Advances in the Biology of Zone II Flexor Tendon Healing and Adhesion Formation

Modulation of peritendinous adhesion formation by alginate solution in a rabbit flexor tendon model

“…13 In an effort to minimize adhesion after tendon repair, biochemical materials such as monomolecular cellulose filter tubes, 1 polyethylene tubes, 2 and silastic sheaths 3 have been tested as mechanical barriers around the repair site, but no satisfactory approach has been established. All these materials failed because they stimulated a severe inflammatory response or prevented nutrient diffusion to the healing tendon, leading to tendon necrosis.…”

“…6 Tenocytes within the tendon and epitenon play an important role in the intrinsic mechanism, while in the extrinsic mechanism, inflammatory cells and fibroblasts from the overlying sheath and periphery are the main participants. 13,14 Although synovial sheath cells move into the tendon core soon after tendon injury, 5 there is a time lag in the initiation of intrinsic healing. 6 It is therefore considered that if an intrinsic response could be stimulated at the early stage of tendon healing, the outcome of tendon repair would be preferable with regard to reducing peritendinous adhesion.…”

Biomechanics of tendon injury and repair

“…It is plausible that tendon healing most likely occurs as a combination of both processes and is dependent on tendon location, the magnitude of tendon trauma, availability of synovial fluid and a blood supply, and degree of tendon mobilization. A better understanding of this balance between processes may allow surgeons to eventually tailor their surgical procedures to best reestablish tendon continuity and function (Jaibaji, 2000;Manske, 1988;Lundborg et al, 1985;Manske et al, 1985).…”

“…After trauma, the ECM degradation products are essential for tendon healing because they provide chemotactic signals for fibroblasts, leukocytes, and endothelial cells, and serve as a reservoir for cytokines (Jaibaji, 2000). Despite the similarity of having cells and extracellular matrix proteins becoming more active in response to an injury, tendons do exhibit a differential capacity to heal.…”

Autologous venous grafting promotes healing and reduces adhesion formation in experimentally severed canine superficial digital flexor tendons

“…Despite advances in the surgical techniques and postoperative management, difficulties with tendon repair (delayed return of tendon strength for approximately 3 weeks following repair, gap formation, longitudinal fibre orientation complicating sutureholding, adhesion formation) are faced. Furthermore, tendon repair encounters technical (essentially physical problems) and biological (concerns primarily with vascularisation and peri-tendinous fibrosis causing adhesion formation) issues (Akali et al, 1999;Jaibaji, 2000;Ferguson & Rinker, 2006;Temizet al, 2008;Mousavi et al, 2009). …”