Published Articles

Joint Diseases & Related Surgery

Vol 30 • No 3 • 2019: 259-266
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The effect of pentoxifylline on Achilles tendon healing in tenotomized rabbits
Tenotomize tavşanlarda pentoksifilinin Aşil tendonu iyileşmesi üzerine etkisi

Abdullah Alper Şahin1, Kutay Engin Özturan2, Alper Çıraklı1, Fahri Yılmaz3, Mehmet Boz4, Hasan Kızılay5
1Department of Orthopedics and Traumatology, Ordu University Training and Research Hospital, Ordu, Turkey

2Department of Orthopedics and Traumatology, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turk

3Department of Pathology, Sakarya University Training and Research Hospital, Sakarya, Turkey

4Department of Orthopedics and Traumatology, Malatya Training and Research Hospital, Malatya, Turkey

5Department of Orthopedics and Traumatology, Gerede State Hospital, Bolu, Turkey

Objectives: This study aims to evaluate the potential effects of pentoxifylline (PTX) on tendon healing and to compare the histopathological and biomechanical findings of the healed tendon among the groups. Materials and methods: The study was conducted on 36 male New Zealand albino rabbits (age, 3 months; weighing, 2.5±0.5 kg). Rabbits were randomized into two groups of 18 rabbits each. Partial Achilles tenotomy was performed 1.5 cm proximally from the calcaneal insertion of the tendon in both lower extremities of each rabbit and all groups were repaired primarily. After the operation, saline was injected intramuscularly to the control group and PTX was injected into the PTX group daily. Nine rabbits from each group were euthanized at weeks four and six postoperatively for histopathological (n=4) and biomechanical (n=5) testing. The histopathological findings were evaluated using the staging method of Curtis and Delee. Biomechanical effects were assessed by tensile testing.
Results: In the biomechanical evaluation results, the maximum displacement and maximum breaking force in the PTX group at fourth week were significantly higher than the control group. In the sixth week, the maximum breaking force in the control group was significantly higher than the PTX group. In the histopathological examination, collagen fiber alignment was more regular and vascularization was more frequent in the PTX group at both fourth and sixth weeks and the difference was significant.
Conclusion: Pentoxifylline increased healing and strength in rabbit Achilles tendon by stimulating collagen synthesis, increasing vascularity and reducing inflammation, particularly in the early period both histopathologically and biomechanically. According to our study, PTX may be favorable for the treatment of human Achilles tendon injuries and tendinopathies.

Key words: Achilles tendon, pentoxifylline, rabbit, tendon healing.

Amaç: Bu çalışmada pentoksifilinin (PTX) tendon iyileşmesindeki potansiyel etkileri değerlendirildi ve iyileşmiş tendonun histopatolojik ve biyomekanik bulguları gruplar arasında karşılaştırıldı. Gereç ve yöntemler: Çalışma 36 erkek Yeni Zelanda albino tavşan üzerinde yapıldı (yaş, 3 ay; ağırlık, 2.5±0.5 kg). Tavşanlar her grupta 18 tavşan olacak şekilde iki gruba randomize edildi. Her tavşanın her iki alt ekstremitesinde tendonun kalkaneal yerleşiminin 1.5 cm proksimalinden parsiyel Aşil tenotomisi uygulandı ve tüm gruplar primer olarak onarıldı. Ameliyattan sonra her gün kontrol grubuna intramusküler olarak serum fizyolojik, PTX grubuna ise PTX enjekte edildi. Her gruptan dokuz tavşana histopatolojik (n=4) ve biyomekanik (n=5) testler için ameliyattan dört ve altı hafta sonra ötenazi uygulandı. Histopatolojik bulgular Curtis ve Delee’nin evreleme yöntemi kullanılarak değerlendirildi. Biyomekanik etkiler çekme testi ile değerlendirildi.
Bulgular: Biyomekanik değerlendirme sonuçlarında, dördüncü haftada PTX grubunda maksimum deplasman ve maksimum kopma kuvveti kontrol grubundan anlamlı derece yüksek idi. Altıncı haftada, kontrol grubunda maksimum kopma kuvveti PTX grubundan anlamlı derecede yüksek idi. Histopatolojik incelemede, PTX grubunda hem dördüncü hem altıncı haftada kollajen lif dizilimi daha düzenli ve damarlanma daha fazla idi ve farklılık anlamlı idi.
Sonuç: Pentoksifilin kollajen sentezini uyararak, damarlanmayı artırıp enflamasyonu azaltarak özellikle erken dönemde hem histopatolojik hem biyomekanik olarak tavşan Aşil tendonunda iyileşme ve mukavemeti artırdı. Çalışmamıza göre, PTX insan Aşil tendonu yaralanmalarının ve tendinopatilerin tedavisi için uygun olabilir.

Anahtar kelimeler: Aşil tendonu, pentoksifilin, tavşan, tendon iyileşmesi.

Şahin A A, Özturan K E, Çıraklı A, Yılmaz F, Boz M, Kızılay H. The effect of pentoxifylline on Achilles tendon healing in tenotomized rabbits. Joint Dis Rel Surg 2019; 30(3):259-266