surface treatment of flexor tendon autografts with carbodiimide-derivatized hyaluronic acid by...

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Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka, Anke M. Ettema, and Kai-Nan An J Bone Joint Surg Am Volume 88(10):2181-2191 October 1, 2006 ©2006 by The Journal of Bone and Joint Surgery, Inc.

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Page 1: Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka,

Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid

by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka, Anke M. Ettema, and Kai-Nan An

J Bone Joint Surg AmVolume 88(10):2181-2191

October 1, 2006

©2006 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka,

Carboxyl groups in the hyaluronic acid (HA) are activated by EDC to form O-acylisoureas, which bind to the amino groups on the tendon surface.

Chunfeng Zhao et al. J Bone Joint Surg Am 2006;88:2181-2191

©2006 by The Journal of Bone and Joint Surgery, Inc.

Page 3: Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka,

Illustration of the proximal suture technique.

Chunfeng Zhao et al. J Bone Joint Surg Am 2006;88:2181-2191

©2006 by The Journal of Bone and Joint Surgery, Inc.

Page 4: Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka,

Work-of-flexion tester. 1 = actuator, 2 = load transducer, 3 = specimen, 4 = two metal beads in the middle phalanx, 5 = metal pin in the distal phalanx, 6 = metal pin in the proximal phalanx, 7 =

weight, and 8 = frame.

Chunfeng Zhao et al. J Bone Joint Surg Am 2006;88:2181-2191

©2006 by The Journal of Bone and Joint Surgery, Inc.

Page 5: Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka,

Image obtained with fluoroscopy during testing.

Chunfeng Zhao et al. J Bone Joint Surg Am 2006;88:2181-2191

©2006 by The Journal of Bone and Joint Surgery, Inc.

Page 6: Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka,

The work of flexion normalized according to the proximal and distal interphalangeal joint angle (normalized work of flexion) in the normal, cd-HA-treated, and saline-solution-treated groups at

one, three, and six weeks.

Chunfeng Zhao et al. J Bone Joint Surg Am 2006;88:2181-2191

©2006 by The Journal of Bone and Joint Surgery, Inc.

Page 7: Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka,

The gliding resistance in the normal, cd-HA-treated, and saline-solution-treated groups at one, three, and six weeks.

Chunfeng Zhao et al. J Bone Joint Surg Am 2006;88:2181-2191

©2006 by The Journal of Bone and Joint Surgery, Inc.

Page 8: Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka,

The staining intensity of the cd-HA and saline-solution-treated tendon grafts at one, three, and six weeks.

Chunfeng Zhao et al. J Bone Joint Surg Am 2006;88:2181-2191

©2006 by The Journal of Bone and Joint Surgery, Inc.

Page 9: Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka,

A: cd-HA-treated tendon graft harvested at six weeks, showing a smooth surface without adhesions to the flexor sheath.

Chunfeng Zhao et al. J Bone Joint Surg Am 2006;88:2181-2191

©2006 by The Journal of Bone and Joint Surgery, Inc.

Page 10: Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid by Chunfeng Zhao, Yu-Long Sun, Peter C. Amadio, Toshikazu Tanaka,

A: cd-HA-treated tendon graft harvested at six weeks, showing a smooth surface under scanning electron microscopy (×30).

Chunfeng Zhao et al. J Bone Joint Surg Am 2006;88:2181-2191

©2006 by The Journal of Bone and Joint Surgery, Inc.