Tendon Reconstruction. Plast Reconstr Surg 2023; 152:840e-849e. [PMID: 36912937 PMCID: PMC11095404 DOI: 10.1097/prs.0000000000010390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Flexor digitorum profundus (FDP) tendon injury is common in hand trauma, and flexor tendon reconstruction is one of the most challenging procedures in hand surgery because of severe adhesion that exceeds 25% and hinders hand function. The surface properties of a graft from extrasynovial tendons are inferior to those of the native intrasynovial FDP tendons, which has been reported as one of the major causations. Improved surface gliding ability of the extrasynovial graft is needed. Thus, this study used carbodiimide-derivatized synovial fluid and gelatin (cd-SF-gel) to modify the surface of the graft, thus improving functional outcomes using a dog in vivo model. METHODS Forty FDP tendons from the second and fifth digits of 20 adult women underwent reconstruction with a peroneus longus (PL) autograft after creation of a tendon repair failure model for 6 weeks. Graft tendons were either coated with cd-SF-gel ( n = 20) or not. Animals were euthanized 24 weeks after reconstruction, and digits were collected after the animals were euthanized for biomechanical and histologic analyses. RESULTS Adhesion score (cd-SF-gel, 3.15 ± 1.53; control, 5 ± 1.26; P < 0.00017), normalized work of flexion (cd-SF-gel, 0.47 ± 0.28 N-mm/degree; control, 1.4 ± 1.45 N-mm/degree; P < 0.014), and distal interphalangeal joint motion (cd-SF-gel, 17.63 ± 6.77 degrees; control, 7.07 ± 12.99 degrees; P < 0.0015) in treated grafts all showed significant differences compared with nontreated grafts. However, there was no significant difference in repair conjunction strength between the two groups. CONCLUSION Autograft tendon surface modification with cd-SF-gel improves tendon gliding ability, reduces adhesion formation, and enhances digit function without interfering with graft-host healing. CLINICAL RELEVANCE STATEMENT The authors demonstrate a clinically relevant and translational technology by using the patient's own synovial fluid to "synovialize" an autologous extrasynovial tendon graft to improve functional outcomes following flexor tendon reconstruction.
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Affiliation(s)
- Ramona L. Reisdorf
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905 USA
| | - Haoyu Liu
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905 USA
| | - Chun Bi
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905 USA
| | - Alyssa M. Vrieze
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905 USA
| | - Steven L. Moran
- Division of Plastic and Reconstruction Surgery, Mayo Clinic, Rochester, MN 55905 USA
| | - Peter C. Amadio
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905 USA
| | - Chunfeng Zhao
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905 USA
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Abstract
Over the years, various physical and chemical/biological methods of inhibiting adhesion formation have been developed, focusing on how to suppress healing around the tendon and not inhibit healing within the tendon. Unfortunately, however, these methods are accompanied by drawbacks, both large and small, and no absolute antiadhesion method capable of maintaining tendon repair strength has yet been developed. Recent innovations in biomaterials science and tissue engineering have produced new antiadhesion technologies, such as barriers combined with cytokines and cells, which have improved outcomes in animal models, and which may find clinical relevance in the future.
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Affiliation(s)
- Tomoyuki Kuroiwa
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, USA
| | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, USA.
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3
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Satake T, Komura S, Aoki H, Hirakawa A, Imai Y, Akiyama H. Induction of iPSC-derived Prg4-positive cells with characteristics of superficial zone chondrocytes and fibroblast-like synovial cells. BMC Mol Cell Biol 2022; 23:30. [PMID: 35870887 PMCID: PMC9308249 DOI: 10.1186/s12860-022-00431-8] [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: 05/12/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Lubricin, a proteoglycan encoded by the PRG4 gene, is synthesised by superficial zone (SFZ) chondrocytes and synovial cells. It reduces friction between joints and allows smooth sliding of tendons. Although lubricin has been shown to be effective against osteoarthritis and synovitis in animals, its clinical application remains untested. In this study, we aimed to induce lubricin-expressing cells from pluripotent stem cells (iPSCs) and applied them locally via cell transplantation. Methods To generate iPSCs, OCT3/4, SOX2, KLF4, and L-MYC were transduced into fibroblasts derived from Prg4-mRFP1 transgenic mice. We established a protocol for the differentiation of iPSC-derived Prg4-mRFP1-positive cells and characterised their mRNA expression profile. Finally, we injected Prg4-mRFP1-positive cells into the paratenon, surrounding the Achilles tendons and knee joints of severe combined immunodeficient mice and assessed lubricin expression. Result Wnt3a, activin A, TGF-β1, and bFGF were applied to induce the differentiation of iPSC-derived Prg4-mRFP1-positive cells. Markers related to SFZ chondrocytes and fibroblast-like synovial cells (FLSs) were expressed during differentiation. RNA-sequencing indicated that iPSC-derived Prg4-mRFP1-positive cells manifested expression profiles typical of SFZ chondrocytes and FLSs. Transplanted iPSC-derived Prg4-mRFP1-positive cells survived around the Achilles tendons and in knee joints. Conclusions The present study describes a protocol for the differentiation of iPSC-derived Prg4-positive cells with characteristics of SFZ chondrocytes and FLSs. Transplantation of lubricin-expressing cells offers promise as a therapy against arthritis and synovitis.
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Bao R, Cheng S, Zhu J, Hai F, Mi W, Liu S. A Simplified Murine Model to Imitate Flexor Tendon Adhesion Formation without Suture. Biomimetics (Basel) 2022; 7:biomimetics7030092. [PMID: 35892362 PMCID: PMC9326731 DOI: 10.3390/biomimetics7030092] [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: 05/30/2022] [Revised: 06/25/2022] [Accepted: 07/02/2022] [Indexed: 02/01/2023] Open
Abstract
Peritendinous adhesion (PA) around tendons are daunting challenges for hand surgeons. Tenotomy with various sutures are considered classical tendon repair models (TRM) of tendon adhesion as well as tendon healing. However, potential biomimetic therapies such as anti-adhesion barriers and artificial tendon sheaths to avoid recurrence of PA are sometimes tested in these models without considering tendon healing. Thus, our aim is to create a simplified model without sutures in this study by using three 6 mm longitudinal and parallel incisions called the longitudinal incision model (LCM) in the murine flexor tendon. We found that the adhesion score of LCM has no significant difference to that in TRM. The range of motion (ROM) reveals similar adhesion formation in both TRM and LCM groups. Moreover, mRNA expression levels of collagen I and III in LCM shows no significant difference to that in TRM. The breaking force and stiffness of LCM were significantly higher than that of TRM. Therefore, LCM can imitate flexor tendon adhesion formation without sutures compared to TRM, without significant side effects on biomechanics with an easy operation.
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Affiliation(s)
- Rong Bao
- Department of Orthopaedics, Sixth People’s Hospital, Jiao Tong University, 600 Yishan Rd, Shanghai 200233, China;
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Science, Institutes of Integrative Medicine, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China; (S.C.); (J.Z.); (F.H.)
| | - Shi Cheng
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Science, Institutes of Integrative Medicine, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China; (S.C.); (J.Z.); (F.H.)
| | - Jianyu Zhu
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Science, Institutes of Integrative Medicine, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China; (S.C.); (J.Z.); (F.H.)
| | - Feng Hai
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Science, Institutes of Integrative Medicine, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China; (S.C.); (J.Z.); (F.H.)
| | - Wenli Mi
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Science, Institutes of Integrative Medicine, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China; (S.C.); (J.Z.); (F.H.)
- Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai 200032, China
- Correspondence: (W.M.); (S.L.)
| | - Shen Liu
- Department of Orthopaedics, Sixth People’s Hospital, Jiao Tong University, 600 Yishan Rd, Shanghai 200233, China;
- Correspondence: (W.M.); (S.L.)
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5
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Guo X, Li L, Yan Z, Li Y, Peng Z, Yang Y, Zhang Y, Schmitz C, Feng Z. Efficacy and safety of treating chronic nonspecific low back pain with radial extracorporeal shock wave therapy (rESWT), rESWT combined with celecoxib and eperisone (C + E) or C + E alone: a prospective, randomized trial. J Orthop Surg Res 2021; 16:705. [PMID: 34863239 PMCID: PMC8642949 DOI: 10.1186/s13018-021-02848-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate whether respectively radial extracoporeal shock wave therapy (rESWT) or a combination of rESWT, celecoxib and eperisone (rESWT + C + E) are superior in reducing pain in patients with chronic nonspecific low back pain (cnsLBP) compared to C + E alone (a standard treatment of this condition in China). METHODS 140 patients with cnsLBP were randomly allocated to rESWT (n = 47), rESWT + C + E (n = 45) or C + E alone (n = 48) for four weeks between November 2017 and March 2019. Outcome was evaluated using the Pain Self-Efficacy Questionnaire (PSEQ), Numerical Rating Scale (NRS), Oswestry Low Back Pain Disability Questionnaire and Patient Health Questionnaire 9, collected at baseline as well as one week (W1), W2, W3, W4 and W12 after baseline. RESULTS All scores showed a statistically significant improvement over time. The PSEQ and NRS scores showed a significant Time × Treatment effect. Patients treated with rESWT had significantly lower mean NRS values than patients treated with rESWT + C + E at W1 and W3, as well as than patients treated with C + E alone at W3 and W4. No severe adverse events were observed. CONCLUSIONS rESWT may not be inferior to respectively rESWT + C + E or C + E alone in reducing pain in patients with cnsLBP. LEVEL OF EVIDENCE Level I, prospective, randomized, active-controlled trial. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT03337607. Registered November 09, 2017, https://www.clinicaltrials.gov/ct2/show/NCT03337607 . LEVEL OF EVIDENCE Level I; prospective, randomized, controlled trial.
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Affiliation(s)
- Xuejiao Guo
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Li
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Yuyao People Hospital of Zhejiang, Ningbo, China
| | - Zhe Yan
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunze Li
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiyou Peng
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yixin Yang
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanfeng Zhang
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Christoph Schmitz
- Extracorporeal Shock Wave Research Unit, Chair of Neuroanatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Zhiying Feng
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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6
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Szin N, Silva SM, Moulton SE, Kapsa RMI, Quigley AF, Greene GW. Cellular Interactions with Lubricin and Hyaluronic Acid-Lubricin Composite Coatings on Gold Electrodes in Passive and Electrically Stimulated Environments. ACS Biomater Sci Eng 2021; 7:3696-3708. [PMID: 34283570 DOI: 10.1021/acsbiomaterials.1c00479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the field of bionics, the long-term effectiveness of implantable bionic interfaces depends upon maintaining a "clean" and unfouled electrical interface with biological tissues. Lubricin (LUB) is an innately biocompatible glycoprotein with impressive antifouling properties. Unlike traditional antiadhesive coatings, LUB coatings do not passivate electrode surfaces, giving LUB coatings great potential for controlling surface fouling of implantable electrode interfaces. This study characterizes the antifouling properties of bovine native LUB (N-LUB), recombinant human LUB (R-LUB), hyaluronic acid (HA), and composite coatings of HA and R-LUB (HA/R-LUB) on gold electrodes against human primary fibroblasts and chondrocytes in passive and electrically stimulated environments for up to 96 h. R-LUB coatings demonstrated highly effective antifouling properties, preventing nearly all adhesion and proliferation of fibroblasts and chondrocytes even under biphasic electrical stimulation. N-LUB coatings, while showing efficacy in the short term, failed to produce sustained antifouling properties against fibroblasts or chondrocytes over longer periods of time. HA/R-LUB composite films also demonstrated highly effective antifouling performance equal to the R-LUB coatings in both passive and electrically stimulated environments. The high electrochemical stability and long-lasting antifouling properties of R-LUB and HA/R-LUB coatings in electrically stimulating environments reveal the potential of these coatings for controlling unwanted cell adhesion in implantable bionic applications.
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Affiliation(s)
- Natalie Szin
- Institute for Frontier Materials and ARC Centre of Excellence for Electromaterials Science, Deakin University, Melbourne, VIC 3216, Australia
| | - Saimon M Silva
- Aikenhead Centre for Medical Discovery, St. Vincent's Hospital Melbourne, Melbourne, VIC 3065, Australia.,ARC Centre of Excellence for Electromaterials Science, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Simon E Moulton
- Aikenhead Centre for Medical Discovery, St. Vincent's Hospital Melbourne, Melbourne, VIC 3065, Australia.,ARC Centre of Excellence for Electromaterials Science, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Robert M I Kapsa
- Aikenhead Centre for Medical Discovery, St. Vincent's Hospital Melbourne, Melbourne, VIC 3065, Australia.,School of Electrical and Biomedical Engineering, RMIT University, Melbourne, VIC 3000, Australia
| | - Anita F Quigley
- Aikenhead Centre for Medical Discovery, St. Vincent's Hospital Melbourne, Melbourne, VIC 3065, Australia.,School of Electrical and Biomedical Engineering, RMIT University, Melbourne, VIC 3000, Australia
| | - George W Greene
- Institute for Frontier Materials and ARC Centre of Excellence for Electromaterials Science, Deakin University, Melbourne, VIC 3216, Australia
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Taye N, Karoulias SZ, Hubmacher D. The "other" 15-40%: The Role of Non-Collagenous Extracellular Matrix Proteins and Minor Collagens in Tendon. J Orthop Res 2020; 38:23-35. [PMID: 31410892 PMCID: PMC6917864 DOI: 10.1002/jor.24440] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/02/2019] [Indexed: 02/04/2023]
Abstract
Extracellular matrix (ECM) determines the physiological function of all tissues, including musculoskeletal tissues. In tendon, ECM provides overall tissue architecture, which is tailored to match the biomechanical requirements of their physiological function, that is, force transmission from muscle to bone. Tendon ECM also constitutes the microenvironment that allows tendon-resident cells to maintain their phenotype and that transmits biomechanical forces from the macro-level to the micro-level. The structure and function of adult tendons is largely determined by the hierarchical organization of collagen type I fibrils. However, non-collagenous ECM proteins such as small leucine-rich proteoglycans (SLRPs), ADAMTS proteases, and cross-linking enzymes play critical roles in collagen fibrillogenesis and guide the hierarchical bundling of collagen fibrils into tendon fascicles. Other non-collagenous ECM proteins such as the less abundant collagens, fibrillins, or elastin, contribute to tendon formation or determine some of their biomechanical properties. The interfascicular matrix or endotenon and the outer layer of tendons, the epi- and paratenon, includes collagens and non-collagenous ECM proteins, but their function is less well understood. The ECM proteins in the epi- and paratenon may provide the appropriate microenvironment to maintain the identity of distinct tendon cell populations that are thought to play a role during repair processes after injury. The aim of this review is to provide an overview of the role of non-collagenous ECM proteins and less abundant collagens in tendon development and homeostasis. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:23-35, 2020.
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Affiliation(s)
- Nandaraj Taye
- Leni & Peter W. May Department of Orthopaedics, Orthopaedic Research LaboratoriesIcahn School of Medicine at Mt. SinaiNew York New York 10029
| | - Stylianos Z. Karoulias
- Leni & Peter W. May Department of Orthopaedics, Orthopaedic Research LaboratoriesIcahn School of Medicine at Mt. SinaiNew York New York 10029
| | - Dirk Hubmacher
- Leni & Peter W. May Department of Orthopaedics, Orthopaedic Research LaboratoriesIcahn School of Medicine at Mt. SinaiNew York New York 10029
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8
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Two stage reconstruction of flexor tendon injuries in zone II after missed injury or failed repair. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Wei Z, Reisdorf RL, Thoreson AR, Jay GD, Moran SL, An KN, Amadio PC, Zhao C. Comparison of Autograft and Allograft with Surface Modification for Flexor Tendon Reconstruction: A Canine in Vivo Model. J Bone Joint Surg Am 2018; 100:e42. [PMID: 29613931 PMCID: PMC6372221 DOI: 10.2106/jbjs.17.00925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Flexor tendon injury is common, and tendon reconstruction is indicated clinically if the primary repair fails or cannot be performed immediately after tendon injury. The purpose of the current study was to compare clinically standard extrasynovial autologous graft (EAG) tendon and intrasynovial allogeneic graft (IAG) that had both undergone biolubricant surface modification in a canine in vivo model. METHODS Twenty-four flexor digitorum profundus (FDP) tendons from the second and fifth digits of 12 dogs were used for this study. In the first phase, a model of failed FDP tendon repair was created. After 6 weeks, the ruptured FDP tendons with a scarred digit were reconstructed with the use of either EAG or IAG tendons treated with carbodiimide-derivatized hyaluronic acid and lubricin. At 12 weeks after tendon reconstruction, the digits were harvested for functional, biomechanical, and histologic evaluations. RESULTS The tendon failure model was a clinically relevant and reproducible model for tendon reconstruction. The IAG group demonstrated improved digit function with decreased adhesion formation, lower digit work of flexion, and improved graft gliding ability compared with the EAG group. However, the IAG group had decreased healing at the distal tendon-bone junction. Our histologic findings verified the biomechanical evaluations and, further, showed that cellular repopulation of allograft at 12 weeks after reconstruction is still challenging. CONCLUSIONS FDP tendon reconstruction using IAG with surface modification has some beneficial effects for reducing adhesions but demonstrated inferior healing at the distal tendon-bone junction compared with EAG. These mixed results indicate that vitalization and turnover acceleration are crucial to reducing failure of reconstruction with allograft. CLINICAL RELEVANCE Flexor tendon reconstruction is a common surgical procedure. However, postoperative adhesion formation may lead to unsatisfactory clinical outcomes. In this study, we developed a potential flexor tendon allograft using chemical and tissue-engineering approaches. This technology could improve function following tendon reconstruction.
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Affiliation(s)
- Zhuang Wei
- Orthopedic Biomechanics Laboratory, Division of Orthopedics Research, Mayo Clinic, Rochester, Minnesota
| | - Ramona L. Reisdorf
- Orthopedic Biomechanics Laboratory, Division of Orthopedics Research, Mayo Clinic, Rochester, Minnesota
| | - Andrew R. Thoreson
- Orthopedic Biomechanics Laboratory, Division of Orthopedics Research, Mayo Clinic, Rochester, Minnesota
| | | | - Steven L. Moran
- Orthopedic Biomechanics Laboratory, Division of Orthopedics Research, Mayo Clinic, Rochester, Minnesota
| | - Kai-Nan An
- Orthopedic Biomechanics Laboratory, Division of Orthopedics Research, Mayo Clinic, Rochester, Minnesota
| | - Peter C. Amadio
- Orthopedic Biomechanics Laboratory, Division of Orthopedics Research, Mayo Clinic, Rochester, Minnesota
| | - Chunfeng Zhao
- Orthopedic Biomechanics Laboratory, Division of Orthopedics Research, Mayo Clinic, Rochester, Minnesota,E-mail address for C. Zhao:
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10
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Changes in frictional coefficient with increased tendon surface tear-An experimental animal model. J Clin Orthop Trauma 2018; 9:S19-S25. [PMID: 29628694 PMCID: PMC5883905 DOI: 10.1016/j.jcot.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 11/23/2022] Open
Abstract
AIM Surface tribological properties of a tendon in terms of coefficient of friction and lubrication mechanism are expected to change with the progression of surface tears which can affect the optimal function of the tendon. This study investigated whether coefficient of friction proportionally increases with the progression of a surface tear in a bovine tendon model. METHODS The study was performed using a pin-on-glass tribometer and bovine tendon samples (n = 16) divided into 4 groups. One group of tendons had no surface tears and thus served as a control, whilst the other 3 groups comprised tendons with increasing severity of artificially-induced surface tears. The coefficient of friction and the lubrication mechanism of the four groups of samples were investigated, calculated and compared. RESULTS Statistical analysis showed significant change in coefficient of friction between the control group and the group with minimal tear (p < 0.05) while no difference noted between the groups of moderate to severe tear suggesting that the coefficient of friction increases initially with appearance of surface tears, though further progression to a significant tear do not cause a further increase in the frictional coefficient. There was no change in the lubrication mechanism between the groups. CONCLUSION This finding appears to contradict the speculation that the frictional coefficient continues to increase with an increase in surface tear severity. The finding has not been reported before and requires validation in future with testing in human tissue.
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Abstract
Flexor tendon injuries of the hand are uncommon, and they are among the most challenging orthopaedic injuries to manage. Proper management is essential to ensure optimal outcomes. Consistent, successful management of flexor tendon injuries relies on understanding the anatomy, characteristics and repair of tendons in the different zones, potential complications, rehabilitation protocols, recent advances in treatment, and future directions, including tissue engineering and biologic modification of the repair site.
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12
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Smeeton J, Askary A, Crump JG. Building and maintaining joints by exquisite local control of cell fate. WILEY INTERDISCIPLINARY REVIEWS. DEVELOPMENTAL BIOLOGY 2017; 6:10.1002/wdev.245. [PMID: 27581688 PMCID: PMC5877473 DOI: 10.1002/wdev.245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022]
Abstract
We owe the flexibility of our bodies to sophisticated articulations between bones. Establishment of these joints requires the integration of multiple tissue types: permanent cartilage that cushions the articulating bones, synovial membranes that enclose a lubricating fluid-filled cavity, and a fibrous capsule and ligaments that provide structural support. Positioning the prospective joint region involves establishment of an "interzone" region of joint progenitor cells within a nascent cartilage condensation, which is achieved through the interplay of activators and inhibitors of multiple developmental signaling pathways. Within the interzone, tight regulation of BMP and TGFβ signaling prevents the hypertrophic maturation of joint chondrocytes, in part through downstream transcriptional repressors and epigenetic modulators. Synovial cells then acquire further specializations through expression of genes that promote lubrication, as well as the formation of complex structures such as cavities and entheses. Whereas genetic investigations in mice and humans have uncovered a number of regulators of joint development and homeostasis, recent work in zebrafish offers a complementary reductionist approach toward understanding joint positioning and the regulation of chondrocyte fate at joints. The complexity of building and maintaining joints may help explain why there are still few treatments for osteoarthritis, one of the most common diseases in the human population. A major challenge will be to understand how developmental abnormalities in joint structure, as well as postnatal roles for developmental genes in joint homeostasis, contribute to birth defects and degenerative diseases of joints. WIREs Dev Biol 2017, 6:e245. doi: 10.1002/wdev.245 For further resources related to this article, please visit the WIREs website.
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Affiliation(s)
- Joanna Smeeton
- Department of Stem Cell Biology and Regenerative Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Amjad Askary
- Department of Stem Cell Biology and Regenerative Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - J. Gage Crump
- Department of Stem Cell Biology and Regenerative Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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13
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Wong R, Alam N, McGrouther AD, Wong JKF. Tendon grafts: their natural history, biology and future development. J Hand Surg Eur Vol 2015; 40:669-81. [PMID: 26264585 DOI: 10.1177/1753193415595176] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The use of tendon grafts has diminished as regimes of primary repairs and rehabilitation have improved, but they remain important in secondary reconstruction. Relatively little is known about the cellular biology of grafts, and the general perception is that they have little biological activity. The reality is that there is a wealth of cellular and molecular changes occurring with the process of engraftment that affect the quality of the repair. This review highlights the historical perspectives and modern concepts of graft take, reviews the different attachment techniques and revisits the biology of pseudosheath formation. In addition, we discuss some of the future directions in tendon reconstruction by grafting, which include surface modification, vascularized tendon transfer, allografts, biomaterials and cell-based therapies.
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Affiliation(s)
- R Wong
- Plastic Surgery Research, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - N Alam
- Plastic Surgery Research, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - A D McGrouther
- Plastic Surgery Research, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - J K F Wong
- Plastic Surgery Research, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK
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14
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The effects of biological lubricating molecules on flexor tendon reconstruction in a canine allograft model in vivo. Plast Reconstr Surg 2014; 133:628e-637e. [PMID: 24445876 DOI: 10.1097/prs.0000000000000102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Abstract
Mouse models offer invaluable cellular and molecular tools for the study of human pathologies including those associated with fibrotic and musculoskeletal diseases. In this methods manuscript, we describe a mouse model of repair and segmental reconstruction of flexor tendons, which in our laboratory has been an invaluable model to study tendon scarring and adhesions. Specifically, we describe in details all the surgical procedures involved, as well as the associated endpoint biomechanical assessments including a novel test of the flexion of the metatarsophalangeal joint as a measure of adhesions, and a standard protocol for biomechanical assessment of the tensile strength of the tendon and repair tissue.
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Hayashi M, Zhao C, Thoreson AR, Chikenji T, Jay GD, An KN, Amadio PC. The effect of lubricin on the gliding resistance of mouse intrasynovial tendon. PLoS One 2013; 8:e83836. [PMID: 24349551 PMCID: PMC3862798 DOI: 10.1371/journal.pone.0083836] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 11/17/2013] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to investigate the role of lubricin on the gliding resistance of intrasynovial tendons by comparing lubricin knockout, heterozygous, and wild type mice. A total of thirty-six deep digital flexor (DDF) tendons in the third digits of each hind paw from eighteen adult mice were used, including six lubricin knockout mice (Prg4 –/–), six heterozygous mice (Prg4 +/–), and six wild type mice (Prg4 +/+). The tendon gliding resistance was measured using a custom-made device. Tendon structural changes were evaluated by scanning electron and light microscopy. The gliding resistance of intrasynovial tendons from lubricin knockout mice was significantly higher than the gliding resistance of either wild type or heterozygous mice. The surface of the lubricin knockout tendons appeared to be rougher, compared to the wild type and heterozygous tendons. Synovial hyperplasia was found in the lubricin knockout mice. Cartilage-like tissue was found in the tendon and pulley of the lubricin knockout mice. Our findings confirm the importance of lubricin in intrasynovial tendon lubrication. This knockout model may be useful in determining the effect of lubricin on tendon healing and the response to injury.
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Affiliation(s)
- Masanori Hayashi
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Chunfeng Zhao
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Andrew R. Thoreson
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Takako Chikenji
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Gregory D. Jay
- Department of Emergency Medicine, Rhode Island Hospital and Brown University, Providence, Rhode Island, United States of America
| | - Kai-Nan An
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Peter C. Amadio
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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Fox PM, Farnebo S, Lindsey D, Chang J, Schmitt T, Chang J. Decellularized human tendon-bone grafts for composite flexor tendon reconstruction: a cadaveric model of initial mechanical properties. J Hand Surg Am 2013; 38:2323-8. [PMID: 24055133 DOI: 10.1016/j.jhsa.2013.08.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE After complex hand trauma, restoration of tendon strength is challenging. Tendon insertion tears typically heal as fibrous scars after surgical reconstruction and create a weak point at the tendon-bone interface. In addition, major tendon loss may overwhelm the amount of available autograft for reconstruction. An off-the-shelf product may help address these challenges. We hypothesized that decellularized human flexor digitorum profundus and distal phalanx tendon-bone composite grafts were a feasible option for flexor tendon reconstruction after complex hand trauma. By replacing the entire injured composite segment, the need for tendon repair within the tendon sheath, reconstruction of the tendon-bone interface, and use of limited autograft could be eliminated. METHODS Paired human cadaver forearms were dissected to obtain the flexor digitorum profundus tendon with an attached block of distal phalanx. Tendon-bone grafts were pair-matched and divided into 2 groups: decellularized grafts (n = 12) and untreated (control) grafts (n = 11). Grafts in the decellularized group were subjected to physiochemical decellularization. Pair-matched tendon-bone grafts (decellularized and untreated) were placed back into the flexor tendon sheath and secured distally using a tie-over button and proximally by weaving the graft into the flexor digitorum superficialis tendon in the distal forearm. The ultimate load, location of failure, and excursion were determined. RESULTS Decellularized tendon-bone composite grafts demonstrated no significant difference in ultimate failure load or stiffness compared with untreated grafts. Both groups eventually failed in varied locations along the repair. The most common site of failure in both groups was the tie-over button. The decellularized group failed at the tendon-bone insertion in 3 specimens (25%) compared with none in the untreated group. Both groups demonstrated an average tendon excursion of approximately 82 mm before failure. CONCLUSIONS Decellularization of human flexor tendon-distal phalanx tendon-bone constructs did not compromise initial strength despite chemical and mechanical decellularization in a cadaveric model. At the time of repair, decellularized flexor tendon-bone grafts can exceed the strength and excursion needed for hand therapy immediately after reconstruction. CLINICAL RELEVANCE These tendon-bone grafts may become an option for complex hand reconstruction at or near tendon-bone insertions and throughout the tendon sheath. Further work is required to assess the role of reseeding in an in vivo model.
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Affiliation(s)
- Paige M Fox
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center; and Section of Plastic Surgery, VA Palo Alto Health Care System, Stanford, CA
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Defects in tendon, ligament, and enthesis in response to genetic alterations in key proteoglycans and glycoproteins: a review. ARTHRITIS 2013; 2013:154812. [PMID: 24324885 PMCID: PMC3842050 DOI: 10.1155/2013/154812] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/07/2013] [Indexed: 11/17/2022]
Abstract
This review summarizes the genetic alterations and knockdown approaches published in the literature to assess the role of key proteoglycans and glycoproteins in the structural development, function, and repair of tendon, ligament, and enthesis. The information was collected from (i) genetically altered mice, (ii) in vitro knockdown studies, (iii) genetic variants predisposition to injury, and (iv) human genetic diseases. The genes reviewed are for small leucine-rich proteoglycans (lumican, fibromodulin, biglycan, decorin, and asporin); dermatan sulfate epimerase (Dse) that alters structure of glycosaminoglycan and hence the function of small leucine-rich proteoglycans by converting glucuronic to iduronic acid; matricellular proteins (thrombospondin 2, secreted phosphoprotein 1 (Spp1), secreted protein acidic and rich in cysteine (Sparc), periostin, and tenascin X) including human tenascin C variants; and others, such as tenomodulin, leukocyte cell derived chemotaxin 1 (chondromodulin-I, ChM-I), CD44 antigen (Cd44), lubricin (Prg4), and aggrecan degrading gene, a disintegrin-like and metallopeptidase (reprolysin type) with thrombospondin type 1 motif, 5 (Adamts5). Understanding these genes represents drug targets for disrupting pathological mechanisms that lead to tendinopathy, ligamentopathy, enthesopathy, enthesitis and tendon/ligament injury, that is, osteoarthritis and ankylosing spondylitis.
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Zhao C, Hashimoto T, Kirk RL, Thoreson AR, Jay GD, Moran SL, An KN, Amadio PC. Resurfacing with chemically modified hyaluronic acid and lubricin for flexor tendon reconstruction. J Orthop Res 2013; 31:969-75. [PMID: 23335124 PMCID: PMC3628950 DOI: 10.1002/jor.22305] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 12/07/2012] [Indexed: 02/04/2023]
Abstract
We assessed surface coating with carbodiimide derivatized hyaluronic acid combined with lubricin (cd-HA-Lubricin) as a way to improve extrasynovial tendon surface quality and, consequently, the functional results in flexor tendon reconstruction, using a canine in vivo model. The second and fifth flexor digitorum profundus tendons from 14 dogs were reconstructed with autologs peroneus longus (PL) tendons 6 weeks after a failed primary repair. One digit was treated with cd-HA-Lubricin, and the other was treated with saline as the control. Six weeks following grafting, the digits and graft tendons were functionally and histologically evaluated. Adhesion score, normalized work of flexion, graft friction in zone II, and adhesion breaking strength at the proximal repair site in zone III were all lower in the cd-HA-Lubricin treated group compared to the control group. The strength at the distal tendon/bone interface was decreased in the cd-HA-Lubricin treated grafts compared to the control grafts. Histology showed inferior healing in the cd-HA-Lubricin group at both proximal and distal repair sites. However, cd-HA-Lubricin treatment did not result in any gap or rupture at either the proximal or distal repair sites. These results demonstrate that cd-HA-Lubricin can eliminate graft adhesions and improve digit function, but that treatment may have an adverse effect on tendon healing.
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Affiliation(s)
- Chunfeng Zhao
- Orthopedic Biomechanics Laboratory & Tendon and Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
| | - Takahiro Hashimoto
- Orthopedic Biomechanics Laboratory & Tendon and Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
| | - Ramona L. Kirk
- Orthopedic Biomechanics Laboratory & Tendon and Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
| | - Andrew R. Thoreson
- Orthopedic Biomechanics Laboratory & Tendon and Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
| | | | - Steven L. Moran
- Orthopedic Biomechanics Laboratory & Tendon and Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
| | - Kai-Nan An
- Orthopedic Biomechanics Laboratory & Tendon and Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
| | - Peter C. Amadio
- Orthopedic Biomechanics Laboratory & Tendon and Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
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Thorpe CT, Birch HL, Clegg PD, Screen HRC. The role of the non-collagenous matrix in tendon function. Int J Exp Pathol 2013; 94:248-59. [PMID: 23718692 DOI: 10.1111/iep.12027] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 04/16/2013] [Indexed: 01/26/2023] Open
Abstract
Tendon consists of highly ordered type I collagen molecules that are grouped together to form subunits of increasing diameter. At each hierarchical level, the type I collagen is interspersed with a predominantly non-collagenous matrix (NCM) (Connect. Tissue Res., 6, 1978, 11). Whilst many studies have investigated the structure, organization and function of the collagenous matrix within tendon, relatively few have studied the non-collagenous components. However, there is a growing body of research suggesting the NCM plays an important role within tendon; adaptations to this matrix may confer the specific properties required by tendons with different functions. Furthermore, age-related alterations to non-collagenous proteins have been identified, which may affect tendon resistance to injury. This review focuses on the NCM within the tensional region of developing and mature tendon, discussing the current knowledge and identifying areas that require further study to fully understand structure-function relationships within tendon. This information will aid in the development of appropriate techniques for tendon injury prevention and treatment.
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Affiliation(s)
- Chavaunne T Thorpe
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK.
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Sun YL, Zhao C, Jay GD, Schmid TM, An KN, Amadio PC. Effects of stress deprivation on lubricin synthesis and gliding of flexor tendons in a canine model in vivo. J Bone Joint Surg Am 2013; 95:273-8. [PMID: 23389791 PMCID: PMC3748971 DOI: 10.2106/jbjs.k.01522] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lubricin facilitates boundary lubrication of cartilage. The synthesis of lubricin in cartilage is regulated by mechanical stimuli, especially shear force. Lubricin is also found in flexor tendons. However, little is known about the effect of mechanical loading on lubricin synthesis in tendons or about the function of lubricin in flexor tendons. The purpose of this study was to investigate the relationship of mechanical loading to lubricin expression and gliding resistance of flexor tendons. METHODS Flexor tendons were harvested from canine forepaws that had been suspended without weight-bearing for twenty-one days and from the contralateral forepaws that had been allowed free motion. Lubricin expression in each flexor tendon was investigated with real-time RT-PCR (reverse transcription polymerase chain reaction) and immunohistochemistry. Lubricin in the flexor tendon was extracted and quantified with ELISA (enzyme-linked immunosorbent assay). The friction between the flexor tendon and the proximal pulley was measured. RESULTS The non-weight-bearing flexor tendons had a 40% reduction of lubricin expression (p < 0.01) and content (p < 0.01) compared with the flexor tendons in the contralateral limb. However, the gliding resistance of the tendons in the non-weight-bearing limb was the same as that of the tendons on the contralateral, weight-bearing side. CONCLUSIONS Mechanical loading affected lubricin expression in flexor tendons, resulting in a 40% reduction of lubricin content, but these changes did not affect the gliding resistance of the flexor tendons.
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Affiliation(s)
- Yu-Long Sun
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for Y.-L. Sun:
| | - Chunfeng Zhao
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for Y.-L. Sun:
| | - Gregory D. Jay
- Department of Emergency Medicine, Rhode Island Hospital, The CORO Building, Suite 106, One Hoppin Street, Providence, RI 02903
| | - Thomas M. Schmid
- Department of Biochemistry, Rush University, 1735 West Harrison Street, Cohn Research Building, Suite 556, Chicago, IL 60612
| | - Kai-Nan An
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for Y.-L. Sun:
| | - Peter C. Amadio
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for Y.-L. Sun:
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Kolodzinskyi MN, Zhao C, Sun YL, An KN, Thoreson AR, Amadio PC, Moran SL. The effects of hylan g-f 20 surface modification on gliding of extrasynovial canine tendon grafts in vitro. J Hand Surg Am 2013; 38:231-6. [PMID: 23294647 PMCID: PMC3625943 DOI: 10.1016/j.jhsa.2012.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Studies have shown that a lubricant exogenously applied on extrasynovial tendon surfaces can reduce the gliding resistance after flexor tendon repair; however, the reagents that have been tested are solely for experimental testing and are not available for clinical use. The purpose of this study was to investigate the effect of exogenously applied hylan G-F 20, a U.S. Food and Drug Administration-approved hyaluronic acid for the treatment of osteoarthritis, on extrasynovial tendon gliding resistance in an in vitro canine model. METHODS Twenty-four canine peroneus longus (PL) tendons and proximal pulleys of the ipsilateral paws were treated with 1 of 3 solutions: saline, carbodiimide derivatized hylan G-F 20, or unmodified hylan G-F 20. The gliding resistance of each tendon preparation was then measured over 1000 cycles in a saline bath. RESULTS After 1,000 cycles, the gliding resistance of the PL tendons treated with unmodified hylan G-F 20 decreased significantly compared with the saline-treated tendons. The gliding resistance of the PL tendons treated with modified hylan G-F 20 increased significantly compared with the saline group. CONCLUSIONS The PL tendons treated with pure hylan G-F 20 showed a positive effect on the gliding resistance. CLINICAL RELEVANCE The results of this in vitro canine study suggest that exogenously applied hylan G-F 20 improves gliding of the extrasynovial tendon graft. This material may be capable of reducing friction over flexor tendon repair sites and flexor tendon grafts.
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Juneja SC, Schwarz EM, O’Keefe RJ, Awad HA. Cellular and molecular factors in flexor tendon repair and adhesions: a histological and gene expression analysis. Connect Tissue Res 2013; 54:218-26. [PMID: 23586515 PMCID: PMC3697755 DOI: 10.3109/03008207.2013.787418] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Flexor tendon healing is mediated by cell proliferation, migration, and extracellular matrix synthesis that contribute to the formation of scar tissue and adhesion. The biological mechanisms of flexor tendon adhesion formation have been linked to transforming growth factor β (TGF-β). To elucidate the cellular and molecular events in this pathology, we implanted live flexor digitorum longus grafts from the reporter mouse Rosa26(LacZ/+) in wild-type recipients, and used histological β-galactosidase (β-gal) staining to evaluate the intrinsic versus extrinsic cellular origins of scar, and reverse transcription-polymerase chain reaction to measure gene expression of TGF-β and its receptors, extracellular matrix proteins, and matrix metalloproteinases (MMPs) and their regulators. Over the course of healing, graft cellularity and β-gal activity progressively increased, and β-gal-positive cells migrated out of the Rosa26(LacZ/+) graft. In addition, there was an evidence of influx of host cells (β-gal-negative) into the gliding space and the graft, suggesting that both graft and host cells contribute to adhesions. Interestingly, we observed a biphasic pattern in which Tgfb1 expression was the highest in the early phases of healing and gradually decreased thereafter, whereas Tgfb3 increased and remained upregulated later. The expression of TGF-β receptors was also upregulated throughout the healing phases. In addition, type III collagen and fibronectin were upregulated during the proliferative phase of healing, confirming that murine flexor tendon heals by scar tissue. Furthermore, gene expression of MMPs showed a differential pattern in which inflammatory MMPs were the highest early and matrix MMPs increased over time. These findings offer important insights into the complex cellular and molecular factors during flexor tendon healing.
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Affiliation(s)
- Subhash C. Juneja
- The Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA,Division of Orthopaedic Surgery, TWH, UHN, Toronto, ON M5T 2S8
| | - Edward M. Schwarz
- The Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA,Department of Orthopaedics, University of Rochester, Rochester, NY, USA
| | - Regis J. O’Keefe
- The Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA,Department of Orthopaedics, University of Rochester, Rochester, NY, USA
| | - Hani A. Awad
- The Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA,Department of Orthopaedics, University of Rochester, Rochester, NY, USA,Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
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Zhao C, Sun YL, Jay GD, Moran SL, An KN, Amadio PC. Surface modification counteracts adverse effects associated with immobilization after flexor tendon repair. J Orthop Res 2012; 30:1940-4. [PMID: 22714687 PMCID: PMC3449004 DOI: 10.1002/jor.22177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/01/2012] [Indexed: 02/04/2023]
Abstract
Although post-rehabilitation is routinely performed following flexor tendon repair, in some clinical scenarios post-rehabilitation must be delayed. We investigated modification of the tendon surface using carbodiimide derivatized hyaluronic acid and lubricin (cd-HA-Lub) to maintain gliding function following flexor tendon repair with postoperative immobilization in a in vivo canine model. Flexor digitorum profundus tendons from the 2nd and 5th digits of one forepaw of six dogs were transected and repaired. One tendon in each paw was treated with cd-HA-Lub; the other repaired tendon was not treated. Following tendon repair, a forearm cast was applied to fully immobilize the operated forelimb for 10 days, after which the animals were euthanized. Digit normalized work of flexion (nWOF) and tendon gliding resistance were assessed. The nWOF of the FDP tendons treated with cd-HA-Lub was significantly lower than the nWOF of the untreated tendons (p < 0.01). The gliding resistance of cd-HA-Lub treated tendons was also significantly lower than that of the untreated tendons (p < 0.05). Surface treatment with cd-HA-Lub following flexor tendon repair provides an opportunity to improve outcomes for patients in whom the post-operative therapy must be delayed after flexor tendon repair.
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Affiliation(s)
- Chunfeng Zhao
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Yu-Long Sun
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Gregory D. Jay
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Steven L. Moran
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Kai-Nan An
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Peter C. Amadio
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Leonardi R, Loreto C, Talic N, Caltabiano R, Musumeci G. Immunolocalization of lubricin in the rat periodontal ligament during experimental tooth movement. Acta Histochem 2012; 114:700-4. [PMID: 22209395 DOI: 10.1016/j.acthis.2011.12.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 12/07/2011] [Accepted: 12/08/2011] [Indexed: 01/06/2023]
Abstract
Lubricin is a protein which contributes to the boundary lubrication, facilitating low friction levels at the interfacing surfaces of joints. In tendons and ligaments it facilitates the relative movement of collagen bundles. Its expression is affected by mechanical signals and cytokines. During application of orthodontic forces to teeth, there is a transduction of mechanical forces to the cells of the periodontal ligament (PDL), which triggers several biological reactions causing the synthesis of prostaglandins, cytokines and growth factors. The aim of the present study was to examine the immunolocalization of lubricin and to evaluate if it is time-dependently and differentially detected within the PDL following the application of orthodontic forces to create areas of compression and tension. This was achieved by placing elastic bands between the maxillary first and second molars of 16 male Sprague-Dawley rats (each weighing 120-200g) for 12 and 24h. The molar-bearing segments were dissected and processed for histological and immunohistochemical examination. Binding of a monoclonal antibody was used to evaluate lubricin localization using an indirect streptavidin/biotin immunperoxidase technique. Lubricin, was constitutively expressed in the PDL of rat molars. After the experimental force was applied to the tooth, lubricin was down-regulated, on both sides (compression and tension) of the PDL, in a time-dependent fashion, although to a different extent, being at any time more expressed on the tension side. Furthermore, in every sample, almost all PDL cells in the adjacent tooth cementum and alveolar bone, were more heavily immunolabeled by lubricin antibody, contrary to those located in the central portion of the PDL. Lubricin expression therefore seems related to PDL remodeling and tooth displacement following the application of an orthodontic force, and it appears that lubricin may play an important role during tooth movement.
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Affiliation(s)
- Rosalia Leonardi
- Department of Dentistry, Faculty of Dentistry, University of Catania, Policlinico Universitario, Catania, Italy.
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Drewniak EI, Jay GD, Fleming BC, Zhang L, Warman ML, Crisco JJ. Cyclic loading increases friction and changes cartilage surface integrity in lubricin-mutant mouse knees. ACTA ACUST UNITED AC 2012; 64:465-73. [PMID: 21905020 PMCID: PMC3252402 DOI: 10.1002/art.33337] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the effects of lubricin gene dosage and cyclic loading on whole joint coefficient of friction and articular cartilage surface integrity in mouse knee joints. METHODS Joints from mice with 2 (Prg4(+/+)), 1 (Prg4(+/-)), or no (Prg4(-/-)) functioning lubricin alleles were subjected to 26 hours of cyclic loading using a custom-built pendulum. Coefficient of friction values were measured at multiple time points. Contralateral control joints were left unloaded. Following testing, joints were examined for histologic evidence of damage and cell viability. RESULTS At baseline, the coefficient of friction values in Prg4(-/-) mice were significantly higher than those in Prg4(+/+) and Prg4(+/-) mice (P < 0.001). Cyclic loading continuously increased the coefficient of friction in Prg4(-/-) mouse joints. In contrast, Prg4(+/-) and Prg4(+/+) mouse joints had no coefficient of friction increases during the first 4 hours of loading. After 26 hours of loading, joints from all genotypes had increased coefficient of friction values compared to baseline and unloaded controls. Significantly greater increases occurred in Prg4(-/-) and Prg4(+/-) mouse joints compared to Prg4(+/+) mouse joints. The coefficient of friction values were not significantly associated with histologic evidence of damage or loss of cell viability. CONCLUSION Our findings indicate that mice lacking lubricin have increased baseline coefficient of friction values and are not protected against further increases caused by loading. Prg4(+/-) mice are indistinguishable from Prg4(+/+) mice at baseline, but have significantly greater coefficient of friction values following 26 hours of loading. Lubricin dosage affects joint properties during loading, and may have clinical implications in patients for whom injury or illness alters lubricin abundance.
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Affiliation(s)
- Elizabeth I Drewniak
- Alpert Medical School of Brown University, Rhode Island Hospital Providence, Rhode Island 02903, USA
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McGonagle L, Jones MD, Dowson D, Theobald PS. The bio-tribological properties of anti-adhesive agents commonly used during tendon repair. J Orthop Res 2012; 30:775-80. [PMID: 22012635 DOI: 10.1002/jor.21569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 09/26/2011] [Indexed: 02/04/2023]
Abstract
Frictional resistance to tendon gliding is minimized by surrounding loose areolar tissue. During periods of prolonged immobilization, for example, post-tendon-repair, adhesions can form between these two adjacent tissues, thereby limiting tendon function. Anti-adhesive agents can be applied during surgery to prevent adhesion formation, whilst reportedly providing some reduction in friction during in vitro tendon-bony pulley investigations. This bio-tribological study evaluates whether application of these agents can improve the lubrication between the tendon and surrounding tissue, thus potentially reducing the risk of re-rupturing the tendon at the repair site. The use of bovine synovial fluid (BSF) enabled an approximation of the in vivo lubrication regime, and subsequent comparison of the performance of three synthetic agents (50 mg/ml 5-fluorouracil; 5 mg/ml hyaluronic acid; ADCON-T/N). Coefficient of friction data was recorded and then compared with the Stribeck curve. BSF generated a fluid film that separated the two surfaces, giving rise to optimal lubrication conditions. This efficient regime was also generated following application of each anti-adhesion agent. The use of phosphate-buffered saline solution in generating only a boundary lubrication regime highlighted the effectiveness of the agents in reducing friction. Hyaluronic acid (5 mg/ml) was marginally deemed the most effective anti-adhesive agent at lubricating the tendon. Subsequently, it is concluded that the application of anti-adhesive agents post-surgery has secondary, tribological benefits that serve to reduce friction, and thus potentially the risk of failure, at the tendon repair site.
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Affiliation(s)
- Lorcan McGonagle
- Trauma Biomechanics Research Group, Institute of Medical Engineering and Medical Physics, Cardiff University, Queen's Building, The Parade, Cardiff, CF24 3AA, UK
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Leonardi R, Musumeci G, Sicurezza E, Loreto C. Lubricin in human temporomandibular joint disc: an immunohistochemical study. Arch Oral Biol 2012; 57:614-9. [PMID: 22244189 DOI: 10.1016/j.archoralbio.2011.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 11/20/2011] [Accepted: 12/12/2011] [Indexed: 12/11/2022]
Abstract
AIMS To evaluate, immunohistochemically, the presence and distribution of lubricin in human temporomandibular joint (TMJ) discs without any degenerative changes, obtained from autopsies, in order to elucidate the TMJ lubrication system and disc tribology. METHODS Immunohistochemistry for lubricin detection was carried out on 34 TMJ discs. Any disc had signs of degenerative or inflammatory joint disease nor disc were displaced. Sections were incubated with diluted rabbit polyclonal anti-lubricin antibody and scored according to the percentage of lubricin immunopositive cells. Three different TMJ disc tissue compartments taken from the intermediate zone were analysed, namely: the central region as well as the temporal (superior) and condylar (inferior) disc surfaces. The Friedman test, was used to compare lubricin at a protein level expression, amongst the regions of disc specimens. RESULTS Staining was noted within the TMJ disc cell populations in every disc tissue sample, however, the number of disc cells immunolabelled varied according to disc tissue regions. The percentage of immunostained cells, was statistically significant lower in the central region than in each disc surface (p<0.0001), whilst any statistically significant difference was found when comparing the two surfaces one another. CONCLUSIONS Lubricin is present in several location of TMJ disc being significantly more expressed at disc surfaces than in the central part.
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Affiliation(s)
- Rosalia Leonardi
- Department of Dentistry, Faculty of Dentistry, University of Catania, Policlinico Universitario, Italy.
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Leonardi R, Rusu MC, Loreto F, Loreto C, Musumeci G. Immunolocalization and expression of lubricin in the bilaminar zone of the human temporomandibular joint disc. Acta Histochem 2012; 114:1-5. [PMID: 21955422 DOI: 10.1016/j.acthis.2010.11.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/01/2010] [Accepted: 11/02/2010] [Indexed: 12/20/2022]
Abstract
Lubricin, which is a boundary joint lubricant, was investigated immunohistochemically in the bilaminar zone (BZ) of the human temporomandibular joint (TMJ), without any degenerative changes. Immunohistochemistry for lubricin detection was carried out on 33 TMJ discs obtained from 17 cadavers. Sections were incubated with diluted rabbit polyclonal anti-lubricin antibody and scored according to the percentage of lubricin immunopositive cells. Three different TMJ disc tissue compartments were analyzed, namely: the upper lamina, the inferior lamina and the loose connective tissue in the space between the laminae. The Mann-Whitney U test was used to compare protein expression (lubricin) among disc specimens' regions. Staining was noted within the TMJ disc cell populations in every disc tissue sample, with almost every cell immunolabeled by the lubricin antibody. The number of disc cells immunolabeled was almost the same in the 3 bilaminar zone regions. Positive extracellular matrix staining was also seen. The results of the present study suggest that lubricin is expressed in the TMJ disc bilaminar zone. Lubricin may have a role in normal disc posterior attachment physiology through the prevention of cellular adhesion as well as providing lubrication during normal bilaminar zone function.
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Musumeci G, Loreto C, Carnazza ML, Coppolino F, Cardile V, Leonardi R. Lubricin is expressed in chondrocytes derived from osteoarthritic cartilage encapsulated in poly (ethylene glycol) diacrylate scaffold. Eur J Histochem 2011; 55:e31. [PMID: 22073377 PMCID: PMC3203476 DOI: 10.4081/ejh.2011.e31] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 07/31/2011] [Indexed: 12/20/2022] Open
Abstract
Osteoarthritis (OA) is characterized by degenerative changes within joints that involved quantitative and/or qualitative alterations of cartilage and synovial fluid lubricin, a mucinous glycoprotein secreted by synovial fibroblasts and chondrocytes. Modern therapeutic methods, including tissue-engineering techniques, have been used to treat mechanical damage of the articular cartilage but to date there is no specific and effective treatment. This study aimed at investigating lubricin immunohistochemical expression in cartilage explant from normal and OA patients and in cartilage constructions formed by Poly (ethylene glycol) (PEG) based hydrogels (PEG-DA) encapsulated OA chondrocytes. The expression levels of lubricin were studied by immunohistochemistry: i) in tissue explanted from OA and normal human cartilage; ii) in chondrocytes encapsulated in hydrogel PEGDA from OA and normal human cartilage. Moreover, immunocytochemical and western blot analysis were performed in monolayer cells from OA and normal cartilage. The results showed an increased expression of lubricin in explanted tissue and in monolayer cells from normal cartilage, and a decreased expression of lubricin in OA cartilage. The chondrocytes from OA cartilage after 5 weeks of culture in hydrogels (PEGDA) showed an increased expression of lubricin compared with the control cartilage. The present study demonstrated that OA chondrocytes encapsulated in PEGDA, grown in the scaffold and were able to restore lubricin biosynthesis. Thus our results suggest the possibility of applying autologous cell transplantation in conjunction with scaffold materials for repairing cartilage lesions in patients with OA to reduce at least the progression of the disease.
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Affiliation(s)
- G Musumeci
- Department of Bio-Medical Sciences, Human Anatomy section, University of Catania, Italy.
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Reuvers J, Thoreson AR, Zhao C, Zhang L, Jay GD, An KN, Warman ML, Amadio PC. The mechanical properties of tail tendon fascicles from lubricin knockout, wild type and heterozygous mice. J Struct Biol 2011; 176:41-5. [PMID: 21821131 DOI: 10.1016/j.jsb.2011.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 07/20/2011] [Accepted: 07/24/2011] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to analyze the effects of lubricin on tendon stiffness and viscoelasticity. A total of 36 mice were tested with 12 mice in each of the following groups: lubricin knock-out ⁻/⁻, heterozygous ⁺/⁻ and wild-type ⁺/⁺. A ramp test was used to determine the elastic modulus by pulling the fascicles to 2.5% strain amplitude at a rate of 0.05 mm/s. Then, followed by a relaxation test that pulled the fascicles to 5% strain amplitude at a rate of 2 mm/s. The fascicles were allowed to relax for 2 min at the maximum strain and a single-cycle relaxation ratio was used to characterize viscoelastic properties. There was no significant difference in the Young's modulus between the three groups (p > 0.05), but the knockout mice had a significantly (p < 0.05) lower relaxation ratio than the wild type mice. Based on these data, we concluded that lubricin expression has an effect on the viscoelastic properties of tendon fascicles. The clinical significance of this finding, if any, remains to be demonstrated.
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Affiliation(s)
- John Reuvers
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
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Ikeda J, Zhao C, Chen Q, Thoreson AR, An KN, Amadio PC. Compressive properties of cd-HA-gelatin modified intrasynovial tendon allograft in canine model in vivo. J Biomech 2011; 44:1793-6. [PMID: 21549380 DOI: 10.1016/j.jbiomech.2010.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/06/2010] [Accepted: 12/27/2010] [Indexed: 11/18/2022]
Abstract
Although we sometimes use the intrasynovial tendon allograft as a donor, the gliding ability of allograft prepared by lyophilization is significantly decreased. The gliding ability of the grafted tendon after tendon reconstruction is very important because the high gliding resistance causes more adhesion and leads to poor clinical results. We recently revealed that tendon surface treatment with a carbodiimide derivatized HA (cd-HA)-gelatin mixture for intrasynovial tendon allograft significantly improved its gliding ability. The purpose of this study was to investigate whether this cd-HA-gelatin treatment affects the tendon mechanical property or not. A total of 40 flexor digitorum profundus (FDP) tendons from canines were evaluated for compressive property by using indentation test. Indentation stiffness was measured for normal tendon, rehydrated tendon after lyophilization, rehydrated tendon after lyophilization that was implanted 6 weeks in vivo, and cd-HA treated rehydrated tendon after lyophilization that was implanted 6 weeks in vivo. The results for all groups showed no significant difference in the tendon compressive properties. The findings of these results demonstrate that cd-HA treatment for intrasynovial tendon allograft is an excellent method to improve the tendon gliding ability after lyophilization without changing the compressive property of donor tendon.
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Affiliation(s)
- Jun Ikeda
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Kohrs RT, Zhao C, Sun YL, Jay GD, Zhang L, Warman ML, An KN, Amadio PC. Tendon fascicle gliding in wild type, heterozygous, and lubricin knockout mice. J Orthop Res 2011; 29:384-9. [PMID: 20886657 DOI: 10.1002/jor.21247] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 07/19/2010] [Indexed: 02/04/2023]
Abstract
The objective of this study was to investigate the role of lubricin in the lubrication of tendon fascicles. Lubricin, a glycoprotein, lubricates cartilage and tendon surfaces, but the function of lubricin within the tendon fascicle is unclear. We developed a novel method to assess the gliding resistance of a single fascicle in a mouse tail model and used it to test the hypothesis that gliding resistance would be increased in lubricin knockout mice. Thirty-six mouse tails were used from 12 wild type, 12 heterozygous, and 12 lubricin knockout mice. A 15 mm long fascicle segment was pulled proximally after being divided distally. The peak resistance during fascicle pullout and the fascicle perimeter were measured. Lubricin expression was evaluated by immunohistochemistry. The peak gliding resistance in the lubricin knockout mice was significantly higher than in the wild type (p < 0.05). Fascicles from heterozygous mice were intermediate in value, but not significantly different from either wild type or lubricin knockout fascicles in peak gliding resistance. No significant difference was found in fascicle perimeter among the three groups. No correlation was observed between fascicle perimeter and gliding resistance. While lubricin was detected by immunostaining on the fascicle surface in wild type and heterozygous mice, lubricin was not detectable in the tendons of knockout mice. We conclude that the absence of lubricin is associated with increased interfascicular friction and that lubricin may play an important role in interfascicular lubrication.
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Affiliation(s)
- Ross T Kohrs
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Ikeda J, Sun YL, An KN, Amadio PC, Zhao C. Application of carbodiimide derivatized synovial fluid to enhance extrasynovial tendon gliding ability. J Hand Surg Am 2011; 36:456-63. [PMID: 21371626 PMCID: PMC3625936 DOI: 10.1016/j.jhsa.2010.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 12/10/2010] [Accepted: 12/11/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effects of surface modification of extrasynovial tendon with a carbodiimide derivatized synovial fluid (SF) on the gliding ability of extrasynovial tendon for a possible tendon graft application. METHODS We used 63 peroneus longus tendons from canine hind legs. We immediately assessed 3 tendons morphologically using a scanning electron microscope (SEM); these served as the normal tendon group. The other 60 tendons were randomly assigned to each of 6 experimental groups treated with (1) control (saline); (2) 1% 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC) plus 1% N-hydroxysuccinimide (NHS) (cd only); (3) 1% EDC/NHS plus 10% gelatin (cd-G); (4) SF plus 1% EDC/NHS plus 10% gelatin (cd-SF-G); (5) SF only; or (6) SF plus 1% EDC/NHS (cd-SF). We measured the gliding resistance for 1,000 cycles of simulated flexion-extension motion. We also observed the tendon surface smoothness by SEM. RESULTS Compared with the first cycle in each group, the gliding resistance after 1,000 cycles of tendon motion was significantly increased in the control, cd only, cd-gelatin, SF only, and cd-SF groups (p<.05). In contrast, we found no significant difference in gliding resistance between the first cycle and 1,000 cycles for the cd-SF-G-treated group. In addition, the gliding resistance in the cd-SF, cd-G, and cd-SF-G groups was significantly lower than the control group after 1,000 cycles of tendon motion (p<.05) and the gliding resistance of the cd-SF-G group was significantly lower than both the cd-G and cd-SF groups (p<.05). On SEM, the surface treated with cd-SF-G was smooth after 1,000 cycles, whereas the other surfaces were rough. CONCLUSIONS Surface modification of extrasynovial tendon with cd-SF-G improves tendon gliding ability. This treatment may be useful clinically in improving the outcomes of tendon autografts.
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Affiliation(s)
- Jun Ikeda
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
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Kohn MD, Sun YL, Zhao C, Thoreson AR, Jay GD, An KN, Amadio PC. Human synoviocyte lubricin and bovine synovial fluid lubricin equally improve gliding resistance in a canine model in vitro. Biomed Mater Eng 2011; 21:281-9. [PMID: 22561248 DOI: 10.3233/bme-2012-0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The lubricating ability of human synoviocyte lubricin and bovine lubricin purified from synovial fluid was investigated and compared using a canine in vitro tendon model. Our null hypothesis was that these two forms of lubricin would have equal lubricating ability. Forty two canine hind-limbs were used. The peroneus longus (PL) tendons were harvested, along with the proximal phalanx and flexor digitorum profundus of the second or fifth digit with its proximal fibro-osseous pulley. Forty PL tendons were randomly assigned to one of four treatment groups. After gliding resistance testing, two intact PL tendons and two tendons in each group were randomly selected for surface observation with scanning electron microscopy (SEM). The variance of the PL saline group mean gliding resistance was significantly different from other groups. There was a significant treatment-cycle interaction effect on the mean gliding resistance. On SEM, the surface of the saline treated PL tendons appeared rough, whereas the other tendon surfaces appeared smooth. Human synoviocyte lubricin functioned as well as bovine synovial fluid lubricin to reduce friction of canine PL tendons in vitro. This data suggest that treatment using the two forms of lubricin are mechanically similar.
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Affiliation(s)
- Mark D Kohn
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
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Moriya T, Zhao C, Yamashita T, An KN, Amadio PC. Effect of core suture technique and type on the gliding resistance during cyclic motion following flexor tendon repair: a cadaveric study. J Orthop Res 2010; 28:1475-81. [PMID: 20872584 PMCID: PMC3906802 DOI: 10.1002/jor.21177] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We investigated the effects of two suture techniques using three suture types in a human model in vitro. We obtained 60 flexor digitorum profundus (FDP) tendons from cadavers and measured the gliding resistance during 1,000 cycles of simulated flexion-extension motion and load to failure of six groups: the modified Kessler (MK) repair using 3-0 coated, braided polyester (Ethibond, Ethicon, Somerville, NJ), 3-0 coated, braided polyester/monofilament polyethylene composite (FiberWire®; Arthrex, Naples, FL), or 4-0 FiberWire; and the Massachusetts General Hospital (MGH) repair using 3-0 Ethibond, 3-0 FiberWire, or 4-0 FiberWire. The 3-0 Ethibond MGH suture had significantly higher ultimate load to failure than the 3-0 or 4-0 FiberWire MK suture. The 3-0 and 4-0 FiberWire MGH sutures had significantly higher load to failure than the three MK groups. The gliding resistances of the three MGH groups were significantly higher than that of the three corresponding MK groups. The MGH repair had more gliding resistance than an MK repair, even when comparing large diameter suture in the MK repair with smaller diameter suture in the MGH repair. In this study, suture technique was more important in predicting repair load to failure and gliding resistance than the nature or caliber of the suture material that was used.
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Affiliation(s)
- Tamami Moriya
- Orthopedic Biomechanics Laboratory, Division of Orthopaedic Research, Mayo Clinic, 200 1st Street Southwest, Rochester, Minnesota
| | - Chunfeng Zhao
- Orthopedic Biomechanics Laboratory, Division of Orthopaedic Research, Mayo Clinic, 200 1st Street Southwest, Rochester, Minnesota
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University of Medicine, Sapporo, Japan
| | - Kai-Nan An
- Orthopedic Biomechanics Laboratory, Division of Orthopaedic Research, Mayo Clinic, 200 1st Street Southwest, Rochester, Minnesota
| | - Peter C. Amadio
- Orthopedic Biomechanics Laboratory, Division of Orthopaedic Research, Mayo Clinic, 200 1st Street Southwest, Rochester, Minnesota
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Technical and biological modifications for enhanced flexor tendon repair. J Hand Surg Am 2010; 35:1031-7; quiz 1038. [PMID: 20513584 PMCID: PMC2896490 DOI: 10.1016/j.jhsa.2009.12.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/29/2009] [Accepted: 12/29/2009] [Indexed: 02/02/2023]
Abstract
Clinical outcomes after intrasynovial flexor tendon repair have been substantially improved over the past 2 decades through advances in tendon suture techniques and postoperative rehabilitation methods. Nevertheless, complications such as repair site elongation (i.e., gap formation) and rupture continue to occur frequently. Experimental studies have shown that repair site strength fails to increase in the first 3 weeks after tendon suture. After 3 weeks, the strength and rigidity of the repair site improve significantly, a process that continues for several months. Formation of a repair site gap during the early rehabilitation period has been shown to considerably delay the accrual of repair site strength over time. Thus, it is of prime importance that the method of tendon suture achieves and maintains a stiff and strong repair site during the early healing interval by maintaining close approximation of the tendon stumps and by stimulating, where possible, the intrinsic repair response. In this review, we describe recent efforts to enhance the integrity of the immature repair site. We focus on 2 major areas of advancement: surgical technique modifications and manipulation of the biologic and biochemical environment.
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Zhao C, Sun YL, Kirk RL, Thoreson AR, Jay GD, Moran SL, An KN, Amadio PC. Effects of a lubricin-containing compound on the results of flexor tendon repair in a canine model in vivo. J Bone Joint Surg Am 2010; 92:1453-61. [PMID: 20516321 PMCID: PMC2874669 DOI: 10.2106/jbjs.i.00765] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tendon surface modification with a synthetic biopolymer, carbodiimide-derivatized hyaluronic acid and gelatin with the addition of lubricin (CHL), has been shown to reduce gliding resistance after tendon repair in an in vitro model. The purpose of the study was to investigate whether CHL would reduce adhesion formation and improve digital function after flexor tendon repair in a canine model in vivo. METHODS Sixty dogs were randomly assigned to either a biopolymer-treated group (n = 30) or an untreated control group (n = 30). The second and fifth flexor digitorum profundus tendons from each dog were lacerated fully at the zone-II area and then repaired. Passive synergistic motion therapy was started on the fifth postoperative day and continued until the dogs were killed on day 10, day 21, or day 42. The repaired tendons were evaluated for adhesions, normalized work of flexion, gliding resistance, repair strength, stiffness, and histological characteristics. RESULTS The normalized work of flexion of the repaired tendons treated with CHL was significantly lower than that of the non-CHL-treated repaired tendons at all time points (p < 0.05), and the prevalence of severe adhesions was also significantly decreased in the CHL-treated tendons at day 42 (p < 0.05). However, the repair failure strength and stiffness of the CHL-treated group were also significantly reduced compared with those of the control group at days 21 and 42 (p < 0.05) and the rate of tendon rupture was significantly higher in the treated group than in the control group at day 42 (p < 0.05). CONCLUSIONS Treatment with the lubricin-containing gel CHL appears to be an effective means of decreasing postoperative flexor tendon adhesions, but it is also associated with some impairment of tendon healing. Future studies will be necessary to determine if the positive effects of CHL on adhesion formation can be maintained while reducing its adverse effect on the structural integrity of the repaired tendon.
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Affiliation(s)
- Chunfeng Zhao
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio:
| | - Yu-Long Sun
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio:
| | - Ramona L. Kirk
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio:
| | - Andrew R. Thoreson
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio:
| | - Gregory D. Jay
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 1 Hopping Street, Providence, RI 02903
| | - Steven L. Moran
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio:
| | - Kai-Nan An
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio:
| | - Peter C. Amadio
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio:
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Ikeda J, Zhao C, Sun YL, An KN, Amadio PC. Carbodiimide-derivatized hyaluronic acid surface modification of lyophilized flexor tendon: a biomechanical study in a canine in vitro model. J Bone Joint Surg Am 2010; 92:388-95. [PMID: 20124066 PMCID: PMC6948808 DOI: 10.2106/jbjs.h.01641] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Intrasynovial grafts are the ideal solution to replace defects in intrasynovial flexor tendons, but autologous graft sources are rarely available. The purpose of the present study was to test the hypotheses that an intrasynovial tendon prepared with repetitive freeze-thaw cycles and lyophilization (as a means of reducing immunogenicity) has increased frictional force (gliding resistance) in comparison with fresh intrasynovial tendons and that a lyophilized intrasynovial flexor tendon that is modified with carbodiimide-derivatized hyaluronic acid and gelatin has decreased frictional force in comparison with untreated lyophilized tendons. METHODS Thirty-six flexor digitorum profundus tendons from the second and fifth digits of canine hind paws were randomly assigned to three groups. Twelve tendons were immediately assessed both mechanically and morphologically and served as the normal tendon group. The other twenty-four tendons were prepared with repetitive freeze-thaw cycles and lyophilization and were randomly assigned to two groups, including one group in which the tendons were treated with carbodiimide-derivatized hyaluronic acid and gelatin and one group in which the tendons were not treated. The frictional force was measured during 1000 cycles of simulated flexion-extension motion in all tendons, and the mean frictional forces were compared. The tendons were then observed with use of transmitted light microscopy for residual hyaluronic acid on the tendon surface, and the smoothness of the surface was evaluated with use of scanning electron microscopy. RESULTS The frictional force after lyophilization was significantly increased by 104.9% after the first cycle and by 99.5% after 1000 cycles in comparison with the normal tendon (p < 0.05). The frictional force of the lyophilized tendons after treatment with carbodiimide-derivatized hyaluronic acid and gelatin was not significantly different from that of normal tendons. The untreated lyophilized tendon surfaces were observed on scanning electron microscopy to be rough in appearance, whereas the normal surface and the surface treated with carbodiimide-derivatized hyaluronic acid and gelatin were smooth, with residual hyaluronic acid present on the gliding surface. CONCLUSIONS Lyophilization alters tendon surface morphology and increases tendon frictional force. Surface modification with carbodiimide-derivatized hyaluronic acid and gelatin can mitigate this adverse effect. CLINICAL RELEVANCE Tendon surface modification with carbodiimide-derivatized hyaluronic acid and gelatin can improve the gliding ability of lyophilized flexor tendons and therefore may improve the utility of lyophilized tendon allografts as a tendon graft substitute.
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Affiliation(s)
- Jun Ikeda
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Chunfeng Zhao
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Yu-Long Sun
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Kai-Nan An
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Peter C. Amadio
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
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Taguchi M, Zhao C, Sun YL, Jay GD, An KN, Amadio PC. The effect of surface treatment using hyaluronic acid and lubricin on the gliding resistance of human extrasynovial tendons in vitro. J Hand Surg Am 2009; 34:1276-81. [PMID: 19556078 PMCID: PMC2730995 DOI: 10.1016/j.jhsa.2009.04.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 03/20/2009] [Accepted: 04/07/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effects of tendon surface treatment using hyaluronic acid (HA) and lubricin on the gliding resistance of human extrasynovial palmaris longus (PL) tendon in vitro. METHODS Thirty-two fresh-frozen cadaver human fingers and 16 ipsilateral PL tendons were used. Each PL tendon was divided into 2 pieces, which were randomly assigned into 4 experimental groups. After the gliding resistance of the normal PL tendon segments were measured, the tendons were treated with either saline, carbodiimide derivatized (cd) gelatin and HA (cd-HA gelatin), cd gelatin with lubricin added (cd gelatin plus lubricin), or cd-HA gelatin plus lubricin. After treatment, tendon gliding resistance was measured during up to 1000 cycles of simulated flexion and extension motion. RESULTS The gliding resistance of the PL tendons in the cd-HA gelatin, cd gelatin plus lubricin, and cd-HA gelatin plus lubricin groups was significantly lower than that of the saline-treated control after 1000 cycles. The gliding resistance in these treatment groups decreased within the first 50 cycles and then increased at a much more gradual rate over the 1000 cycles, with the cd-HA gelatin plus lubricin group being most stable. CONCLUSIONS The results suggest that tendon surface treatment using HA and lubricin can improve the gliding of human PL tendon in vitro. If validated in vivo, tendon surface treatment has the potential to improve the gliding ability of tendon grafts clinically.
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Affiliation(s)
- Manabu Taguchi
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research Mayo Clinic, Rochester, MN
| | - Chunfeng Zhao
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research Mayo Clinic, Rochester, MN
| | - Yu-Long Sun
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research Mayo Clinic, Rochester, MN
| | - Gregory D. Jay
- Department of Emergency Medicine, Rhode Island Hospital and Brown University, Providence, Rhode Island
| | - Kai-Nan An
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research Mayo Clinic, Rochester, MN
| | - Peter C. Amadio
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research Mayo Clinic, Rochester, MN
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