An Atelocollagen Injection Enhances the Healing of Nonoperatively Treated Achilles Tendon Tears: An Experimental Study in Rats

Seong Kyeong Jo; In Ha Yoo; Hyeon Yeong Park; Chan Kang; Seung Yun Han; Ji Hyun Moon; Won Ho Park; Yong Ho Yeo; Sangmi Jun; Yoon-Sun Yi; Su Jeong Lee; Jung Yeon Tae; Jae Hwang Song

doi:10.1177/23259671231200933

An Atelocollagen Injection Enhances the Healing of Nonoperatively Treated Achilles Tendon Tears: An Experimental Study in Rats

Orthop J Sports Med. 2023 Oct 18;11(10):23259671231200933. doi: 10.1177/23259671231200933. eCollection 2023 Oct.

Authors

Seong Kyeong Jo¹, In Ha Yoo², Hyeon Yeong Park³, Chan Kang⁴, Seung Yun Han⁵, Ji Hyun Moon⁵, Won Ho Park⁶, Yong Ho Yeo⁶, Sangmi Jun⁷, Yoon-Sun Yi⁷, Su Jeong Lee⁸, Jung Yeon Tae⁹, Jae Hwang Song¹

Affiliations

¹ Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea.
² Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
³ Department of Occupational Therapy, College of Medical Science, Konyang University, Daejeon, Republic of Korea.
⁴ Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea.
⁵ Department of Anatomy, College of Medicine, Konyang University, Daejeon, Republic of Korea.
⁶ Department of Organic Materials Engineering, Chungnam National University, Daejeon, Republic of Korea.
⁷ Center for Research Equipment, Korea Basic Science Institute, Daejeon, Republic of Korea.
⁸ Department of Microbiology, School of Medicine, CHA University, Seongnam, Republic of Korea.
⁹ Department of Medicine, College of Medicine, Konyang University, Daejeon, Republic of Korea.

Abstract

Background: There is growing interest in nonoperative treatment for the management of Achilles tendon ruptures (ATRs). However, nonoperative treatment is limited by the risk of tendon reruptures and low satisfaction rates. Recently, atelocollagen injections have been reported to have beneficial effects on tendon healing.

Purpose: To evaluate the beneficial effects of injected atelocollagen on Achilles tendon healing and investigate the mechanism of atelocollagen on tendon healing.

Study design: Controlled laboratory study.

Methods: Percutaneous tenotomy of the right Achilles tendon in 66 rats was performed. The animals were equally divided into the noninjection group (NG) and the collagen injection group (CG). At 1, 3, and 6 weeks, the Achilles functional index, cross-sectional area, load to failure, stiffness, stress, and the modified Bonar score were assessed. Transmission electron microscopy, western blotting, and immunohistochemistry were also performed.

Results: The Achilles functional index (-6.8 vs -43.0, respectively; P = .040), load to failure (42.1 vs 27.0 N, respectively; P = .049), and stiffness (18.8 vs 10.3 N/mm, respectively; P = .049) were higher in the CG than those in the NG at 3 weeks. There were no significant differences in histological scores between the 2 groups. Transmission electron microscopy analysis showed that the mean diameter of collagen fibrils in the CG was greater than that in the NG at 3 weeks (117.2 vs 72.6 nm, respectively; P < .001) and 6 weeks (202.1 vs 144.0 nm, respectively; P < .001). Western blot analysis showed that the expression of collagen type I in the CG was higher than that in the NG at 1 week (P = .005) and 6 weeks (P = .001).

Conclusion: An atelocollagen injection had beneficial effects on the healing of nonoperatively treated Achilles tendon injuries. The Achilles tendon of CG rats exhibited better functional, biomechanical, and morphological outcomes compared with NG rats. The molecular data indicated that the mechanism of atelocollagen injections may be associated with an increased amount of collagen type I.

Clinical relevance: An atelocollagen injection might be a good adjuvant option for the nonoperative treatment of ATRs.

Keywords: Achilles tendon rupture; atelocollagen; collagen type I; injection; nonoperative treatment; rat.