Effects of a lubricin-containing compound on the results of flexor tendon repair in a canine model in vivo

Chunfeng D Zhao, Yu Long Sun, Ramona L. Kirk, Andrew R. Thoreson, Gregory D. Jay, Steven Lawrence Moran, Kai Nan An, Peter C Amadio

Research output: Contribution to journalArticle

50 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1453-1461
Number of pages9
JournalJournal of Bone and Joint Surgery - Series A
Volume92
Issue number6
DOIs
StatePublished - Jun 1 2010

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Tendons
Canidae
Biopolymers
Dogs
Control Groups
lubricin
Carbodiimides
Hyaluronic Acid
Gelatin
Rupture
Gels

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Effects of a lubricin-containing compound on the results of flexor tendon repair in a canine model in vivo. / Zhao, Chunfeng D; Sun, Yu Long; Kirk, Ramona L.; Thoreson, Andrew R.; Jay, Gregory D.; Moran, Steven Lawrence; An, Kai Nan; Amadio, Peter C.

In: Journal of Bone and Joint Surgery - Series A, Vol. 92, No. 6, 01.06.2010, p. 1453-1461.

Research output: Contribution to journalArticle

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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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AU - Moran, Steven Lawrence

AU - An, Kai Nan

AU - Amadio, Peter C

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