• 1

    Werd MB: Achilles tendon sports injuries: a review of classification and treatment. JAPMA 97: 37, 2007.

  • 2

    Apaydin N, Ünlü S, Bozkurt M, et al.: Aşil tendonu’nun fonksiyonel anatomisi ve biyomekanik özellikleri. TOTBİD J 10: 61, 2011.

  • 3

    Strickland JW: The scientific basis for advances in flexor tendon surgery. J Hand Ther 18: 94, 2005.

  • 4

    Evans RB: Managing the injured tendon: current concepts. J Hand Ther 25: 173, 2012.

  • 5

    Azad-Tirgan M, Sarrafzadeh-Rezaei F, Malekinejad H, et al.: Evaluation of tendon healing using fibroblast like synoviocytes in rabbits: a biomechanical study. Veterinary Res Forum 7: 21, 2016.

    • Search Google Scholar
    • Export Citation
  • 6

    Sharma P, Maffulli N: Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am 87: 187, 2005.

  • 7

    James R, Kesturu G, Balian G, et al.: Tendon: biology, biomechanics, repair, growth factors, and evolving treatment options. J Hand Surg 33: 102, 2008.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Riboh JC, Saltzman BM, Yanke AB, et al.: Human amniotic membrane–derived products in sports medicine: basic science, early results, and potential clinical applications. Am J Sports Med 44: 2425, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Dogramaci Y, Duman IG: Reinforcement of the flexor tendon repair using human amniotic membrane: a biomechanical evaluation using the modified Kessler method of tendon repair. JAPMA 106: 319, 2016.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Fairbairn NG, Randolph MA, Redmond RW: The clinical applications of human amnion in plastic surgery. J Plast Reconstr Aesthet Surg 67: 662, 2014.

  • 11

    Toda A, Okabe M, Yoshida T, et al.: The potential of amniotic membrane/amnion-derived cells for regeneration of various tissues. J Pharmacol Sci 105: 215, 2007.

  • 12

    Mamede AC, Carvalho MJ, Abrantes AM, et al.: Amniotic membrane: from structure and functions to clinical applications. Cell Tissue Res 349: 447, 2012.

  • 13

    Fernandez‐Garcia B, Eiró N, Marín L, et al.: Expression and prognostic significance of fibronectin and matrix metalloproteases in breast cancer metastasis. Histopathology 64: 512, 2014.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Gong F, Cui L, Zhang X, et al.: Piperine ameliorates collagenase-induced Achilles tendon injury in the rat. Connect Tissue Res 59: 21, 2018.

  • 15

    Laskoski LM, Valadão CAA, Vasconcelos RDO, et al.: Expression of matrix metalloproteases-2 and-9 in horse hoof laminae after intestinal obstruction, with or without Hydrocortisone treatment. Ciênc Rural 43: 66, 2013.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Koskinen SOA, Höyhtyä M, Turpeenniemi‐Hujanen T, et al.: Serum concentrations of collagen degrading enzymes and their inhibitors after downhill running. Scand J Med Sci Sports 11: 9, 2001.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Karousou E, Ronga M, Vigetti D, et al.: Collagens, proteoglycans, MMP-2, MMP-9 and TIMPs in human achilles tendon rupture. Clin Orthop Relat Res 466: 1577, 2008.

  • 18

    Riboh JC, Saltzman BM, Yanke AB, et al.: Human amniotic membrane–derived products in sports medicine: basic science, early results, and potential clinical applications. Am J Sports Med 44: 2425, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Tang JB, Shi D, Zhang QG: Biomechanical and histologic evaluation of tendon sheath management. J Hand Surg 21: 900, 1996.

  • 20

    Sánchez M, Anitua E, Azofra J, et al.: Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med 35: 245, 2007.

  • 21

    Carr AJ, Norris SH: The blood supply of the calcaneal tendon. J Bone Joint Surg Br 71: 100, 1989.

  • 22

    Yepes H, Tang M, Geddes C, et al.: Digital vascular mapping of the integument about the Achilles tendon. J Bone Joint Surg Am 92: 1215, 2010.

  • 23

    Theobald P, Benjamin M, Nokes L, et al.: Review of the vascularisation of the human Achilles tendon. Injury 36: 1267, 2005.

  • 24

    Wolff KS, Wibmer AG, Binder H, et al.: The avascular plane of the Achilles tendon: a quantitative anatomic and angiographic approach and a base for a possible new treatment option after rupture. Eur J Radiol 81: 1211, 2012.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Ozbölük Ş, Ozkan Y, Oztürk A, et al.: The effects of human amniotic membrane and periosteal autograft on tendon healing: experimental study in rabbits. J Hand Surg Eur Vol 35: 262, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Ozgenel GY: The effects of a combination of hyaluronic and amniotic membrane on the formation of peritendinous adhesions after flexor tendon surgery in chickens. J Bone Joint Surg Br 86: 301, 2004.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Demirkan F, Colakoglu N, Herek O, et al.: The use of amniotic membrane in flexor tendon repair: an experimental model. Arch Orthop Trauma Surg 122: 396, 2002.

  • 28

    Çoban İ, Satoğlu İS, Gültekin A, et al.: Effects of human amniotic fluid and membrane in the treatment of Achilles tendon ruptures in locally corticosteroid-induced Achilles tendinosis: an experimental study on rats. Foot Ankle Surg 15: 22, 2009.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Nicodemo MDC, Neves LRD, Aguiar JC, et al.: Amniotic membrane as an option for treatment of acute Achilles tendon injury in rats. Acta Cir Bras 32: 125, 2017.

  • 30

    Prakash S, Kalra P, Dhal A: Flexor tendon repair with amniotic membrane. Int Orthop 44: 2037, 2020.

  • 31

    Taghiabadi E, Nasri S, Shafieyan S, et al.: Fabrication and characterization of spongy denuded amniotic membrane based scaffold for tissue engineering. Cell J 16: 476, 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Sartoneva R, Haimi S, Miettinen S, et al.: Comparison of a poly-l-lactide-co-ɛ caprolactone and human amniotic membrane for urothelium tissue engineering applications. J R Soc Interface 8: 671, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Okabe M, Kitagawa K, Yoshida T, et al.: Hyperdry human amniotic membrane is useful material for tissue engineering: physical, morphological properties, and safety as the new biological material. J Biomed Mater Res A 102: 862, 2014.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Hopkinson A, Shanmuganathan VA, Gray T, et al.: Optimization of amniotic membrane (AM) denuding for tissue engineering. Tissue Eng Part C Methods 14: 371, 2008.

  • 35

    Niknejad H, Peirovi H, Jorjani M, et al.: Properties of the amniotic membrane for potential use in tissue engineering. Eur Cell Mater 15: 88, 2008.

  • 36

    Niknejad H, Paeini-Vayghan G, Tehrani FA, et al.: Side dependent effects of the human amnion on angiogenesis. Placenta 34: 340, 2013.

  • 37

    Zhu D, Muljadi R, Chan ST, et al.: Evaluating the impact of human amnion epithelial cells on angiogenesis. Stem Cells Int 2016: 4565612, 2016.

Clinical and Histologic Evaluation of Partial Achilles Tendon Injury Repair with Amniotic Membrane in Rats

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  • 1 Department of Orthopedics and Traumatology, Ankara City Hospital–Neurology Orthopaedic Hospital, Ankara, Turkey.
  • | 2 Department of Orthopedics and Traumatology, Recep Tayyip Erdoğan University Medical School, Rize, Turkey.
  • | 3 Department of Histology and Embryology Recep Tayyip Erdoğan University Medical School, Rize, Turkey.
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Background: Adhesions after tendinopathy in individuals who perform physical work and those physically active in middle age are a challenging problem for orthopedic surgeons. We evaluated the effects of human-derivated amniotic membrane on tendon healing, adhesions, angiogenesis, and the inflammatory process.

Methods: Thirty-five rats were divided evenly into five groups, and the left lower extremity was used in this study. No interventions were applied to the control group (group 5). In the other groups, Achilles tendons were partially cut to the midline. Then, primary repair (group 1), amniotic membrane treatment with no repair (group 2), primary repair and amniotic membrane treatment (group 3), or secondary healing with no repair (group 4) was performed.

Results: Use of amniotic membrane in tendon healing resulted in decreased adhesion formation and positive effects on collagen sequencing and anti-inflammatory effects. In addition, for the vascular endothelial growth factor evaluation there was no difference among the amniotic membrane repair groups, but there was an increase in vascular endothelial growth factor positivity compared with the control group.

Conclusions: These data show that amniotic membrane treatment can alter biological behavior and induce surface-dependent angiogenesis and can have angiogenetic effects on ischemia and inflammation.

Corresponding author: Nurettin Manti, MD, Department of Orthopedics and Traumatology, Ankara City Hospital–Neurology Orthopaedic Hospital, Ankara, Turkey. (E-mail: nurettinmanti@gmail.com)