Tendon grafts with peritendinous areolar tissue increase the survival of endotendinous tissues and diminish postoperative shrinkage.

Abstract

We observed greater postoperative shrinkage of grafted fascia lata without peritendinous areolar tissue (PAT) than with PAT in blepharoptosis surgery. In this article, we sought to evaluate the influence of PAT on tendon grafts. Pairs of anterior tibial tendons with or without PAT were grafted onto the backs of 12 adult Wistar rats. The cephalic and caudal ends of the tendons with or without PAT were fixed tightly on the fascia of the erector spinae muscles with 6/0 polypropylene sutures. A 7-mm distance was maintained between the sutures. Changes in the length between the sutures as well as changes in the histology of the tendons with or without PAT were evaluated at 1 and 5 months after grafting. The mean lengths of the grafted tendons with PAT at 1 and 5 months after grafting were significantly longer than those without PAT at 1 and 5 months after grafting, respectively (5.4 mm and 4.5 mm vs. 3.8 mm and 2.9 mm, respectively; Wilcoxon signed-rank test; P < 0.05). The grafted tendons without PAT displayed central necrosis and scar formation, whereas those with PAT displayed no alteration in the tissue properties. At both 1 and 5 months after grafting, the grafted tendons with PAT were significantly longer and survived better than those without PAT. Tendon grafts with PAT had increased survival of the endotendinous tissue and diminished postoperative shrinkage, since the vascular network of the PAT potentially contributes to early revascularisation of the graft.