Experimental study of tendon sheath repair via decellularized amnion to prevent tendon adhesion

Abstract

The adhesion of tendon and surrounding tissue is the most common complication after repairing an injured tendon. The injured flexor tendons in zone II are frequently accompanied by tendon sheath defects, which lead to poor recovery. A variety of biological and non-biological materials have been recently used for repair or as substitute for tendon sheaths to prevent tendon adhesion. However, non-biological materials, such as polyethylene films, have been used to prevent tendon adhesions by mechanical isolation. The possibility of tendon necrosis and permanent foreign body remains due to the lack of permeability and the obstruction of nutrient infiltration. The natural macromolecule amniotic membrane derived from organisms is a semi-permeable membrane with the following characteristics: smooth; without vascular, nerve, and lymphatic; and rich in matrix, cytokines, enzymes, and other active ingredients. The unique structure of this membrane makes it an ideal biomaterial. In the experiment in Henry chicken, the model of tendon sheath defect and the flexor digitorum tendon in zone II was established and randomly divided into control group, medical membrane group, and decellularized amniotic membrane group. Samples were obtained at the 2nd, 4th, 8th, and 12th week after operation. General, histological, and biomechanical tests were performed to investigate the preventive effect of repaired tendon sheath by decallularized amniotic membrane. Experimental results showed the following: the amniotic membrane group and the medical membrane group had mild inflammatory reaction and tissue edema, and nearly no adhesion was observed in the surrounding tissue; the fibroblast-like cells were distributed in layers under the light microscope; the amniotic membrane group was denser than the medical membrane group cells, and numerous fibroblasts were disorganized in the control group. Biomechanical measurements showed that the sliding distance of tendon, the total flexion angle of the toes, and the tendon maximum tensile breaking strength at the early postoperative were significantly better than in the control group. Through this experiment, the amniotic membrane, as a natural biological substitute material in the construction of tendon sheath, can effectively inhibit exogenous healing and promote endogenous healing to prevent tendon adhesion.

Cross‐linked cartilage acellular matrix film decreases postsurgical peritendinous adhesions

“…The barrier also requires a longer degradation profile compared to abdominal surgery products, as tendon healing requires a longer period of time compared to intra‐abdominal organs. The barrier should selectively block extrinsic healing and not interfere with intrinsic healing of the tendon . In the current study, we have developed an antiadhesive barrier film utilizing decellularized cartilage ECM for use in tendon surgery.…”

“…Most natural polymer based products, however, are biomechanically weak and degrade too quickly to be used during tendon surgery. Such limitations have led to research regarding decellularized tissue, which are both bioactive and biomechanically stronger than classic natural polymers . Liu et al have used decellularized amniotic membrane in a chicken flexor tendon injury model and achieved both less adhesion and better healing than the repair alone group .…”

“…The barrier should selectively block extrinsic healing and not interfere with intrinsic healing of the tendon. 24 In the current study, we have developed an antiadhesive barrier film utilizing decellularized cartilage ECM for use in tendon surgery. The resultant CAM film was biomechanically robust to withstand surgical handling and sutures while being biochemically similar to cartilage ECM.…”

“…Such limitations have led to research regarding decellularized tissue, which are both bioactive and biomechanically stronger than classic natural polymers. 24,34 Liu et al have used decellularized amniotic membrane in a chicken flexor tendon injury model and achieved both less adhesion and better healing than the repair alone group. 24 Authors described the membrane to be smooth and elastic, while degradable in vivo.…”

“…24,34 Liu et al have used decellularized amniotic membrane in a chicken flexor tendon injury model and achieved both less adhesion and better healing than the repair alone group. 24 Authors described the membrane to be smooth and elastic, while degradable in vivo. They also noted that the amniotic membrane holds variety of collagen, glycoproteins, and proteoglycans, which may have contributed to tendon gliding and reduced peritendinous adhesions.…”