REPAIR AND REHABILITATION OF FLEXOR TENDON INJURY

描述（申请人逐字逐句）：肌腱损伤是常见的， 通常是毁灭性的问题，主要影响年轻的成年人。 尽管正在进行大量的研究，但临床上的改善 在过去几十年中，成果相对有限。更好的 了解以下早期恢复的机械事件 肌腱损伤与康复过程中力学因素的控制 到目前为止，这是最有效的干预措施。这个竞争激烈 更新建议评估滑动阻力，断裂强度， 新型肌腱修复术的组织学和新型康复治疗的效果 肌腱修复后的方法。在初始供资期间，使用部分 肌腱撕裂模型，我们确定了一些决定因素的摩擦 肌腱修复后，并表明增加摩擦与 体内结果较差。我们发现，目前的高强度修补， 由于高摩擦成本而受到损害，我们证明了 增强肌腱滑动在体内产生更好的最终结果，但代价是 早期修复间隙。我们现在建议通过研究更新的 可结合联合收割机高强度和低摩擦的修复，以及修复 根据肌腱滑动的力学调整治疗方法， 随着时间的推移而变化。我们的假设是通过优化肌腱 在康复期间的滑行，最终肌腱运动和 可以提高最终的钢筋束强度。为了研究这一假设， 提出了以下三个具体目标：1）识别高强度，低 体外完全撕裂犬模型中的摩擦修复，2） 描述对滑动和工作的阻力的短期自然历史 的屈曲，以及3）在体内测试滑动 的特性、强度抵抗间隙形成和组织学。 高强度，低滑动阻力修复在这个模型中，比较， 在具体的结果的基础上设计的优化康复模型 目标2采用常规治疗。我们早期的结果表明， 协同运动的好处，已经被纳入临床 在我们的机构工作。我们相信，这项研究的结果将 也能迅速转移到临床竞技场。

DESCRIPTION (Verbatim from the Applicant): Tendon injuries are a frequent and often devastating problem which primarily affects the young adult population. Despite a considerable volume of ongoing research, improvements in clinical outcome have been relatively limited over the past few decades. A better understanding of the mechanical events surrounding early recovery following tendon injury and control of mechanical factors during the rehabilitation program have thus far been the most effective interventions. This competitive renewal proposes to assess the gliding resistance, breaking strength, and histology of newer types of tendon repairs and the effect of new rehabilitation methods after tendon repair. In the initial funding period, using a partial tendon laceration model, we identified a number of determinants of friction following tendon repair and showed that increased friction is associated with poorer results in vivo. We found that the current high strength repairs are compromised by high friction costs, and we demonstrated that therapy which enhanced tendon gliding produced better final results in vivo, but at a cost of early repair gapping. We now propose to expand upon this work by studying newer repairs that may combine high strength and low friction, and rehabilitation methods which tailor the therapy to the mechanics of tendon gliding as these vary over time with tendon healing. Our hypothesis is that by optimizing tendon gliding during the rehabilitation period, both ultimate tendon motion and ultimate tendon strength can be improved. In order to study this hypothesis the following three Specific Aims are proposed: 1) to identify high strength, low friction repairs in a complete laceration canine model in vitro, 2) to characterize the short-term natural history of resistance to gliding and work of flexion in this model in vivo, and 3) to test in vivo the gliding characteristics, strength resistance to gap formation, and histology of a high-strength, low gliding resistance repair in this model, comparing an optimized rehabilitation model designed on the basis of the results in Specific Aim 2 with conventional therapy. Our earlier results, demonstrating the benefits of synergistic motion, have already been incorporated into clinical practice at our institution. We believe that the results of this study will also have rapid transference to the clinical arena.