Restoration of the Injured Flexor Tendon Surface: A Possible Role for Endotenon Cells

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Abstract
The ability of rabbit deep flexor tendons to restore the gliding surface and to heal, without the normal contribution of the superficial epitenon layer of the tendons, was studied by light and scanning electron microscopy. The epitenon layer was carefully removed from defined segments of the tendons. The remaining central tendon tissue was divided, sutured and placed in diffusion chambers subcutaneously in the back of the rabbits. After two weeks of culture, most of the sutured gaps were bridged and the tendons were encapsulated by flattened and spindle-shaped cells which covered a random network of thin collagen fibres. After five and 11 weeks, fibroblast-like cells in multiple layers formed a cobblestone-like surface. Thus, a tendon deprived of its epitenon layer still contains cells which can produce collagen, bridge the gap and restore the injured tendon surface.