The Effect of Sodium Hyaluronate plus Sodium Chondroitin Sulfate Solution on Peritendinous Adhesion and Tendon Healing: An Experimental Study

Abstract

Background: Adhesion formation following tendon injury is a serious clinical problem. Aims: In this experimental study, the effects of the combination of sodium hyaluronate (HA) and chondroitin sulfate (CS) on peritendinous adhesion and tendon healing were evaluated. Study Design: Animal experimentation. Methods: Twenty-one mature Sprague Dawley male rats were randomly divided into three equal groups. The rats' Achilles tendons were cut and repaired with a modified Kessler technique. About 0.25 and 0.50 mL of the HA and CS (HA+CS) combination were injected subcutaneously into the repair site of the rats in groups 1 and 2, respectively, on days 0, 3, 7, and 10. The subjects in group 3 were used as the control group. At 6 weeks, all rats were euthanized. The tenotomy site was examined macroscopically in all animal subjects. Four samples were assigned to the histopathological examination group, and the others were assigned to the biomechanical assessment group.Results: Inflammation and adhesion in both treatment groups were observed at a lower rate than in the control group. The collagen filaments in both treatment groups were regular and the number was low when compared to the control group. However, there was no statistically significant difference between group 1 and the control group. The quantity, quality, and grade of the adhesions were statistically significantly lower in group 2 when compared with the other groups. The mean maximum stress strength in group 2 was statistically significantly higher than that in group 1 and the control group. Conclusion: Local administration of the HA+CS combination solution is a valid tool for preventing peritendinous adhesion after extrasynovial tendon repair such as Achilles tendon, and is a treatment option in such cases.

Do Nonsteroidal Anti-Inflammatory Drugs Affect Tissue Healing After Arthroscopic Anterior Cruciate Ligament Reconstruction?

“…However, the performance of selective COX-2 inhibitors used in clinic remains unclear. Several experimental studies of NSAID treatment on rats have revealed NSAID could impair healing of supraspinatus reattachment, patellar tendon reattachment, and the Achilles tendon [ 30 – 33 ]. To our knowledge, our study is the first time to investigate whether celecoxib could affect functional healing in patients undergoing ACL reconstruction.…”

The Effect of Sodium Hyaluronate on Ligamentation and Biomechanical Property of Tendon in Repair of Achilles Tendon Defect with Polyethylene Terephthalate Artificial Ligament: A Rabbit Tendon Repair Model

“…Deng et al [13] investigated the feasibility of using adipose derived stem cells (ASCs) for engineered tendon repair in vivo in a rabbit Achilles tendon model, and they found no difference in tensile strength at 5 weeks but found significant difference at the time points of 12 weeks, 21 weeks, and 45 weeks. Some other studies also show treatment of HA strongly improved the biomechanical properties of the injured tendons and the ultimate strength [10, 27]. One conceivable possibility is that, unlike with the normal Achilles tendon, PET artificial ligament has much better characteristic of strength and stiffness, and injection of HA may not add significant improvement of biomechanical property to PET artificial ligament.…”

“…Artificial ligaments can promise a fast functional recovery and avoid complications. In addition, there are various treatments applied for helping the healing of tendon injuries such as platelet-rich plasma (PRP) [8, 9] and sodium hyaluronate (HA) [10]. Sodium hyaluronate (HA) is polysaccharide, which is found in all extracellular matrix of vertebrates and in some bacteria as well [11].…”

The effect of sodium hyaluronate–chondroitin sulfate combined solution on cartilage formation in osteochondral defects of the rabbit knee: an experimental study

“…Tosun et al36 observed cartilaginous metaplasia formation after local combined HA+CS administration after Achilles tendon repair, and expressed the view that combined HA+CS administration might be useful in cartilage injuries.…”