Prevention of peritendinous adhesions using a hyaluronan-derived hydrogel film following partial-thickness flexor tendon injury

Peritendinous adhesions are an important complication of flexor tendon injury. Three hyaluronan (HA)-derived biomaterials were evaluated for the reduction of peritendinous adhesions following partial-thickness tendon injury in rabbits. Rabbits (n = 24) were divided into three groups (n = 8 per group), which were used for gross evaluation, histologic assessment, or biomechanical testing. The fourth and third toes from both hindpaws of each rabbit were randomly assigned to one of four treatments: (i) untreated control, (ii) Seprafilm((R)), (iii) Carbylan (TM)-SX in situ crosslinked hydrogel, and (iv) preformed Carbylan (TM)-SX film. Rabbits were sacrificed at 3 weeks postsurgery and evaluated anatomically, histologically, and mechanically. All materials used reduced adhesions relative to untreated controls for all three evaluations. Both the gross anatomic and histologic results revealed that Carbylan (TM)-SX film was statistically superior to Seprafilm((R)) and Carbylan (TM)-SX gel in preventing tendon adhesion formation. In biomechanical tests, the Carbylan (TM)-SX film-treated hindpaws required the least force to pull the tendon from the sheath. This force was statistically indistinguishable from that required to extrude an unoperated tendon (n = 8). Carbylan (TM)-SX gel was less effective than Carbylan (TM)-SX film but superior to Seprafilm((R)) for all evaluations. A crosslinked HA-derived film promoted healing of a flexor tendon injury without the formation of fibrosis at 3 weeks postoperatively. (c) 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.