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Preventing peritendinous adhesions using lubricious supramolecular hydrogels
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  • Published: 31 March 2026

Preventing peritendinous adhesions using lubricious supramolecular hydrogels

  • Emily L. Meany  ORCID: orcid.org/0000-0001-9060-12531,2 na1,
  • Christian M. Williams2 na1,
  • Ye Eun Song  ORCID: orcid.org/0000-0001-8764-80772,
  • Vanessa M. Doulames  ORCID: orcid.org/0000-0003-4800-36922,
  • Alakesh Alakesh  ORCID: orcid.org/0000-0001-8038-04342,
  • Sophia J. Bailey2,
  • Shoshana C. Williams  ORCID: orcid.org/0000-0001-5669-63403,4,
  • Carolyn K. Jons2,
  • Paige M. Fox  ORCID: orcid.org/0000-0002-4166-85475,6,7 &
  • …
  • Eric A. Appel  ORCID: orcid.org/0000-0002-2301-71261,2,8,9 

Nature Communications , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Biomedical engineering
  • Biomedical materials
  • Translational research

Abstract

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.

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Data availability

All source data generated are provided with this paper in the Source Data file. Source data are provided with this paper.

Code availability

All code supporting the findings of this study was deposited into a public GitHub repository (https://github.com/cmw290/preventing-peritendinous-adhesions, release tag 1.0, https://doi.org/10.5281/zenodo.18636339).

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Acknowledgements

E.L.M. was supported by the NIH Biotechnology Training Program (T32-GM008412). C.M.W., C.K.J., and S.C.W. were supported by the National Science Foundation Graduate Research Fellowship (Award Number DGE-2146755). S.C.W. was supported by the Sarafan ChEM-H Chemistry/Biology Interface training program. The authors would like to thank every member of the Appel Lab, former and current, for their on-going support, technical expertise, and scientific discussion. In particular, the authors thank Noah Eckman and Samya Sen for their contributions to theorizing calculations, and Noah Eckman for assistance socializing animals. The authors would also like to thank Prof. Dauskardt and lab members for training on and use of their MTS instrument. Histological analysis was performed by Dr. José Vilches-Moure, DVM, PhD, with Stanford’s Veterinary Service Center Comparative Pathology services. Part of this work was performed at nano@stanford (RRID:SCR_026695).

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Author notes

  1. These authors contributed equally: Emily L. Meany, Christian M. Williams.

Authors and Affiliations

  1. Department of Bioengineering, Stanford University, Stanford, CA, USA

    Emily L. Meany & Eric A. Appel

  2. Department of Material Science & Engineering, Stanford University, Stanford, CA, USA

    Emily L. Meany, Christian M. Williams, Ye Eun Song, Vanessa M. Doulames, Alakesh Alakesh, Sophia J. Bailey, Carolyn K. Jons & Eric A. Appel

  3. Sarafan ChEM- H, Stanford University, Stanford, CA, USA

    Shoshana C. Williams

  4. Department of Chemistry, Stanford University, Stanford, CA, USA

    Shoshana C. Williams

  5. Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Stanford, CA, USA

    Paige M. Fox

  6. Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Paige M. Fox

  7. Division of Plastic Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

    Paige M. Fox

  8. Wood Institute for the Environment, Stanford University, Stanford, CA, USA

    Eric A. Appel

  9. Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, USA

    Eric A. Appel

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Contributions

E.L.M., C.M.W., P.M.F., and E.A.A. conceptualized and designed the research; P.M.F. and E.A.A. supervised all work; E.L.M., C.M.W., Y.E.S., and P.M.F. contributed to methodology; E.L.M., C.M.W.,. V.M.D., A.A., S.J.B., S.C.W., C.K.J., and P.M.F. conducted experiments and C.M.W. coded software; E.L.M. and C.M.W. produced figures, data visualization, and wrote the manuscript with review and edits from S.J.B., S.C.W., P.M.F., and E.A.A.

Corresponding authors

Correspondence to Paige M. Fox or Eric A. Appel.

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E.A.A, Y.E.S., E.L.M., and C.M.W. are listed as inventors on a patent application describing the dynamic hydrogel technology reported in this manuscript (patent PCT/US2023/079149). E.A.A. is a co-founder equity holder, and advisor for Appel Sauce Studios LLC, which holds a global exclusive license to the technology reported in this manuscript. The remaining authors declare no competing interests.

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Meany, E.L., Williams, C.M., Song, Y.E. et al. Preventing peritendinous adhesions using lubricious supramolecular hydrogels. Nat Commun (2026). https://doi.org/10.1038/s41467-026-71244-y

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  • Received: 13 February 2025

  • Accepted: 16 March 2026

  • Published: 31 March 2026

  • DOI: https://doi.org/10.1038/s41467-026-71244-y

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