Flexor tendon injuries affecting hand function are common in young adults, and frequently result in significant disability. Adhesion formation continues to be a difficult problem, which leads a poor outcome after flexor tendon repairs. The tendon graft still plays a very important role in reconstruction to restore finger function, either to replace a damaged tendon or to lengthen a healthy tendon for transfer. Clinically, although most tendon grafts go into a synovial environment i.e., a tendon system that includes a synovially lined sheath, most tendon grafts come from extrasynovial tendon sources. Animal models have shown that extrasynovial tendon grafts are associated with more adhesions to the surrounding tissue than intrasynovial tendon grafts. In the previously pilot study, we found that extrasynovial tendon has a rough surface and higher gliding resistance compared to intrasynovial tendon. Although friction can be reduced with the application of hyaluronic acid (HA) applied to the tendon surface, its effect is diminished after repetitive motion because of weak binding between HA and the tendon surface. Furthermore, the half-life of HA in tissues is short. We have found that carbodiimide derivatization of HA (cd-HA) gelatin enhances the binding ability of HA to the tendon surface, decreases the friction, and increase the half-life of HA in tissues in vitro. We hypothesize that cd-HA gelatin can improve the gliding ability and the abrasion effect of tendon grafts in vivo, and thereby decreasing adhesion formation. In order to test this hypothesis, the following specific aims are proposed: 1) To identify and quantify the surface status of extrasynovial tendon modified by cd-HA gelatin in vitro, 2) To identify the gliding characteristics, adhesion formation, and healing status in vivo after tendon grafting with an extrasynovial tendon treated by the cd-HA gelatin. If the hypothesis is supported, future studies can investigate the mechanisms by which this effect on tendon graft gliding and adhesions is achieved, and the use of cd-HA gelatin as a vehicle to carry anti-inflammatory or growth factors to the tendon surface, to improve the quality of tendon graft healing.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Small Research Grants (R03)
Project #
1R03AR049407-01A1
Application #
6709737
Study Section
Special Emphasis Panel (ZAR1-RJB-D (O1))
Program Officer
Panagis, James S
Project Start
2004-09-30
Project End
2007-05-31
Budget Start
2004-09-30
Budget End
2005-05-31
Support Year
1
Fiscal Year
2004
Total Cost
$73,750
Indirect Cost
Name
Mayo Clinic, Rochester
Department
Type
DUNS #
006471700
City
Rochester
State
MN
Country
United States
Zip Code
55905
Ikeda, Jun; Zhao, Chunfeng; Chen, Qingshan et al. (2011) Compressive properties of cd-HA-gelatin modified intrasynovial tendon allograft in canine model in vivo. J Biomech 44:1793-6
Ikeda, Jun; Sun, Yu-Long; An, Kai-Nan et al. (2011) Application of carbodiimide derivatized synovial fluid to enhance extrasynovial tendon gliding ability. J Hand Surg Am 36:456-63
Moriya, Tamami; Zhao, Chunfeng; An, Kai-Nan et al. (2010) The effect of epitendinous suture technique on gliding resistance during cyclic motion after flexor tendon repair: a cadaveric study. J Hand Surg Am 35:552-8
Giambini, Hugo; Ikeda, Jun; Amadio, Peter C et al. (2010) The quadriga effect revisited: designing a ""safety incision"" to prevent tendon repair rupture and gap formation in a canine model in vitro. J Orthop Res 28:1482-9
Zhao, Chunfeng; Sun, Yu-Long; Ikeda, Jun et al. (2010) Improvement of flexor tendon reconstruction with carbodiimide-derivatized hyaluronic acid and gelatin-modified intrasynovial allografts: study of a primary repair failure model. J Bone Joint Surg Am 92:2817-28
Sun, Yu-Long; Thoreson, Andrew R; Cha, Stephen S et al. (2010) Temporal response of canine flexor tendon to limb suspension. J Appl Physiol 109:1762-8
Omae, H; Zhao, C; Sun, Y-L et al. (2009) The effect of tissue culture on suture holding strength and degradation in canine tendon. J Hand Surg Eur Vol 34:643-50
Dorf, Erik R; Chhabra, A Bobby; Golish, S Raymond et al. (2007) Effect of elbow position on grip strength in the evaluation of lateral epicondylitis. J Hand Surg Am 32:882-6
Tanaka, Toshikazu; Zhao, Chunfeng; Sun, Yu-Long et al. (2007) The effect of carbodiimide-derivatized hyaluronic acid and gelatin surface modification on peroneus longus tendon graft in a short-term canine model in vivo. J Hand Surg Am 32:876-81
Tanaka, Toshikazu; Sun, Yu-Long; Zhao, Chunfeng et al. (2006) Effect of curing time and concentration for a chemical treatment that improves surface gliding for extrasynovial tendon grafts in vitro. J Biomed Mater Res A 79:451-5

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