Lecithin-based multifunctional composite hydrogel membrane: Synergistic prevention of postoperative tendon adhesion via hydration lubrication and immunomodulation.

Abstract

Postoperative tendon adhesion is mainly driven by mechanical irritation and oxidative stress-induced inflammation at the injury site, which activates fibroblasts and disrupts the local immune microenvironment, thereby impairing tendon gliding and functional recovery. Thus, a biomaterial integrating lubrication, anti-adhesion, antioxidant, and immunomodulatory functions is urgently needed. Here, we developed PCL@ZwitterGel, a multifunctional lubricating composite, by loading a lecithin-based hydrogel onto an electrospun PCL fiber membrane to form an interpenetrating fiber-gel network. In vitro, PCL@ZwitterGel demonstrates significantly enhanced lubrication performance, with the friction coefficient reduced from 0.42 to 0.018, and suppresses fibroblast adhesion and proliferation. Reduced intracellular ROS levels were observed in the PCL@ZwitterGel group under the tested conditions. Additionally, a shift in macrophage polarization toward the M2 phenotype was also observed. In a rat Achilles tendon adhesion model, PCL@ZwitterGel significantly reduced adhesion formation, enhanced physiological collagen remodeling, and improved functional recovery and mechanical strength. Through synergistic physical lubrication, mechanical isolation, and biological modulation, it offers a promising strategy for preventing postoperative tendon adhesions.