CORRInsights®: Combined Administration of ASCs and BMP-12 Promotes an M2 Macrophage Phenotype and Enhances Tendon Healing

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Achieving rapid (less than 6 weeks), near-normal tensile strength with minimal or no adhesions is considered the “holy grail” of tendon healing among hand surgeons. Why? With conventional repair techniques, the tendon generally needs at least 6 weeks to heal and regain its tensile properties for unrestricted activity, and this process is always accompanied by the formation of adhesions between the tendon and the surrounding structures (particularly within the flexor sheaths). Because of this, managing injured flexor tendons remains an unsolved challenge. In the current study, Gelberman and colleagues attempt to accelerate tendon healing by avoiding the inflammatory process and its byproducts, namely adhesions.
Generally, hand surgeons attempt to prevent adhesions through early mobilization. But we must also recognize that inflammation is the essential trigger and coordinator to the entire healing process, and macrophages play a key role in initiating this process [2]. Although modulation of inflammation is an attractive prospect, it may create a ripple effect later in the healing process, resulting in poor tensile strength in the repaired tendon.
New approaches have emerged [4, 5, 7], which can be divided into three broad categories: (1) Mechanical strategies, (2) biological manipulation of adhesions, and (3) tissue engineering.
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