Modulation of the formation of adhesions during the healing of injured tendons

The formation of restrictive adhesions around the musculotendinous unit aft er injury is one of the most vexing processes faced by the surgeon. In flex or tendons it has been shown that the synovial tissue is the source of aggr essive fibroblasts which contribute to this process. Using a rabbit model, we have examined the effects of treating the synovial sheath with the antim etabolite 5-fluorouracil (5-FU) for five minutes. Inflammatory, proliferati ve and molecular markers were compared in the response of the treated and c ontrol tendons to injury, Compared with a control group we found that the p roliferative and inflammatory responses were significantly reduced (p < 0.0 01) in the treated tendons. Not only was there a reduction in the cellular and cytokine response, but there also was a significant (p < 0.001) reducti on in the level of activity of the known pro-scarring agent, transforming g rowth factor beta 1 (TGF-beta 1). These pilot studies indicate that the for mation of restrictive adhesions may be modulated using a simple single-touc h technique in the hope of producing a better return of function.