Mehmet Boz1, Hüsamettin Çakıcı2, Murat Pakdil3, Abdullah Alper Şahin4, Selma Erdoğan Düzcü5, Mehmet Murat Bala6, Metin Çelik1

1Department of Orthopedics and Traumatology, Malatya Training and Research Hospital, Malatya, Turkey
2Department of Orthopedics and Traumatology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
3Department of Mechanical Engineering, Abant Izzet Baysal University Faculty of Engineering, Bolu, Turkey
4Department of Orthopedics and Traumatology, Ordu University Training and Research Hospital, Ordu, Turkey
5Department of Pathology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
6Department of Orthopedics and Traumatology, Trabzon Health Sciences University Kanuni Training and Research Hospital, Trabzon, Turkey

Keywords: Chicken flexor tendon, flexor tendon adhesion, methylene blue, tendon healing.


Objectives: This study aims to biomechanically and histopathologically investigate the effects of methylene blue (MB) on preventing postoperative adhesion in chickens undergoing full- thickness flexor tendon incision.

Materials and methods: This study was performed between June 2017 and June 2018 on Hubbard JA 57 type chickens (age, 6 months; weight, 2.2±0.3 kg). Sixty-four tendons were studied in 32 chickens, including 16 in the control group and 16 in the experimental group. The second and third finger flexor digitorum profundus tendons of the left foot of each chicken were repaired primarily after a full-thickness incision approximately 1 cm proximal to the distal adhesion area. In the control (n=32) and experimental groups (n=32), 0.25 mL of normal saline and 0.25 mL of 1% MB solutions were applied locally to the surgical site, respectively. The operated limb was immobilized using a circular cast. 16 chickens were randomly selected in each group and examined at the fourth week, and the remaining 16 chickens were examined at the sixth week. Thirty-two of these tendons were evaluated using the Tang histopathological adhesion classification system, and the other 32 were evaluated with a biomechanical pull system.

Results: Adhesion was found to be less in the experimental group compared to the control group at the end of the fourth and sixth weeks both histopathologically and biomechanically. Furthermore, adhesion was significantly less in the experimental group at the end of the sixth week compared to the fourth week both histopathologically and biomechanically.

Conclusion: Histopathological and biomechanical results show that MB, which has anti-inflammatory, antiseptic, antimicrobial and antioxidant effects, reduces adhesion during the healing process after tendon repair. We think that local MB application, particularly in surgeries performed after this type of injury, will be beneficial on early rehabilitation and functional results.

Citation: Boz M, Çakıcı H, Pakdil M, Şahin AA, Erdoğan Düzcü S, Bala MM ,Çelik M. Does methylene blue reduce adhesion during the healing process after tendon repair?. Jt Dis Relat Surg 2020;31(2):246-254.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.