Preventing peritendinous adhesions using lubricious supramolecular hydrogels

Over 30-40% of 1.5 million annual hand flexor tendon injuries in the United States result in peritendinous adhesions which limit range of motion (ROM) and severely impact quality of life. Currently, no widespread solution exists for adhesion prevention in the delicate space of the digit while allowing full ROM quickly following surgery. Here, we develop dynamically crosslinked, bioresorbable supramolecular hydrogels as easy-to-apply peritendinous adhesion barriers. These hydrogels exhibit long-term stability, injectability, and thermally stable viscoelastic properties that enable simple storage and application. Interactions at the interface of hydrogel and human tissues demonstrate maintenance of a lubricious hydrogel barrier between tissues. Ex vivo studies show cadaveric tendon biomechanics are unimpaired. Application in preclinical rat tendon injury reveals prolonged hydrogel retention and improved functional recovery, including ROM and maximal dorsiflexion. These hydrogels are safe, do not impair tendon healing, and present a scalable intervention to limit peritendinous adhesions with translational potential. Widely used, effective methods to prevent adhesions after digit flexor tendon injury are lacking. Here, authors develop a bioresorbable, supramolecular hydrogel as a lubricating barrier to preserve tendon biomechanics and improve functional recovery.