Effects of repetitive injections of hyaluronic acid on peritendinous adhesions after flexor tendon repair: a preliminary randomized, placebo-controlled clinical trial

Abstract

AMAÇBu çalışmada, zon-II fleksör tendon onarımlarından sonra, iki haftalık süre içerisinde enjekte edilen 3 doz hyaluronik asit (HA) enjeksiyonunun plaseboya (salin) karşı etkinliği araştırıldı. GEREÇ VE YÖNTEMÇalışmaya İkinci parmak izole zon-II fleksör tendon hasarlanması olan 22 hasta dahil edildi. Tenorafi öncesi, parmaklar randomize olarak iki gruba ayrıldı; 11 parmakta tenorafi çevresine 3 doz HA enjekte edilirken, aynı şekilde salin enjekte edilen 11 parmak da plasebo grubunu oluşturdu. Birinci doz tenorafi sırasında verildi ve ilave 2 doz 1 hafta ara ile enjekte edildi. Operasyon sonrası Kleinert rehabilitasyon protokolü uygulandı. Eklem hareket açıklığı, 3. hafta, 3. ay ve uzun dönemde total aktif ve pasif eklem açıklığı ölçüle-rek değerlendirildi. Fonksiyonel sonuç, Strickland sınıflan-dırmasına göre belirlendi. BULGULARÜçüncü haftada eklem hareket açıklığı açısından iki grup arasında bir fark tespit edilmedi. Ancak, 3. ay ve uzun dö-nemde, eklem hareket açıklığında, HA enjekte edilen parmaklarda plasebo grubuna göre anlamlı derecede iyileşme olduğu gözlendi. SONUÇBu plasebo kontrollü ön çalışmada, mükerrer HA enjeksiyonlarının, primer tendon onarımında, muhtemelen adezyon azaltıcı etkisine bağlı olarak, klinik sonuçları iyileşti-rebildiği ileri sürülmektedir.Anahtar Sözcükler: Adezyon önleme; hyaluronik asit; tendon adezyonları; tendon onarımı.

Glycosaminoglycans in Tendon Physiology, Pathophysiology, and Therapy

“…In a smaller study, 11 patients received three HA injections following flexor tendon repair. 225 In the short term, 3 weeks following treatment, there was no difference in functional outcome between the treatment and placebo groups; however, at three months and in the longer-term patients receiving injections had better improved function. Although investigation needs to be performed in much larger patient populations; as it stands, Hyaloglide is a much more promising approach in prevention of adhesion formation and may drastically improve postoperative outcomes in the future.…”

Hyaluronic acid and tendon lesions

“…HA appears to inhibit the expression of key intermediaries for the inflammatory signaling pathways (NF-kB), in a dosedependent manner 19,43 . By reducing the expression of proinflammatory factors, adding exogenous HA reduces the fragmentation of endogenous HA and stimulates synovial synthesis of endogenous HA 16,26,36 . Concerning the therapeutic protocol for HA injections for tendinopathies, comparatively to other recent treatments for these conditions, where post-injection rehabilitation could be crucial 44 , such as PRP for example 45 , only 1 or 2 injections alone are described for HA treatments [30][31][32][35][36][37][38][39] .…”

“…By reducing the expression of proinflammatory factors, adding exogenous HA reduces the fragmentation of endogenous HA and stimulates synovial synthesis of endogenous HA 16,26,36 . Concerning the therapeutic protocol for HA injections for tendinopathies, comparatively to other recent treatments for these conditions, where post-injection rehabilitation could be crucial 44 , such as PRP for example 45 , only 1 or 2 injections alone are described for HA treatments [30][31][32][35][36][37][38][39] . However, comparatively to PRP treatments, where it exist a wide variability in the administered product 46,47 , the molecular weight and the concentration of HA are known 18 ; high molecular weight HA seems to have a better effect on tendons 18 in the short-term.…”

Ultrasound-guided intervention in the ankle and foot

“…9,10 However, there is only scarce evidence, and therefore the use of viscosupplementation around tendons should be limited before further investigation on safety and efficacy is undertaken. Surgical treatment of tendinopathy is indicated after failure of conservative measures or in recalcitrant cases.…”

“…3,4 Besides establishing the diagnosis of tendinopathy or tenosynovitis, ultrasound can also be used to guide the injection of steroid and local anaesthetic into the tendon sheath. [5][6][7] Patient positioning depends on the anatomic location, and a linear high-frequency transducer (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) MHz) is used to identify the pathological tendon and guide the needle. If possible, a hockey stick transducer is used, as it allows more space to manipulate the needle.…”