Ahmet Yurteri1, Numan Mercan2, Murat Çelik3, Fatih Doğar4, Mehmet Kılıç1, Ahmet Yıldırım5

1Department of Orthopedics and Traumatology, Konya City Hospital, Konya, Türkiye
2Department of Orthopedics and Traumatology, Necip Fazıl City Hospital, Kahramanmaraş, Türkiye
3Department of Medical Pathology, Medicine Faculty of Selçuk University, Konya, Türkiye
4Department of Orthopedics and Traumatology, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Türkiye
5Department of Orthopedics and Traumatology, University of Health Sciences, Health Application and Research Center, Konya, Türkiye

Keywords: Achilles tendon, antioxidant, caffeic acid, phenolic, tendon injury model, tendon healing.


Objectives: This study aims to examine the effect of caffeic acid on tendon healing histopathologically and biomechanically in rats with an Achilles tendon injury model.

Materials and methods: Twenty male Wistar-albino rats were used in this study. The rats were divided into two groups as the experimental group and control group. All rats underwent a bilateral achillotomy injury model and then surgical repair. Postoperatively, for four weeks, the experimental group was given intraperitoneal caffeic acid (100 mg/kg/day suspended in saline), while the control group was given only intraperitoneal saline. At the end of four weeks, after sacrificing each rat, right Achilles tendons were subjected to biomechanical analysis and the Achilles tendons were subjected to histopathological analysis. Bonar and Movin scores were used for histopathological analysis. In biomechanical analysis, tensile test was applied to Achilles tendons until rupture. For each tendon, failure load, displacement, cross-sectional area, maximum energy, total energy, length, stiffness, ultimate stress and strain parameters were recorded.

Results: According to Bonar and Movin scoring, the experimental group had lower scoring values than the control group (p=0.002 and p=0.002, respectively). Bonar scoring parameters were analyzed separately. Vascularity, collagen, and ground substance scores were lower in the experimental group compared to the control group (p=0.001, p=0.003, and p=0.047, respectively). No significant difference was found for tenocyte (p=0.064). In biomechanical analysis, failure load, displacement, ultimate stress, strain, and stiffness values were found to be higher in the experimental group compared to the control group (p=0.049, p=0.005, p=0.028, p=0.021, and p=0.049, respectively).

Conclusion: The caffeic acid contributed positively to tendon healing histopathologically and biomechanically in rats with an Achilles tendon injury model.

Citation: Yurteri A, Mercan N, Çelik M, Doğar F, Kılıç M, Yıldırım A. The effect of caffeic acid on tendon healing in rats with an Achilles tendon injury model. Jt Dis Relat Surg 2023;34(3):669-678. doi: 10.52312/jdrs.2023.1248.

Ethics Committee Approval

The study protocol was approved by the Selçuk University Experimental Medicine Application and Research Center Animal Experiments Ethics Committee (date: 27.01.2023, no: 2020/58). Throughout our study, the principle of the Declaration of Helsinki was adhered to and care was taken to ensure that the animals did not feel pain.

Author Contributions

Conceptualization, methodology, software, data curation, writing, original draft: A.Y., N.M., M.K.; Methodology, project administration: A.Y., F.D.; Histopathological analysis: M.Ç.

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.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.