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J Hand Microsurg 2012; 04(02): 60-64
DOI: 10.1007/s12593-012-0074-y
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

The Biomechanical and Histological Effects of Diabetes on Tendon Healing: Experimental Study in Rats

Onur Egemen
1   Plastic and Reconstructive Surgery Department, Okmeydani Education and Reserch Hospital, Istanbul, Turkey
,
Ozay Ozkaya
1   Plastic and Reconstructive Surgery Department, Okmeydani Education and Reserch Hospital, Istanbul, Turkey
,
Muhammed Besir Ozturk
1   Plastic and Reconstructive Surgery Department, Okmeydani Education and Reserch Hospital, Istanbul, Turkey
,
Ebru Sen
2   Plastic and Reconstructive Surgery Department, Bagcilar Education and Reserch Hospital, Istanbul, Turkey
,
Mithat Akan
2   Plastic and Reconstructive Surgery Department, Bagcilar Education and Reserch Hospital, Istanbul, Turkey
,
Damlanur Sakiz
3   Sisli Etfal Education and Reserch Hospital, Pathology Department, Istanbul, Turkey
,
Cemal Aygit
2   Plastic and Reconstructive Surgery Department, Bagcilar Education and Reserch Hospital, Istanbul, Turkey
› Author Affiliations
Subject Editor:
Further Information

Publication History

29 May 2012

16 July 2012

Publication Date:
05 September 2016 (online)

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Abstract

The aim of this study was to investigate the biomechanical and histological perspectives of healing of Achilles tendon in diabetic rats and compare the results with non-diabetic subjects. Fifty four adult Wistar Albino rats weighing 300–350 g were used throughout the study. Six animals were excluded from the study and replaced. Rats were randomly assigned to either the experimental or the control group comprised of 24 rats in each. Diabetes was induced in experimental group with streptozotocin. 3 days after the induction of diabetes, both Achilles tendons were transected 5 mm proximal to their insertions to the calcaneal bone and repaired by using 6/0 polypropylene sutures with modified Kessler method. At weeks 2, 4 and 6, eight rats from each group were euthanized. Left Achilles tendons including the repair site were prepared for histological evaluation and right legs were prepared for mechanical testing. When compared to control group, diabetic animals displayed a lower peak force for failure in each of the second, fourth and sixth week. The differences between the groups in each week were found to be significant in statistical assessments (p<0.05). Histologic assessment revealed that the diabetic animals had significantly less amount of fibroblast proliferation and lymphocyte infiltration compared to the control group. There is significant delay in tendon strength at the end of week 2, 4 and 6 postoperatively in the diabetic rats. Therefore diabetic individuals require specific postoperative follow up and rehabilitation procedures.

Keywords

Tendon - Tendon healing - Diabetes - Wound healing - Rat - Streptozotocin - Biomechanical
 

  • References

  • 1 Christopherson K. The impact of diabetes on wound healing: Implications of microcirculatory changes. Br J Community Nurs 2003; 8: S6-S13
    PubMedSearch in Google Scholar
  • 2 Wild S, Roglic G, Green A, Sicree R, Kings H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047-1053
    Search in Google Scholar
  • 3 Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest 2007; 117: 1219-1222
    CrossrefPubMedSearch in Google Scholar
  • 4 Blakytny R, Jude E. The moleculer biology of chronic wounds and delayed healing in diabetes. Diabet Med 2006; 23: 594-608
    CrossrefPubMedSearch in Google Scholar
  • 5 Witte MB, Kiyama T, Barbul A. Nitric oxide enhances experimental wound healing in diabetes. Br J Sur 2002; 89: 1594-1601
    CrossrefPubMedSearch in Google Scholar
  • 6 Pecaro RE, Reiber GE, Burqess EM. Pathway to diabetic limb amputation. Basis for prevention. Diabetes Care 1990; 13: 513-521
    CrossrefPubMedSearch in Google Scholar
  • 7 Akturk M, Karaahmetoglu S, Kacar M, Muftuoglu O. Thickness of the supraspinatus and biceps tendons in diabetic patients. Diabetes Care 2002; 25: 408
    PubMedSearch in Google Scholar
  • 8 Batista F, Nery C, Pinzur M, Monteiro AC, de Souze EF, Felippe FH et al Achilles tendinopathy in diabetes mellitus. Foot Ankle Int 2008; 5: 498-501
    PubMedSearch in Google Scholar
  • 9 Balci N, Balci MK, Tuzuner SK. Shoulder adhesive capsulitis and shoulder range of motion in type II diabetes: Association with diabetic complications. J Diabetes Compl 1999; 13: 135-140
    CrossrefPubMedSearch in Google Scholar
  • 10 Holmes GB, Lin J. Etiologic factors associated with symptomatic Achilles tendinopathy. Foot Ankle Int 2006; 27: 952-959
    CrossrefPubMedSearch in Google Scholar
  • 11 Reddy GK, Stehno Bittel L, Enwemeka CS. Glycatin induced matrix stability in the rabbit Achilles tendon. Arch Bio-chem Biophy 2002; 15: 174-180
    PubMedSearch in Google Scholar
  • 12 Bai P, Phua K, Hardt T, Cernadas M, Brodsky B. Glycation alters collagen fibril organization. Connect Tissue Res 1992; 28: 1-12
    CrossrefPubMedSearch in Google Scholar
  • 13 Li Q, Kao H, Matros E, Peng C, Murphy GF, Guo L. Pulsed radiofrequency energy accelerates wound healing in diabetic mice. Plas Reconstr Surg 2011; 127: 2255-2262
    CrossrefPubMedSearch in Google Scholar
  • 14 Hapa O, Cakici H, Gideroglu K, Ozturan K, Kukner A, Bugdayci G. The effect of ethanol intake on tendon healing: a histological and biomechanical study in a rat model. Arch Orthop Trauma Surg 2009; 129: 1721-1726
    CrossrefPubMedSearch in Google Scholar
  • 15 Brownlee M. Advanced protein glycosylation in diabetes and aging. Annu Rev Med 1995; 223-234
    PubMedSearch in Google Scholar
  • 16 Menzel EJ, Reihsner R. Alterations of biochemical and biomechanical properties of rat tail tendons caused by nonenzymatic glycation and their inhibition by dibasic aminoacids arginine and lysine. Diabetologia 1991; 34: 12-16
    CrossrefPubMedSearch in Google Scholar
  • 17 Reiser KM. Nonenzymatic glycation of collagen in aging and diabetes. Proc Soc Exp Biol Med 1998; 218: 23-37
    CrossrefPubMedSearch in Google Scholar
  • 18 Longo UG, Ramamurthy C, Denaro V, Maffulli N. Minimally invasive stripping for chronic Achilles tendinopathy. Disabil Rehabil 2008; 30: 1709-1713
    CrossrefPubMedSearch in Google Scholar
  • 19 Maffulli N, Longo UG, Maffulli GD, Khana A, Denaro V. Achilles tendon ruptures in diabetic patients. Arch Orthop Trauma Surg 2011; 131: 33-38
    CrossrefPubMedSearch in Google Scholar
  • 20 Staresinic M, Sebecic B, Patrlj L, Jadrijevic S, Sucnaic S, Provic D et al Gastric pentadecapeptide BPC 157 accelerates healing of transected rat Achilles tendon and in vitro stimulates tendocytes growth. J Ortoph Res 2003; 21: 976-983
    PubMedSearch in Google Scholar
  • 21 Krivic A, Anic T, Seiwerth S, Huljev D, Sikiric P. Achilles detachment in rat and stable gastric pentadecapeptide BPC 157: Promoted tendon-to-bone healing and opposed corticosteroid aggravation. J Ortoph Res 2006; 24: 982-989
    PubMedSearch in Google Scholar
  • 22 Chang CH, Tsai WC, Lin MS, Hsu YH, Pang JH. The promoting effect of pentadecapeptide BPC 157 on tendon healing involves tendon outgrowth, cell survival, and cell migration. J Appl Physiol 2011; 110: 774-780
    CrossrefPubMedSearch in Google Scholar
  • 23 Reddy GK. Cross-linking in collagen by non-enzymatic glycation increases the matrix stiffness in rabbit Achilles tendon. Experimental Diab Res 2004; 5: 143-153
    PubMedSearch in Google Scholar
  • 24 Chbinou N, Frenette J. Insulin dependent diabetes impairs the inflammatory response and delays angiogenesis following Achilles tendon injury. Am J Physiol Regul Comp Physiol 2004; 288: R952-R957
    PubMedSearch in Google Scholar