Intrinsic healing of the laceration site in human superficialis flexor tendons in vitro

The intrinsic capability of the human superficialis flexor tendon to heal a reapproximated laceration site in vitro was examined. Segments of lacerated and sutured human superficialis flexor tendons from zone II were cultured for two, four, or eight weeks in vitro and analyzed by use of light and electron microscopy. We noted a specific pattern of intrinsic healing at the repair site during the incubation period. After two weeks, the cells of the epitenon from both tendon stumps proliferated and appeared to migrate into the repair site. Elongated cells of the thickened epitenon bridged the laceration and synthesized new collagen fibers. By eight weeks, a smooth contiguous tendon surface was restored and the internal collagen bundles were brought into intimate contact. The fibroblasts bridging the laceration, both in the epitenon and centrally in the repair site, were oriented perpendicular to the cut surfaces. The cells in the repair site were active in protein synthesis, and new collagen fibers were present. No cellular necrosis was observed in the internal repair site. Our results indicate that human superficialis tendons possess an intrinsic capacity to heal with diffusion and without dependence on extratendinous cells or on adhesions.