An experimental study on the application of a hydroxyapatite artificial tendon sheath to prevent adhesions after tendon repair (Part 1)

The formation of adhesions around the lacerated flexor tendons in zone II was studied in chickens after using an artificial tendon sheath made of hydroxyapatite (HAp). The flexor sheath was excised between the proximal and distal pulleys in zone II to create a window in the fibro-osseous tunnel. After suturing the severed profundus tendon, an HAp sheath was placed around the suture site followed by 3 weeks of immobilization. The results were compared with controls in which no HAp sheaths were used after the operation. Adhesion formation was assessed both biomechanically and histologically. The mobility of the tendons was better in the HAp group at all the periods studied. HAp sheath was not firmly adherent to either the granulation tissue or the surface of the tendon. Histology at 3 as well as 6 weeks in HAp groups revealed epitenon-like structure on the tendon surface including the tenorrhaphy site and a wide space around the tendon after the HAp sheath was removed. The outer margins of this space was lined by a layer of fibrocyte-like cells and collagen fibers thereby resembling new formed tendon sheath. In the cases of control, marked peritendinous adhesions were observed.