Chondroitin sulfate-coated polyhydroxyethyl methacrylate membrane prevents adhesion in full-thickness tendon tears of rabbits.

Polyhydroxyethyl methacrylate (pHEMA) membranes coated on one side with chondroitin sulfate (CS) were used to block adhesion physically and to reduce friction between healing flexor tendons and the surrounding tissue in rabbit forepaws after surgical repair. Digits with pHEMA-only, standard tendon sheath repair, and with no sheath repair were the controls. Over 12 weeks the CS-coated membranes were evaluated for joint flexion, adhesion limitation, and tendon healing progress. The membranes initially allowed for better flexion (ie, for 6 weeks), but their relative superior effectiveness faded afterward. Histology showed that adhesions were less severe and healing was better in the CS-pHEMA membranes at 3 and 6 weeks. If further studies determine precise amounts or thicknesses of CS coats that will maximize its healing properties, CS-pHEMA should prove useful in clinical settings in which restoration of tendon sheath integrity with a minimum of adhesions is not possible.

[1]  M. Nyska,et al.  Decreased adhesion formation in flexor tendons by topical application of enriched collagen solution — a histological study , 1987, Archives of orthopaedic and traumatic surgery.

[2]  M. Jaibaji Advances in the Biology of Zone II Flexor Tendon Healing and Adhesion Formation , 2000, Annals of plastic surgery.

[3]  P. Khaw,et al.  Decrease in adhesion formation by a single application of 5-fluorouracil after flexor tendon injury. , 1999, Plastic and reconstructive surgery.

[4]  Yuehuei H. An,et al.  Animal Models in Orthopaedic Research , 1999 .

[5]  Y. Tropet,et al.  Immediate active mobilisation after flexor tendon repairs in Verdan's zones I and II. A prospective study of 20 cases. , 1998, Chirurgie de la main.

[6]  P R Manske,et al.  Effect of immobilization, immediate mobilization, and delayed mobilization on the resistance to digital flexion using a tendon injury model. , 1997, The Journal of hand surgery.

[7]  S. Shalaby,et al.  Efficacy of hyaluronic acid/nonsteroidal anti-inflammatory drug systems in preventing postsurgical tendon adhesions. , 1997, Journal of biomedical materials research.

[8]  D. Shi,et al.  Biomechanical and histologic evaluation of tendon sheath management. , 1996, The Journal of hand surgery.

[9]  P. Klopper,et al.  Reconstruction of the Flexor Tendon Sheath , 1996, Journal of hand surgery.

[10]  J. Lane,et al.  Collagen in tendon, ligament, and bone healing. A current review. , 1995, Clinical orthopaedics and related research.

[11]  T. Ide,et al.  Effects of hydroxyapatite and alumina sheaths on postoperative peritendinous adhesions in chickens. , 1995, Journal of applied biomaterials : an official journal of the Society for Biomaterials.

[12]  S. Ishii,et al.  Flexor sheath closure during delayed primary tendon repair. , 1994, The Journal of hand surgery.

[13]  B. Widenfalk,et al.  Fibrin sealant in prevention of flexor tendon adhesions: an experimental study in the rabbit. , 1993, The Journal of hand surgery.

[14]  L. Hagberg,et al.  Sodium hyaluronate as an adjunct in adhesion prevention after flexor tendon surgery in rabbits. , 1992, The Journal of hand surgery.

[15]  D. Bartel,et al.  Effects of sodium hyaluronate on tendon healing and adhesion formation in horses. , 1991, American journal of veterinary research.

[16]  R. Szabo,et al.  Effects of indomethacin on adhesion formation after repair of zone II tendon lacerations in the rabbit. , 1990, The Journal of hand surgery.

[17]  D. Horwitz,et al.  Effect of various methods of restoring flexor sheath integrity on the formation of adhesions after tendon injury. , 1990, The Journal of hand surgery.

[18]  B. T. Bennett,et al.  Essentials for animal research. A primer for research personnel. , 1990 .

[19]  J. Nunley,et al.  Effect of hyaluronic acid/chondroitin sulfate on healing of full‐thickness tendon lacerations in rabbits , 1989, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[20]  M. Cohen,et al.  Histology and ultrastructure of the human flexor tendon sheath. , 1987, The Journal of hand surgery.

[21]  Strickland Jw Flexor tendon injuries. Part 1. Anatomy, physiology, biomechanics, healing, and adhesion formation around a repaired tendon. , 1986 .

[22]  D. Hungerford,et al.  Hyaluronic acid and its effect on postoperative adhesions in the rabbit flexor tendon. A preliminary look. , 1986, Clinical orthopaedics and related research.

[23]  S. C. Thomas Hyaluronic acid and its effect on postoperative adhesions in the rabbit flexor tendon , 1986 .

[24]  R. Szabo,et al.  The inhibition of flexor tendon adhesions. , 1986, Bulletin of the Hospital for Joint Diseases Orthopaedic Institute.

[25]  A. Poole,et al.  Biological roles of dermatan sulphate proteoglycans. , 1986, Ciba Foundation symposium.

[26]  M. Nyska,et al.  Increased collagenolytic activity in severed and sutured tendons following topical application of exogenous collagen in chickens , 1985, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[27]  H E Kleinert,et al.  Flexor tendon injuries. , 1981, The Surgical clinics of North America.

[28]  E. Balazs,et al.  A preliminary assessment of Na-hyaluronate injection into "no man's land" for primary flexor tendon repair. , 1980, Clinical orthopaedics and related research.

[29]  R. Austin,et al.  Flexor tendon healing and adhesion formation after Sterispon wrapping: a study in the rabbit. , 1979, Injury.

[30]  G. Lundborg,et al.  Experimental intrinsic healing of flexor tendons based upon synovial fluid nutrition. , 1978, The Journal of hand surgery.

[31]  J. Boyes,et al.  The use of paratenon, polyethylene film, or silastic sheeting to prevent restricting adhesions to tendons in the hand. , 1977, The Journal of bone and joint surgery. American volume.

[32]  T. Hovig,et al.  The ultrastructure of normal digital flexor tendon sheath and of the tissue formed around silicone and polyethylene implants in man , 1977 .

[33]  D. Prockop,et al.  Inhibitors of collagen biosynthesis as a means of controlling scar formation in tendon injury. , 1972, The Journal of bone and joint surgery. American volume.

[34]  J. M. Hunter,et al.  Flexor-tendon reconstruction in severely damaged hands. A two-stage procedure using a silicone-dacron reinforced gliding prosthesis prior to tendon grafting. , 1971, The Journal of bone and joint surgery. American volume.

[35]  W. K. Lindsay,et al.  The effects of an antihistamine (promethazine) on the reaction of tendons to trauma (a histological study). , 1965, Acta chirurgiae plasticae.

[36]  A D POTENZA,et al.  CRITICAL EVALUATION OF FLEXOR-TENDON HEALING AND ADHESION FORMATION WITHIN ARTIFICIAL DIGITAL SHEATHS. , 1963, The Journal of bone and joint surgery. American volume.

[37]  J. Goldner,et al.  An experimental study of the effect of cortisone on the healing process and tensile strength of tendons. , 1954, The Journal of bone and joint surgery. American volume.