History and performance of implant materials applied as peritendinous antiadhesives

Abstract

Peritendinous fibrotic adhesions after tendon surgery are still a problem up-to-date. Approaches to overcome or at least minimize adhesion formation include implantation of barrier materials, application of lubricants or combinations of materials and functionalized drugs that are controllably released and support the healing tendon to glide and achieve the full range of motion after regeneration. Although a huge amount of different materials have been experimentally tested, the optimal strategy with respect to material and method has not yet been determined. In this review, we present a historical overview of physical barriers as well as liquid agents that have been used in order to prevent peritendinous adhesion formation. The materials are divided according to their first publication into two time frames; before and after 1980. There is no claim to include all materials tested neither will the "best" material be chosen; however, we present several materials that were experimentally tested in different animal trials as well as in clinical trials in contrast to other materials that were only tested once and disappeared from the assortment of anti-adhesives; which as such is a valuable information about its applicability for this purpose.

Dual functional core–sheath electrospun hyaluronic acid/polycaprolactone nanofibrous membranes embedded with silver nanoparticles for prevention of peritendinous adhesion

“…Since Thomas et al first reported the efficacy of HA in preventing postoperative adhesions in a rabbit flexor tendon model [25], it has become one of the most widely used peritendinous anti-adhesives [26]. The scientific rationale for the use of HA in the prevention of adhesion formation is based on several biological effects, including non-coagulant activity, modulation of fibrous tissue formation, barrier effect to fibrinogen and inhibition of superoxide release from granulocytes [27].…”

Battling adhesions: from understanding to prevention

“…In relation to tendon adhesions, the barriers used to prevent them must also promote gliding to avoid interfering with tendon movement [95]. To this end, hyaluronic acid gels seem to be the most promising option, although positive results have been mostly observed in preclinical studies since the clinical findings have produced limited and moderate results [53,96]. One example of a commercially available product based on hyaluronic acid is Hyaloglide®, a highly purified auto-cross-linked hyaluronic acid gel.…”

“…Currently, the main fibrinolytic agents investigated are streptokinase, t-PA and PAI-1. Nevertheless, the results obtained have shown poor performance in animal studies and side effects such as bleeding after their use [3,78,96,105].…”

“…Thus, strategies to extend its endurance in the body, such as crosslinking, are being studied to increase its antiadhesion properties. Other anti-inflammatory drugs have been tested in the peritoneum [78], pericardium [3] and tendon [96] to prevent adhesions. Examples of the studied agents include ibuprofen [106], celecoxib [107], resveratrol [108] or pirfenidone [109].…”

Impact of PDGF‐BB on cellular distribution and extracellular matrix in the healing rabbit Achilles tendon three weeks post‐operation

“…An insufficiently strong scar tissue lacking the aligned collagen organization seen in normal healthy tendons often leads to reruptures. The second drawback, adhesion formation between the regenerating tendon and the surrounding tissue, occurs in 7–15% of all cases, leading to a reduced range of motion, which ends up in higher work disability and costs . To address these two problems, an elastic biodegradable polymer tube was developed in our research team .…”