The Journal of Bone and Joint Surgery, Vol 73, Issue 1 66-75, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Healing of digital flexor tendons: importance of the interval from injury to repair. A biomechanical, biochemical, and morphological study in dogs
RH Gelberman, DB Siegel, SL Woo, D Amiel, S Takai and D Lee
Massachusetts General Hospital-Harvard Medical School, Boston 02114.
The effect of an elapsed interval of time between injury and operative
repair of the flexor tendons was investigated in a canine model. Transected
intrasynovial flexor tendons were repaired either immediately or after a
delay of seven or twenty-one days. The biomechanical, biochemical, and
morphological characteristics were compared at three and six weeks. The
values for angular rotation, linear excursion, ultimate load, and linear
slope were determined; concentrations of collagen and reducible collagen
cross-links, an index of newly synthesized collagen, were measured; and the
ultrastructural morphology of the tendons was examined by high-voltage
electron microscopy. For the tendons that were repaired immediately, the
values for angular rotation were 9.4 +/- 3.2 and 13.0 +/- 3.7 degrees at
three and six weeks; for those that were repaired at seven days, 4.1 +/-
1.3 and 2.5 +/- 1.4 degrees; and for those that were repaired at twenty-one
days, 2.7 +/- 0.8 and 4.7 +/- 0.7 degrees. There was a significant effect
of the delay until repair on the angular rotation and linear excursion in
all three groups (p less than 0.005 for both). Tensile testing of the
bone-tendon complex revealed no significant effect of the delay on the
values for ultimate load (p greater than 0.05). There were no significant
differences in total concentration of collagen at the sites of repair or in
the levels of reducible Schiff-base cross-links (indicators of newly
synthesized cross-links) in tendons from the three groups.(ABSTRACT
TRUNCATED AT 250 WORDS)
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