Morphological, histological and biomechanical comparison of bone marrow aspirate concentrate, micro-fragmented adipose tissue and platelet-rich plasma in prevention of tendon adhesion

Abstract

Background: Flexor tendon repair often leads to peritendinous adhesions, reducing finger motion and hand function. This study compares the effects of stromal cells from different sources and platelet-rich plasma (PRP) on adhesion formation after tendon repair.

Methods: Forty rabbits had their flexor digitorum profundus tendons transected and repaired with a modified Kessler suture technique. The control group received an isotonic solution. PRP, bone marrow aspirate concentrate (BMAC), and micro-fragmented adipose tissue (MFAT) were injected in groups 2, 3, and 4, respectively. Rabbits wore casts for 2 weeks. Assessments included morphology, histopathology, range of motion (ROM), and biomechanical testing at the 3rd and 8th weeks.

Results: At 3 weeks, the BMAC group had the thickest and longest adhesions, the highest Tang Score, and inflammation score. However, at 8 weeks, the BMAC group had the lowest Tang Score and inflammation score. ROM was higher in the PRP group at 3 weeks and BMAC group at 8 weeks. No significant differences were found between BMAC and MFAT groups in adhesion measurements. Biomechanical parameters were higher in BMAC and MFAT groups at 8 weeks compared to control.

Conclusion: BMAC therapy after primary flexor tendon repair improves adhesion formation and maintains ROM. It also enhances the biomechanical properties of the flexor tendon during the later stages of healing.

Keywords: Adhesion; Adipose tissue; Fibrosis; Flexor tendon; Platelet-rich plasma; Stem cells.