Nick Sekouris, Athanasios Kefalas, Konstantinos Soultanis, Kalliopi Diamantopoulou, Georgia Karagiannopoulou, Panayotis Soucacos and Aristides Zoubos
Purpose: We aimed to investigate the synovial sheath cell migration in response to flexor tendon injury under direct visualization.
Methods: We used New Zealand rabbits based on an animal model described in previous studies, which we modified in order to create conditions similar to real tendon injury and healing. We used a special paint marker (1,1’-dioctadecyl1-3,3,3’,3’-tetramethylindocarbocyanine-percolate-Dil) of the sheath cells. The Flexor Digitorum Profondus first was sectioned through a distal skin incision and pulled outside the sheath through a proximal skin incision. Then the sheath was labeled. A second intrasynovial full thickness cross-section of the flexor was done and repaired by Kessler and running type suture. We harvested the tendons day 1, 3, 5, 7, 14 and 28 after tendon injury. Tendon sections were prepared with cryotomy and tested by infrared microscope. To evaluate our results, we divided the migration of synovial sheath cells in four phases: 1st phase) no or sporadic migration to the surface of the tendon, 2nd phase) massive migration to the surface of the tendon, 3rd phase) migration just below the surface of the tendon, and 4th phase) migration in the endotenon. For each day’s group the percentage of tendon sections in each phase of migration was determined.
Results: According to our findings the second phase of migration of cells was 85% reached on the 3rd day, the third phase 66.6% reached on the seventh day and the fourth phase 50% reached on the fourteenth day after flexor tendon injury.
Conclusions: This study confirms that the synovial sheath cells migrate first into the surface and later into the core of the healing tendon.
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