Revitalized and synovialized allograft for intrasynovial flexor tendon reconstruction in an in vivo canine model

Zhang, Tao; Lu, Cheng‐Chang; Reisdorf, Ramona L.; Thoreson, Andrew R.; Gingery, Anne; Moran, Steven L.; Amadio, Peter C.; Zhao, Chunfeng

doi:10.1002/jor.23889

Cited by 6 publications

(10 citation statements)

References 47 publications

(72 reference statements)

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“…In the One Health scenario, the investigation of the treatment of flexor tendon diseases in dogs can be useful for the collection of preclinical data. The flexor tendon system of dogs has often been studied as an animal model for the investigation of the flexor tendon healing process, and the results have already been applied in human medicine ( 24 ). Moreover, the regenerative approach seems to be promising for tendon pathology management in both veterinary and human medicine, since PRP is currently the most exploited strategy in human clinical practice to provide a regenerative stimulus for tendon healing.…”

Section: Discussionmentioning

confidence: 99%

Case report: Flexor carpi ulnaris tendinopathy in a lure-coursing dog treated with three platelet-rich plasma and platelet lysate injections

Franini¹,

Entani²,

Colosio³

et al. 2023

Front. Vet. Sci.

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In the present case report a 7-year-old male Whippet competing in lure-coursing presented with third-degree recurrent lameness of the right forelimb, pain on palpation of the caudal aspect of the carpus and swelling of the forearm proximally to the accessory carpal bone. Clinical, radiographic, and ultrasonographic evaluation diagnosed a flexor carpi ulnaris (FCU) chronic tendinopathy unresponsive to previously attempted conservative treatments such as oral non-steroidal anti-inflammatory drugs (NSAIDs) administration along with padded palmar splint application and rest. The dog was subjected to one injection of autologous platelet-rich plasma (PRP) obtained using a double centrifugation tube method, followed by two platelet lysate (PL) injections. Treatment was administered at three-week intervals. The healing process was assessed through clinical and ultrasonographic imaging (US) on the day of the first injection (T0), and at week three (T1), six (T2), twelve (T3), fifty-two (T4), and one-hundred-and-four (T5). Fiber alignment score (FAS) and echogenicity score (ES) were developed by modifying a previously published US assessment scale. At T1, ES, and FAS improvement was detected, and at T2, further improvements in ES and FAS were observed. Ultrasonographic results were clinically consistent with the improvement in lameness: lameness grade 3/4 was detected at T0 and grade 2/4 at T1. A lameness grade of 1/4 was detected at T2, and grade 0/4 was observed at T3, T4, and T5. Moreover, at T5, the dog returned to competition, and no history of re-injury was reported. Our results suggest that the treatment of FCU tendinopathy in lure-coursing dogs with a combination of consecutive injections of autologous PRP and PL could be feasible. Additionally, no adverse reactions were observed.

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Section: Discussionmentioning

confidence: 99%

Case report: Flexor carpi ulnaris tendinopathy in a lure-coursing dog treated with three platelet-rich plasma and platelet lysate injections

Franini¹,

Entani²,

Colosio³

et al. 2023

Front. Vet. Sci.

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“…Afterward, each tendon was laterally made with slits for cellseeding and revitalization and then decellularized and sterilized according to previously established protocols. 11,13 Briefly, six slits were made laterally on both sides of the tendons. The tendons were then immersed in liquid nitrogen for 1 min, followed by thawing in a F I G U R E 1 Study design.…”

Section: Allogenic and Autologous Graft Preparationmentioning

confidence: 99%

Cell‐based tissue engineered flexor tendon allograft: A canine in vivo study

Lin,

Reisdorf,

et al. 2024

Journal Orthopaedic Research

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This study aimed to compare the clinically established autologous extrasynovial tendon graft to a newly developed tissue‐engineered allograft (Eng‐allograft) in terms of functional outcomes following flexor tendon reconstruction in a canine model. The second and fifth flexor digitorum profundus (FDP) tendons from 16 dogs were transected and repaired in Zone II. After 6 weeks of cage activity, the repaired tendons were intentionally ruptured, creating a clinically relevant model for reconstruction. The re‐ruptured FDP tendons were then reconstructed using either the clinically standard autologous extrasynovial tendon graft or the Eng‐allograft, which had been revitalized with autologous bone marrow‐derived mesenchymal stem cells (BMSCs) and synovialized using carbodiimide derivatized synovial fluid (cd‐SYN). Following 12 weeks of postoperative rehabilitation, the functional outcomes of the surgical digits were evaluated. The Eng‐allograft group exhibited improved digital function, including lower digit work of flexion and reduced adhesion status, while maintaining similar tendon gliding resistance compared to the autograft group. However, the failure load of both the distal and proximal host/graft conjunctions in the Eng‐allograft group was significantly lower than that of the autograft group with higher graft rupture at the host−graft junction. In conclusion, the decellularized allogenic intrasynovial tendon, when revitalized BMSCs and synovialized with cd‐SYN, demonstrates positive effects on digital function improvement and adhesion reduction. However, the healing at both proximal and distal graft/host junctions is far lower than the autograft. Further research is needed to enhance the healing capacity of allograft conjunctions, aiming to achieve a comparable level of healing seen with autografts.

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“…108 Future developments in tendon allografts with ideal strength and gliding properties will negate the need for donor tendon harvest. 109,110…”

Section: Future Directionsmentioning

confidence: 99%

Secondary Procedures following Flexor Tendon Reconstruction

Gillis

Moran

2021

Plastic &Amp; Reconstructive Surgery

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he incidence of flexor tendon injury is 33 injuries per 100,000 person-years. 1,2 Advancements in flexor tendon repair, including wide-awake surgery, have led to improved outcomes. 3 In studies using multiple strand repairs and active range of motion, excellent results (defined as total active range of motion more than 150 degrees 4 ) have been noted in up to 86 percent of cases. 5,6 Despite this, reoperation still occurs. In a retrospective review of 5229 patients undergoing primary flexor tendon repair, there was a 6 percent reoperation rate, with 58 percent of these patients requiring tenolysis alone, 38 percent requiring rerepair alone, and 4 percent requiring both. 7 In such cases, the surgeon must have an understanding of the available reconstructive options for the treatment of patients with neglected, failed, or scarred tendon repairs. This article will review the indications and management options for failed flexor tendon surgery. THE MECHANICAL IMPACT OF FAILED FLEXOR TENDON REPAIRComplications following flexor tendon repairs include decreased range of motion, tendon bowstringing, quadriga, and lumbrical-plus deformity. 8-10 Compared to patients with primary flexor tendon repair, who have a mean QuickDASH score of 19.3, patients who require two-stage tendon reconstruction have a mean QuickDASH score of 34.4, emphasizing the importance of successful primary repair. 11 Flexor tendon pulley injury and tendon bowstringing can contribute to poor results. The pulley system consists of several fibro-osseous tunnels that run from the metacarpal head to the distal interphalangeal joint. These tunnels hold the tendons close to the joint's axis, allowing maximal motion for small amounts of tendon excursion. Biomechanical cadaver studies show an 8.5 percent increase in tendon excursion with loss of the A2 pulley, a 9.9 percent increase with loss of the A4 pulley, and a 33.7 percent increase with loss of both A2 and A4. 12 The loss of both pulleys leads to a 107 percent increase in the work of flexion. 12 This can lead to loss of motion and joint contracture. Pulley damage can be avoided by accessing and performing the tendon repair through the cruciate pulleys. Recent reports have shown that

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Revitalized and synovialized allograft for intrasynovial flexor tendon reconstruction in an in vivo canine model

Cited by 6 publications

References 47 publications

Case report: Flexor carpi ulnaris tendinopathy in a lure-coursing dog treated with three platelet-rich plasma and platelet lysate injections

Case report: Flexor carpi ulnaris tendinopathy in a lure-coursing dog treated with three platelet-rich plasma and platelet lysate injections

Cell‐based tissue engineered flexor tendon allograft: A canine in vivo study

Secondary Procedures following Flexor Tendon Reconstruction

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