Skip to main content Skip to main navigation menu Skip to site footer

The effect of freeze-dried human amnion on New Zealand rabbit tendon healing

  • Melissa Anita Ayu Iustitiati ,
  • Sitti Rizaliyana ,
  • Agus Santoso Budi ,


Background: Hand injury often causes acute morbidity and long-term disability. In the case of hand surgery, thirty percent of cases are from tendon injuries. The biomechanical strength of the tendon plays an important role in preventing post-repair rupture, where this strength is believed to be influenced by the number of strands of thread or the suturing technique used. In addition, biological materials such as amnion can reduce the risk of tendon adhesions and increase the biomechanical strength of the tendon itself.

Method: This study used an experimental randomized post-test-only control group research design. 18 male New Zealand rabbits had their right Achilles tendon severed, then divided into 2 groups, where group A was treated as a control while group B was treated with freeze-dried human amnion after tendon repair using braided suture (silk) material. On day 21, all rabbits were terminated and subjected to the macroscopic examination of tensile strength and microscopic examination of the number of fibroblasts and collagen density with hematoxylin-eosin staining. The test that will be carried out on each variable is the Mann-Whitney Test and T-test methods.

Result: The results showed that the average tensile strength in the treatment group was significantly greater than the control group (3.02±1.05 N/mm2 vs. 0.78±0.28 N/mm2, p<0.05). The mean number of fibroblasts in the treatment group was significantly greater than the control group (189.67±23.34 vs. 85.44±9.17, p<0.05). For the variable collagen density, 77.80% of the treatment group had collagen density with a score of 3 (p<0.05).

Conclusion: The application of freeze-dried human amnion after tendon grafting using braided suture material could increase tensile strength, number of fibroblasts, and collagen density in tendon healing.


  1. Liu C, Yu K, Bai J, Tian D, Liu G. Experimental study of tendon sheath repair via decellularized amnion to prevent tendon adhesion. PLoS One. 2018;13(10):e0205811. Published 2018 Oct 16. doi:10.1371/journal.pone.0205811.
  2. Buchanan EP, Longaker MT, Lorenz HP. Fetal skin wound healing. Adv Clin Chem. 2009;48:137-161. doi:10.1016/s0065-2423(09)48006-5.
  3. Han S, Gemmell SJ, Helmer KG, et al. Changes in ADC caused by tensile loading of rabbit achilles tendon: evidence for water transport. J Magn Reson. 2000;144(2):217-227. doi:10.1006/jmre.2000.2075.
  4. Wong YR, Loke AMK, Tay SC. The Effect of Suture Materials on the Biomechanical Performance of Different Flexor Tendon Repairs and the Concept of Construct Efficiency. J Hand Surg Asian Pac Vol. 2018;23(2):243-247. doi:10.1142/S2424835518500285.
  5. Liu C, Bai J, Yu K, Liu G, Tian S, Tian D. Biological Amnion Prevents Flexor Tendon Adhesion in Zone II: A Controlled, Multicentre Clinical Trial. Biomed Res Int. 2019;2019:2354325. Published 2019 Apr 3. doi:10.1155/2019/2354325.
  6. Yang JJ, Jang E, Song KS, and Lee JS. The effect of amniotic membrane transplantation on tendon-healing in a rabbit Achilles tendon model. Tissue Engineering and Regenerative Medicine. 2010;7(3). pp. 323–329.
  7. Arif A, Chaidir R, Ismono D, and Hidajat N. Comparison of post repair tensile strength using a modified Kessler 2, 4, and 6 strand technique assessed in the third week of rabbit Achilles tendon rupture healing. MOI. 2010;38(1). pp8–16.
  8. Caksana P, Kawiyana I, Dusak I, and Nindhia T. Comparison of tensile strength of continuous-core method and 4 strand modifies method of after healing of repaired Kessler rabbit's Achilles tendon injury. IOP Conference Series: Materials Science and Engineering. 2018;622. pp. 1–4. DOI:10.1088/1757-899X/622/1/012021.
  9. Effendi T, Martiana IK, and Suroto H. The comparison of biomechanical properties between autograft flexor tendon with freeze dried flexor tendon composite and auto mesenchymal stem cell for the reconstruction of flexor tendon defect. 2012;1(1). p1-9.
  10. Selvi F, Cakarer S, Can T, et al. Effects of different suture materials on tissue healing. J Istanb Univ Fac Dent. 2016;50(1):35-42. DOI:10.17096/jiufd.79438.
  11. Fairbairn NG, Randolph MA, Redmond RW. The clinical applications of human amnion in plastic surgery. J Plast Reconstr Aesthet Surg. 2014;67(5):662-675. DOI:10.1016/j.bjps.2014.01.031.
  12. Ozbölük S, Ozkan Y, Oztürk A, Gül N, Ozdemir RM, Yanik K. The effects of human amniotic membrane and periosteal autograft on tendon healing: experimental study in rabbits. J Hand Surg Eur Vol. 2010;35(4):262-268. DOI:10.1177/1753193409337961.
  13. Dadkhah Tehrani F, Firouzeh A, Shabani I, Shabani A. A Review on Modifications of Amniotic Membrane for Biomedical Applications. Front Bioeng Biotechnol. 2021;8:606982. DOI:10.3389/fbioe.2020.606982.
  14. Kang M, Choi S, Cho Lee AR. Effect of freeze dried bovine amniotic membrane extract on full thickness wound healing. Arch Pharm Res. 2013;36(4). p472-478. DOI:10.1007/s12272-013-0079-5.
  15. Schmiedova I, Ozanova Z, Stastna E, Kiselakova L, Lipovy B, Forostyak S. Case Report: Freeze-Dried Human Amniotic Membrane Allograft for the Treatment of Chronic Wounds: Results of a Multicentre Observational Study. Front Bioeng Biotechnol. 2021;9:649446. DOI:10.3389/fbioe.2021.649446.

How to Cite

Iustitiati, M. A. A., Rizaliyana, S., & Budi, A. S. (2022). The effect of freeze-dried human amnion on New Zealand rabbit tendon healing. Bali Medical Journal, 11(3), 1939–1944.




Search Panel

Melissa Anita Ayu Iustitiati
Google Scholar
BMJ Journal

Sitti Rizaliyana
Google Scholar
BMJ Journal

Agus Santoso Budi
Google Scholar
BMJ Journal