The effect of poly-l-lactic acid dermal filler on tendon healing

Year 2025, Volume: 16 Issue: 1, 140 - 149, 25.03.2025

Melihcan Sezgiç , Savaş Serel

https://doi.org/10.18663/tjcl.1591774

Abstract

Aim: Tendon healing is a process that can be complicated because of taking long time,heavy burden, adhesion formation, etc., and can cause significant loss of functionif a problem occurs.It’s shown that healing tendon couldn’t reach its previous strength. Collagens are very important for mechanical strength of tendons. Poly-L-Lactic Acid (PLLA) is a synthetic polimeric compound which is becoming more popular nowadays due to its succesful mechanical properties and proper characteristic structure. The use of PLLA-based dermal fillers started in 1999 and is still in use.It has been shown in the literature that they increase collagen synthesis on injection site. In this study, investigation of the effects of PLLA on rat tendon healing model is aimed.
Materials and Methods: Twenty four Wistar Albino female rats were divided in two groups randomly as Control group and PLLA group. In control group, right achilles tendon was cut from 4 mm proximal to its calcaneal insertion. In PLLA group, following the same procedure, PLLA-based dermal filler was injected in between 2 tendon sections. Rats were sacrified after 3 weeks and tendons were excised to examine macroscopically, biomechanically and histologically according to parameters.
Results: According to examinations, macroscopical examination scores of PLLA-based dermal filler group was higher than control group but was not statistically significant (p>0,05). Biomechanically, values were lower for both groups but decrease in failure to load and stifness values were lower in PLLA group compared to control group. This was statiscally significant (p<0,05). Histological scoring was evaluated according to Bonar Criterias and as biomechanical findings PLLA group was superior to control group (p<0,05).
Conclusions: In this study, postive effects of PLLA-based dermal fillers (Sculptra) on tendon healing was shown.

Keywords

Collagen, poly-l-lactic acid, PLLA, tendon healing

Poli-l-laktik asit bileşenli dermal dolgunun tendon iyileşmesi üzerine etkisi

Abstract

Amaç: Tendon iyileşmesi, uzun sürmesi, ağır yük taşıması, yapışıklık oluşumu gibi nedenlerle karmaşık bir süreçtir ve herhangi bir sorun yaşandığında ciddi işlev kayıplarına yol açabilir. İyileşen tendonun önceki gücüne ulaşamadığı gösterilmiştir. Kollajenler, tendonların mekanik dayanımı için oldukça önemlidir. Poli-L-Laktik Asit (PLLA), başarılı mekanik özellikleri ve uygun karakteristik yapısı nedeniyle günümüzde giderek daha popüler hale gelen sentetik bir polimer bileşiğidir. PLLA bazlı dermal dolguların kullanımı 1999 yılında başlamış ve halen devam etmektedir. Literatürde, enjeksiyon yapılan bölgede kollajen sentezini artırdığı gösterilmiştir. Bu çalışmada, PLLA'nın sıçan tendon iyileşme modelindeki etkilerinin araştırılması amaçlandı.
Gereç ve Yöntemler: Yirmi dört Wistar Albino dişi sıçan, Rastgele Kontrol Grubu ve PLLA Grubu olmak üzere iki gruba ayrıldı. Kontrol grubunda, sağ Aşil tendonu, kalkaneal yapışma yerinin 4 mm proksimalinden kesildi. PLLA grubunda ise aynı işlem uygulandıktan sonra iki tendon ucu arasına PLLA bazlı dermal dolgu enjekte edildi. Sıçanlar 3 hafta sonra sakrifiye edilerek tendonlar makroskopik, biyomekanik ve histolojik olarak parametrelere göre incelendi.
Bulgular: İncelemeler sonucunda, PLLA bazlı dermal dolgu grubunun makroskopik inceleme skorları kontrol grubuna göre daha yüksek bulunmuş ancak bu fark istatistiksel olarak anlamlı bulunmamıştır (p>0,05). Biyomekanik olarak, her iki grupta da değerler düşük bulunmuş ancak PLLA grubunda yük taşıma ve sertlik değerlerindeki azalma, kontrol grubuna göre daha düşük olmuş ve bu fark istatistiksel olarak anlamlı bulunmuştur (p<0,05). Histolojik skorlamalar Bonar kriterlerine göre değerlendirilmiş ve biyomekanik bulgulara paralel olarak PLLA grubu, kontrol grubundan üstün bulunmuştur (p<0,05).
Sonuç: PLLA bazlı dermal dolguların (Sculptra) tendon iyileşmesi üzerindeki olumlu etkileri olduğu belirlendi.

Keywords

Kollajen, poli-l-laktik asit, PLLA, tendon iyileşmesi

References

• de Putter CE, Selles RW, Polinder S, Panneman MJ, Hovius SE, and van Beeck EF. Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study. J Bone Joint Surg Am. 2012;94(9):e56.
• Tang JB. Clinical outcomes associated with flexor tendon repair. Hand Clin. 2005;21(2):199-210.
• Docheva D, Muller SA, Majewski M, and Evans CH. Biologics for tendon repair. Adv Drug Deliv Rev. 2015;84:222-39.
• Sharma P and Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005;87(1):187-202.
• Wong JK, Cerovac S, Ferguson MW, and McGrouther DA. The cellular effect of a single interrupted suture on tendon. J Hand Surg Br. 2006;31(4):358-67.
• Lui PP. Stem cell technology for tendon regeneration: current status, challenges, and future research directions. Stem Cells Cloning. 2015;8:163-74.
• Capuana E, Lopresti F, Ceraulo M, and La Carrubba V. Poly-l-Lactic Acid (PLLA)-Based Biomaterials for Regenerative Medicine: A Review on Processing and Applications. Polymers (Basel). 2022;14(6)
• Lee KWA, Chan LKW, Lee AWK, Lee CH, Wong STH, and Yi KH. Poly-d,l-lactic Acid (PDLLA) Application in Dermatology: A Literature Review. Polymers (Basel). 2024;16(18)
• Yang G, Rothrauff BB, and Tuan RS. Tendon and ligament regeneration and repair: clinical relevance and developmental paradigm. Birth Defects Res C Embryo Today. 2013;99(3):203-22.
• Oh S, Lee JH, Kim HM, et al. Poly-L-Lactic Acid Fillers Improved Dermal Collagen Synthesis by Modulating M2 Macrophage Polarization in Aged Animal Skin. Cells. 2023;12(9)
• Ao YJ, Yi Y, and Wu GH. Application of PLLA (Poly-L-Lactic acid) for rejuvenation and reproduction of facial cutaneous tissue in aesthetics: A review. Medicine (Baltimore). 2024;103(11):e37506.
• Brebels J and Mignon A. Polymer-Based Constructs for Flexor Tendon Repair: A Review. Polymers (Basel). 2022;14(5)
• Chen R, Chen F, Chen K, and Xu J. Advances in the application of hydrogel-based scaffolds for tendon repair. Genes Dis. 2024;11(4):101019.
• Stoll C, John T, Conrad C, et al. Healing parameters in a rabbit partial tendon defect following tenocyte/biomaterial implantation. Biomaterials. 2011;32(21):4806-15.
• Zhang B, Luo Q, Kuang D, Ju Y, and Song G. Mechano-growth factor E peptide promotes healing of rat injured tendon. Biotechnol Lett. 2016;38(10):1817-25.
• Maffulli N, Longo UG, Franceschi F, Rabitti C, and Denaro V. Movin and Bonar scores assess the same characteristics of tendon histology. Clin Orthop Relat Res. 2008;466(7):1605-11.
• Nishimoto H, Kokubu T, Inui A, et al. Ligament regeneration using an absorbable stent-shaped poly-L-lactic acid scaffold in a rabbit model. Int Orthop. 2012;36(11):2379-86.
• Inui A, Kokubu T, Makino T, et al. Potency of double-layered poly L-lactic acid scaffold in tissue engineering of tendon tissue. Int Orthop. 2010;34(8):1327-32.
• Wang W, He N, Yao Z, et al. An Integrative Dual-Layer Poly-L-Lactic Acid Fibrous Membrane Prevents Peritendinous Adhesions. Front Bioeng Biotechnol. 2020;8:387.
• Song Z, Shi B, Ding J, et al. A comparative study of preventing postoperative tendon adhesion using electrospun polyester membranes with different degradation kinetics. Science China Chemistry. 2015;58:1159-68.
• Xu Z, Xu W, Zhang T, and Luo L. Mechanisms of tendon-bone interface healing: biomechanics, cell mechanics, and tissue engineering approaches. J Orthop Surg Res. 2024;19(1):817.
• Gould HP, Rate WRt, Harrell RA, Abbasi P, and Fillar AL. Effect of Poly-L-Lactic Acid Mesh Augmentation on Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study. J Knee Surg. 2023;36(12):1224-29.
• Zhang J, Wang W, Zhang X, Yang L, and Zhang J. Research progress of biodegradable polymers in repairing Achilles tendon injury. Frontiers in Materials. 2022;9:815930.
• Inui A, Kokubu T, Fujioka H, et al. Application of layered poly (L-lactic acid) cell free scaffold in a rabbit rotator cuff defect model. Sports Med Arthrosc Rehabil Ther Technol. 2011;3:29.
• Sato M, Maeda M, Kurosawa H, Inoue Y, Yamauchi Y, and Iwase H. Reconstruction of rabbit Achilles tendon with three bioabsorbable materials: histological and biomechanical studies. J Orthop Sci. 2000;5(3):256-67.
• Jouybar A, Seyedjafari E, Ardeshirylajimi A, et al. Enhanced Skin Regeneration by Herbal Extract-Coated Poly-L-Lactic Acid Nanofibrous Scaffold. Artif Organs. 2017;41(11):E296-E307.
• Kim KL, Han DK, Park K, et al. Enhanced dermal wound neovascularization by targeted delivery of endothelial progenitor cells using an RGD-g-PLLA scaffold. Biomaterials. 2009;30(22):3742-8.
• Ballin AC, Brandt FS, and Cazzaniga A. Dermal fillers: an update. Am J Clin Dermatol. 2015;16(4):271-83.
• Lowe NJ. Optimizing poly-L-lactic acid use. J Cosmet Laser Ther. 2008;10(1):43-6.
• Goldberg D, Guana A, Volk A, and Daro-Kaftan E. Single-arm study for the characterization of human tissue response to injectable poly-L-lactic acid. Dermatol Surg. 2013;39(6):915-22.
• Movin T, Gad A, Reinholt FP, and Rolf C. Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients. Acta Orthop Scand. 1997;68(2):170-5.
• Maffulli N, Barrass V, and Ewen SW. Light microscopic histology of achilles tendon ruptures. A comparison with unruptured tendons. Am J Sports Med. 2000;28(6):857-63.
• Maffulli N, Reaper J, Ewen SW, Waterston SW, and Barrass V. Chondral metaplasia in calcific insertional tendinopathy of the Achilles tendon. Clin J Sport Med. 2006;16(4):329-34.
• Hapa O, Cakici H, Gideroglu K, Ozturan K, Kukner A, and Bugdayci G. The effect of ethanol intake on tendon healing: a histological and biomechanical study in a rat model. Arch Orthop Trauma Surg. 2009;129(12):1721-6.
• Muller SA, Durselen L, Heisterbach P, Evans C, and Majewski M. Effect of a Simple Collagen Type I Sponge for Achilles Tendon Repair in a Rat Model. Am J Sports Med. 2016;44(8):1998-2004.