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Carbodiimide-Derivatized Hyaluronic Acid Surface Modification of Lyophilized Flexor Tendon

A Biomechanical Study in a Canine in Vitro Model

¹ Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao: zhao.chunfeng{at}mayo.edu

Investigation performed at the Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Musculoskeletal Transplant Foundation (MTF). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Methods Thirty-six flexor digitorum profundus tendons from the second and fifth digits of canine hind paws were randomly assigned to three groups. Twelve tendons were immediately assessed both mechanically and morphologically and served as the normal tendon group. The other twenty-four tendons were prepared with repetitive freeze-thaw cycles and lyophilization and were randomly assigned to two groups, including one group in which the tendons were treated with carbodiimide-derivatized hyaluronic acid and gelatin and one group in which the tendons were not treated. The frictional force was measured during 1000 cycles of simulated flexion-extension motion in all tendons, and the mean frictional forces were compared. The tendons were then observed with use of transmitted light microscopy for residual hyaluronic acid on the tendon surface, and the smoothness of the surface was evaluated with use of scanning electron microscopy.

Results The frictional force after lyophilization was significantly increased by 104.9% after the first cycle and by 99.5% after 1000 cycles in comparison with the normal tendon (p < 0.05). The frictional force of the lyophilized tendons after treatment with carbodiimide-derivatized hyaluronic acid and gelatin was not significantly different from that of normal tendons. The untreated lyophilized tendon surfaces were observed on scanning electron microscopy to be rough in appearance, whereas the normal surface and the surface treated with carbodiimide-derivatized hyaluronic acid and gelatin were smooth, with residual hyaluronic acid present on the gliding surface.

Conclusions Lyophilization alters tendon surface morphology and increases tendon frictional force. Surface modification with carbodiimide-derivatized hyaluronic acid and gelatin can mitigate this adverse effect.

Clinical Relevance Tendon surface modification with carbodiimide-derivatized hyaluronic acid and gelatin can improve the gliding ability of lyophilized flexor tendons and therefore may improve the utility of lyophilized tendon allografts as a tendon graft substitute.

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