Clinical Orthopaedics and Related Research®

, Volume 470, Issue 9, pp 2522–2527 | Cite as

Surface Treatment of Flexor Tendon Autograft and Allograft Decreases Adhesion Without an Effect of Graft Cellularity: A Pilot Study

Symposium: Allograft Research and Transplantation



Flexor tendon grafting is often required to reconstruct a failed tendon repair. Previous reports have demonstrated flexor grafts coated with lubricants such as carbodiimide derivatized hyaluronic acid (cd-HA) decrease adhesion formation and improve digit function. However, whether this surface modification would affect graft adhesion and cellularity is unknown.


Adhesion score and the cellularity of the graft of untreated and cd-HA surface-modified autograft and allograft tendons were studied using a canine forepaw in vivo model.


The peroneus longus tendons (n = 6) and flexor digitorum profundus tendons (n = 8) were used as extrasynovial autograft and intrasynovial allograft, respectively. The flexor digitorum profundus (FDP) tendons in the second and fifth digits in each dog were reconstructed with one digit treated with cd-HA and the other treated with saline as a control. Six weeks after surgery, the grafted tendons were harvested for histological evaluation with hematoxylin and eosin staining. During dissection, the adhesions were observed and scored.


The adhesion score was greatest in the extrasynovial autograft without surface modification and the least in the intrasynovial allograft with surface modification. Autograft tendons had a higher cell density than the allografts regardless of surface treatment. Cd-HA graft treatment did not affect cellularity when compared with controls.


Our observations suggest surface modification of a tendon graft with cd-HA decreased the adhesion formation without altering the cellularity in either autologous or allograft tendon. We therefore presume this surface modification would not adversely affect graft healing.



We thank Drs Y. L. Sun, S. L. Moran, K. N. An, and P. C. Amadio and Ms Ramona L. Kirk for their great contributions and assistance on animal surgeries and care, data collection and interpretation, and manuscript editing.


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© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  1. 1.Biomechanics Laboratory, Department of Orthopedic ResearchMayo ClinicRochesterUSA
  2. 2.Department of Plastic Surgery, Faculty of MedicineAbant Izzet Baysal UniversityBoluTurkey

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