Sheath formation in response to limited active gliding implants (animals).

Experiments were conducted to further the understanding of tendon reconstructive surgery. A series of 20 dogs was used for replacement of the forepaw extensor carpi radialis tendon (a single tendon only is present in the dog) with active gliding tendon implants. The implants were attached distally and proximally so that new tendon prosthetic designs could be studied as well as new sheath development under gliding conditions. The results, recorded in this paper, show that a “gliding implant” can convert a nonspecific bed of connective tissue or scar into a specific living envelope comparable to a tendon sheath system. This system has been shown to be capable of lubricating and supporting a gliding artificial implant while augmenting normal tendon function. Degrees of active and passive gliding can take place for indefinite periods, providing the mechanical and dynamic capabilities of the new system are understood and controlled. The mature sheath will show a predictable physiologic response to unfavorable stimuli. Further evidence that the new gliding system functions as a physiologic sheath is borne out by the fact that the implant can be replaced in Stage II by a long free tendon graft. The graft is apparently supported in part by fluid nutrition and filmy adhesions between the distal and proximal anastomosis.