The Journal of Bone and Joint Surgery, Vol 74, Issue 8 1207-1216, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Angiogenesis in healing autogenous flexor-tendon grafts
RH Gelberman, CR Chu, CS Williams, JG Seiler and D Amiel
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston 02114.
On the basis of recent evidence that flexor tendon grafts may heal without
the ingrowth of vascular adhesions, eighteen autogenous donor tendons of
intrasynovial and extrasynovial origin were transferred to the synovial
sheaths in the forepaws of nine dogs, and controlled passive mobilization
was instituted early in the postoperative period. The angiogenic responses
of the tendon grafts were determined with perfusion studies with India ink
followed by cleaing of the tissues with the Spalteholz technique at two,
four, and six weeks. A consistent pattern of neovascularization was noted
in the donor tendons of extrasynovial origin. Vascular adhesions arising
from the flexor digitorum superficialis and the tendon sheath enveloped the
tendon grafts by two weeks. By six weeks, the vascularity of the tendon
grafts of extrasynovial origin appeared completely integrated with that of
the surrounding tissues. Examination of cross sections revealed that the
segments of tendon had been completely vascularized by obliquely oriented
intratendinous vessels. In contrast, the flexor tendon grafts of
intrasynovial origin healed without ingrowth of vascular adhesions. Primary
intrinsic neovascularization took place from the proximal and, to a lesser
extent, distal sites of the sutures. Examination of cross sections revealed
vessels extending through the surface layer of the tendon graft, with small
vessels penetrating the interior of the tendons at regular intervals.
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