Hyaluronic Acid

Abstract

In recent times, the field of tissue engineering and regenerative medicine (TERM) has considerably increased the extent of therapeutic strategies for clinical application in orthopedics. However, TERM approaches have its rules and requirements, in the respect of the biologic response of each tissue and bioactive agents which need to be considered, respected, and subject of ongoing studies. Different medical devices/products have been prematurely available on the market and used in clinics with limited success. However, other therapeutics, when used in a serious and evidence-based approach, have achieved considerable success, considering the respect for solid expectations from doctors and patients (when properly informed).Orthobiologics has appeared as a recent technological trend in orthopedics. This includes the improvement or regeneration of different musculoskeletal tissues by means of using biomaterials (e.g., hyaluronic acid), stem cells, and growth factors (e.g., platelet-rich plasma). The potential symbiotic relationship between biologic therapies and surgery makes these strategies suitable to be used in one single intervention.However, herein, the recent clinical studies using hyaluronic acid (HA) in the treatment of orthopedic conditions will mainly be overviewed (e.g., osteochondral lesions, tendinopathies). The possibilities to combine different orthobiologic agents as TERM clinical strategies for treatment of orthopedic problems will also be briefly discussed.

Extracellular Matrix in Calcific Aortic Valve Disease: Architecture, Dynamic and Perspectives

“…In a recent model, HA enrichment induces VIC secretion of VEGF while chondroitin sulfate enrichment leads to increased deposition of oxidized lipoproteins, which, in turn, induce myofibroblastic activation and the production of inflammatory cytokines [ 149 ]. In tissue engineering and regenerative medicine, HA has been used in combination with growth factors, cells, nanotechnology, and advanced scaffolds [ 150 ]. Moreover, HA represent a natural macromolecular crowder able to increase cell-mediated ECM deposition in vitro [ 151 ].…”

The Role of Hyaluronic Acid in Sport-Related Tendinopathies: A Narrative Review

“…This compound is largely present in the extracellular matrix (ECM) of articular cartilage and in synovial fluid and is secreted by synovial cells of the tendon sheath. Rheological characteristics of HA contribute to lubrication, viscoelasticity, and hydration balance, acting as a shock absorber and a structure stabilizer in different tissues, including tendons [16]. Furthermore, HA seems to be involved in the regulation of the tissue repair process, modulating the main phases of tendon healing (i.e., inflammation, cellular migration, and angiogenesis) [17].…”

The Impact of Hyaluronic Acid on Tendon Physiology and Its Clinical Application in Tendinopathies

“…Cells and growth factors alone cannot achieve optimal results in stimulating tenocytes differentiation without appropriate mechanical stimulation [73]. HA has been proposed as hydrogel or a 3D scaffold in combination with orthobiologics, such as tenoblasts, biomaterials, and growth factors to develop and support implantable tenocytes [74]. Scaffolds using HA are biodegradable, biocompatible, and bioabsorbable; HA plays a crucial role in cell signalling and cell growth, which can be attuned to the scaffold through its functional groups and functional domains [75,76].…”