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Evaluating the Effectiveness of Type I Collagen-Glycosaminoglycan in Reducing Adhesions After Flexor Tendon Repair: An In Vivo Pilot Study
Rou Wan, MD
1, Cheng-En Hsu, MD
2, Maggie A. Brosig, BS
1, Ramona Reisdorf, BS
1, Chunfeng Zhao, MD
1; Steve L. Moran, MD
3(1)Mayo Clinic, Rochester, MN, (2)Taichung Veterans General Hospital, Taichung City, Taichung City, Taiwan, (3)Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN
Introduction: Injuries to the flexor tendon of the hand are common. Despite advances in surgical techniques and rehabilitation practices, postoperative adhesions can occur in up to 30% of cases. Adjunct measures have been developed to potentially optimize surgical outcomes. Our previous data demonstrated that type I collagen-glycosaminoglycan (CG) significantly reduced peritendinous adhesion compared to surgery alone and outperformed hyaluronic acid. The aim of this study is to compare two different forms of CG: a commercially available protector sheet (TenoGlide®) and a developmental flowable gel barrier (Collagen Gel), using an in vivo turkey flexor tendon repair model.
Materials&Methods: Nine adult Bourbon Red turkeys were randomized into three groups: (1) control, (2) TenoGlide® sheet form CG and (3) Collagen Gel flowable gel form CG. In all groups, the flexor digitorum profundus tendon of the middle digit was sharply transected at the proximal interphalangeal joint level and then repaired. All operated feet were immobilized in cast until sacrifice six weeks postoperatively. Repaired and contralateral normal digits were collected for biomechanical testing, adhesion score and histological analysis.
Results: At 42 days after tendon repair, the normalized work of flexion (WOF) of the repaired digit in both the TenoGlide® and Collagen Gel groups was lower than that of the control group (Figure 1A). The control group demonstrated the highest load to failure and tendon stiffness (Figure 1B, 1C). Gross adhesion scores, evaluated by two blinded reviewers, were lowest in the TenoGlide group (Figure 2). Histological analysis showed comparable percentages of adhesion tissue between the two treatment groups on H&E staining, as representative images are shown in Figure 3. Longer-term outcome evaluations are currently ongoing up to the 12-week timepoint.
Conclusions: TenoGlide® sheet form of type I collagen and Collagen Gel flowable gel form of type I collagen had comparable mechanical performance effects in this avian model (i.e. statistically equivalent). Current study with a larger cohort and extended follow-up to 12 weeks is ongoing.
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