The use of hyaluronic acid after tendon surgery and in tendinopathies

Michele Abate, Cosima Schiavone, Vincenzo Salini, Michele Abate, Cosima Schiavone, Vincenzo Salini

Abstract

Viscosupplementation with hyaluronic acid is safe and effective in the management of osteoarthritis, but its use in the treatment of tendon disorders has received less attention. The aim of this review is to summarize the current knowledge on this topic, evaluating experimental and clinical trials. A search of English-language articles was performed using the key search terms "hyaluronic acid" or "viscosupplementation" combined with "tendon," "tendinopathy," "adhesions," or "gliding," independently. In quite all the experimental studies, performed after surgical procedures for tendon injuries or in the treatment of chronic tendinopathies, using different hyaluronic acid compounds, positive results (reduced formation of scars and granulation tissue after tendon repair, less adhesions and gliding resistance, and improved tissue healing) were observed. In a limited number of cases, hyaluronic acid has been employed in clinical practice. After flexor tendon surgery, a greater total active motion and fingers function, with an earlier return to work and daily activities, were observed. Similarly, in patients suffering from elbow, patellar, and shoulder tendons disorders, pain was reduced, and function improved. The positive effect of hyaluronic acid can be attributed to the anti-inflammatory activity, enhanced cell proliferation, and collagen deposition, besides the lubricating action on the sliding surface of the tendon.

References

    1. Abate M, Pulcini D, di Iorio A, Schiavone C. Viscosupplementation with intra-articular hyaluronic acid for treatment of osteoarthritis in the elderly. Current Pharmaceutical Design. 2010;16(6):631–640.
    1. Rutjes AW, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Annals of Internal Medicine. 2012;157(3):180–191.
    1. Hagberg L, Heinegard D, Ohlsson K. The contents of macromolecule solutes in flexor tendon sheath fluid and their relation to synovial fluid; A quantitative analysis. Journal of Hand Surgery. 1992;17(2):167–171.
    1. Riccio M, Battiston B, Pajardi G, et al. Efficiency of hyaloglide in the prevention of the recurrence of adhesions after tenolysis of flexor tendons in zone II: a randomized, controlled, multicentre clinical trial. Journal of Hand Surgery: European Volume. 2010;35(2):130–138.
    1. Özgenel GY, Etöz A. Effects of repetitive injections of hyaluronic acid on peritendinous adhesions after flexor tendon repair: a preliminary randomized, placebo-controlled clinical trial. Ulusal Travma ve Acil Cerrahi Dergisi. 2012;18(1):11–17.
    1. Corradi M, Bellan M, Frattini M, Concari G, Tocco S, Pogliacomi F. The four-strand staggered suture for flexor tendon repair: in vitro biomechanical study. Journal of Hand Surgery. 2010;35(6):948–955.
    1. Kolodzinskyi MN, Zhao C, Sun YL, et al. The effects of hylan g-f 20 surface modification on gliding of extrasynovial canine tendon grafts in vitro. Journal of Hand Surgery. 2013;38(2):231–236.
    1. Momose T, Amadio PC, Zobitz ME, Zhao C, An K-N. Effect of paratenon and repetitive motion on the gliding resistance of tendon of extrasynovial origin. Clinical Anatomy. 2002;15(3):199–205.
    1. Işik S, Oztürk S, Gürses S, et al. Prevention of restrictive adhesions in primary tendon repair by HA-membrane: experimental research in chickens. British Journal of Plastic Surgery. 1999;52(5):373–379.
    1. Liu Y, Skardal A, Shu XZ, Prestwich GD. Prevention of peritendinous adhesions using a hyaluronan-derived hydrogel film following partial-thickness flexor tendon injury. Journal of Orthopaedic Research. 2008;26(4):562–569.
    1. Callegari L, Spanó E, Bini A, Valli F, Genovese E, Fugazzola C. Ultrasound-guided injection of a corticosteroid and hyaluronic acid: a potential new approach to the treatment of trigger finger. Drugs in R and D. 2011;11(2):137–145.
    1. Muneta T, Koga H, Ju YJ, Mochizuki T, Sekiya I. Hyaluronan injection therapy for athletic patients with patellar tendinopathy. Journal of Orthopaedic Science. 2012;17(4):425–431.
    1. Petrella RJ, Cogliano A, Decaria J, Mohamed N, Lee R. Management of Tennis Elbow with sodium hyaluronate periarticular injections. Sports Medicine, Arthroscopy, Rehabilitation, Therapy and Technology. 2010;2(1, article 4)
    1. Andia I, Sanchez M, Maffulli N. Tendon healing and platelet-rich plasma therapies. Expert Opinion on Biological Therapy. 2010;10(10):1415–1426.
    1. Foland JW, Trotter GW, Powers BE, Wrighley RH, Smith FW. Effect of sodium hyaluronate in collagenase-induced superficial digital flexor tendinitis in horses. American Journal of Veterinary Research. 1992;53(12):2371–2376.
    1. Tatari H, Skiak E, Destan H, Ulukuş Ç, Özer E, Satoğlu S. Effect of hylan G-F 20 in achilles’ tendonitis: an experimental study in rats. Archives of Physical Medicine and Rehabilitation. 2004;85(9):1470–1474.
    1. Tuncay I, Ozbek H, Atik B, Ozen S, Akpinar F. Effects of hyaluronic acid on postoperative adhesion of tendo calcaneus surgery: an experimental study in rats. Journal of Foot and Ankle Surgery. 2002;41(2):104–108.
    1. Zhao C, Sun YL, Kirk RL, et al. Effects of a lubricin-containing compound on the results of flexor tendon repair in a canine model in vivo. The Journal of Bone & Joint Surgery. 2010;92(6):1453–1461.
    1. Yang C, Amadio PC, Sun Y-I, Zhao C, Zobitz ME, An K-N. Tendon surface modification by chemically modified HA coating after flexor digitorum profundus tendon repair. Journal of Biomedical Materials Research B: Applied Biomaterials. 2004;68(1):15–20.
    1. Sun Y-L, Yang C, Amadio PC, Zhao C, Zobitz ME, An K-N. Reducing friction by chemically modifying the surface of extrasynovial tendon grafts. Journal of Orthopaedic Research. 2004;22(5):984–989.
    1. Jones ARC, Flannery CR. Bioregulation of lubricin expression by growth factors and cytokines. European Cells and Materials. 2007;13:40–45.
    1. Akasaka T, Nishida J, Imaeda T, Shimamura T, Amadio PC, An K-N. Effect of hyaluronic acid on the excursion resistance of tendon graft: a biomechanical in vitro study in a modified human model. Clinical Biomechanics. 2006;21(8):810–815.
    1. Taguchi M, Zhao C, Sun Y-L, Jay GD, An K-N, Amadio PC. The effect of surface treatment using hyaluronic acid and lubricin on the gliding resistance of human extrasynovial tendons in vitro. Journal of Hand Surgery. 2009;34(7):1276–1281.
    1. Shibata Y, Midorikawa K, Emoto G, Naito M. Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. Journal of Shoulder and Elbow Surgery. 2001;10(3):209–216.
    1. Meloni F, Milia F, Cavazzuti M, et al. Clinical evaluation of sodium hyaluronate in the treatment of patients with sopraspinatus tendinosis under echographic guide: experimental study of periarticular injections. European Journal of Radiology. 2008;68(1):170–173.
    1. Costantino C, Olvirri S. Rehabilitative and infiltrative treatment with hyaluronic acid in elderly patients with rotator cuff tears. Acta Biomedica de l’Ateneo Parmense. 2009;80(3):225–229.
    1. Chou W-Y, Ko J-Y, Wang F-S, et al. Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study. Journal of Shoulder and Elbow Surgery. 2010;19(4):557–563.
    1. Ozgen M, Fırat S, Sarsan A, Topuz O, Ardıç F, Baydemir C. Short- and long-term results of clinical effectiveness of sodium hyaluronate injection in supraspinatus tendinitis. Rheumatology International. 2012;32(1):137–144.
    1. Merolla G, Bianchi P, Porcellini G. Ultrasound-guided subacromial injections of sodium hyaluronate for the management of rotator cuff tendinopathy: a prospective comparative study with rehabilitation therapy. Musculoskeletal Surgery. 2013;97(supplement 1):49–56.
    1. Menderes A, Mola F, Tayfur V, Vayvada H, Barutçu A. Prevention of peritendinous adhesions following flexor tendon injury with seprafilm. Annals of Plastic Surgery. 2004;53(6):560–564.

Source: PubMed

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