Purpose: The formation of peritendinous adhesions following tenorrhaphy in zone II injuries has often resulted in functional impairment of tendon excursion. Efforts to reduce adhesion formation have concentrated on early range of motion and dynamic splinting. The purpose of this study is to evaluate the ability of GelfilmŪ (gelatin film) and fibrin glue to prevent the formation of peritendinous adhesion following complete tendon transection and tenorrhaphy.
Methods: Bilateral profundus tendons in the feet of 49 adult chickens were completely transected and repaired using a modified Kessler technique. The chickens were randomized to one of two treatment groups including either wrapping the repair with gelatin film (Group 1) or coating the repair with fibrin glue (Group 2). Each animal had its own internal control on the opposite foot, which was a modified Kessler repair alone. Half of the chickens in each group were sacrificed for histological study (at 3,8,14, and 30 days) and the other half was sacrificed for biomechanical testing at day 30 with goniometry and tensiometry to evaluate tendon excursion and repair strength respectively.
Results: Goniometric analysis revealed that fibrin glue-treated tennorhaphies had significantly improved angular excursion versus controls (46o vs. 28o; p < 0.05) and mean angular excursion for the gelatin film treated group was 19o. Densitometry demonstrated that gelatin film-wrapped tenorrhaphies had significantly greater tensile strength than the control group (29 kg/cm2 vs. 14 kg/cm2. p< 0.05). Tensile strength for the fibrin glue treated group was 17 kg/cm2. On hematoxylin and eosin and Gomori's trichrome-stained histological sections, gelatin film-wrapped tenorrhaphies showed heightened peritendinous inflammation at 3 and 8 days with increased collagen deposition noted at 30 days post-operatively.
Conclusions: Functional and histological testing confirmed that fibrin glue reduced adhesion formation without compromising tenorrhaphy strength. Gelatin film did not reduced adhesions, but it did improve tenorrhaphy strength.