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Review
. 2022 Feb 23;14(5):867.
doi: 10.3390/polym14050867.

Polymer-Based Constructs for Flexor Tendon Repair: A Review

Jef Brebels  1 , Arn Mignon  1
Affiliations
Review

Polymer-Based Constructs for Flexor Tendon Repair: A Review

Jef Brebels et al. Polymers (Basel). .

Abstract

A flexor tendon injury is acquired fast and is common for athletes, construction workers, and military personnel among others, treated in the emergency department. However, the healing of injured flexor tendons is stretched over a long period of up to 12 weeks, therefore, remaining a significant clinical problem. Postoperative complications, arising after traditional tendon repair strategies, include adhesion and tendon scar tissue formation, insufficient mechanical strength for early active mobilization, and infections. Various researchers have tried to develop innovative strategies for developing a polymer-based construct that minimalizes these postoperative complications, yet none are routinely used in clinical practice. Understanding the role such constructs play in tendon repair should enable a more targeted approach. This review mainly describes the polymer-based constructs that show promising results in solving these complications, in the hope that one day these will be used as a routine practice in flexor tendon repair, increasing the well-being of the patients. In addition, the review also focuses on the incorporation of active compounds in these constructs, to provide an enhanced healing environment for the flexor tendon.

Keywords: anti-adhesion; anti-inflammatory; antimicrobial; flexor tendon repair; polymer-based constructs.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hierarchical structure of the tendon. Collagen molecules are shown in the simplified model of the tendon structure to represent the forming complex arrangement from tropo-collagen up to tendon fascicles and the final tendon tissue. The intrinsic compartment is represented by the tendon fascicles as the basic unit. The extrinsic compartment is represented by the synovium-like tissue connecting the vascular, nervous, and immune systems. Reprinted with permission from ref. [12]. 2020 Angelo V. Vasiliadis.
Figure 2
Figure 2
Typical stress-strain curve for a healthy tendon. The righthand side is a schematic representation of the mechanical behavior of the collagen fibers for the different regions. The physiological range (green) consists of the region with the normal use of the tendon and is followed by the overload injuries region (orange) where permanent damage occurs, starting with microscopic failure. Further strain of the tendon will lead to the failure region (red) where rupture of the tendon takes place. Reprinted with permission from ref. [12]. 2020 Angelo V. Vasiliadis.
Figure 3
Figure 3
Overview of the process during tendon healing. Healing includes three phases, which overlap slightly. The duration of each phase is an estimate, as duration depends upon the location and severity of the tendon injury.
Figure 4
Figure 4
Overview of the most commonly used processing techniques, polymeric materials, structures, and modulations for flexor tendon repair in this review paper.
Figure 5
Figure 5
SEM ultra-micrographs of a tubular construct made from chitosan. (A–C): pure chitosan, (D–F): ZnO coated chitosan and (G–J): ZnO nanoparticles coated chitosan. Reprinted with permission from ref. [173]. 2018 A. Yousefi.
Figure 6
Figure 6
A Multi-layered tubular construct from a novel material, acrylate endcapped urethane-based precursor (AUP) with a PCL backbone as the outer and the inner layer, in combination with HA as anti-adhesion and naproxen as an anti-inflammatory. The polypropylene braided structure in the middle acts as mechanical support, based on the Chinese finger trap mechanism. Reprinted with permission from ref. [89]. 2021 N. Pien.
Figure 7
Figure 7
Double layer composite membrane with electrospun nanofibrous poly(lactic-co-glycolic) ibuprofen-loaded inner layer and a hydrogel of poly(ethylene glycol)-block-poly(L-valine) as an outer layer for preventing tendon adhesion and promoting tendon healing. The hydrogel coating prolonged the ibuprofen release in vivo. Reprinted with permission from ref. [97]. 2021 Z. Yan.
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