Effect of hyaluronic acid/chondroitin sulfate on healing of full‐thickness tendon lacerations in rabbits

Meyers, Steven A.; Seaber, Anthony V.; Glisson, Richard R.; Nunley, James A.

doi:10.1002/jor.1100070508

Cited by 53 publications

(25 citation statements)

References 25 publications

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“…[8][9][10][11][12] Clinical results, however, have been highly variable. 9,13,14 One of the reasons for this variability may be the short half-life of topically applied hyaluronic acid in tissues.…”

Section: Introductionmentioning

confidence: 99%

Optimization of surface modifications of extrasynovial tendon to improve its gliding ability in a canine model in vitro

et al. 2006

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Previous studies have shown that the carboxyl groups in hyaluronic acid (HA) could be activated by 1-ethy 1-3-[3-dimethylaminopropyl] carbodiimide hydrochloride (EDC)/N-hydroxysuccinimide (NHS) to form intermediate O-acylisoureas, which can chemically bind to exposed amino groups on the tendon surface, leading to improved gliding ability. However, the optimal ratio and concentrations of the components in this chemical mixture were not investigated. The purpose of this study was to optimize the constituents of this tissue engineering approach to tendon surface modification, to reduce friction and improve durability. Peroneus longus (PL) tendons (n ¼ 40) were harvested from adult mongrel dogs along with the A2 pulley obtained from the ipsilateral hind paw. After the gliding resistance of the normal PL tendon was measured, the tendons were treated under varying concentrations of HA (0.5, 1, and 2%) and EDC/NHS (0.05, 0.25, and 1%) mixed with a 10% gelatin. Tendon friction was measured for 1000 cycles of simulated flexion/extension motion. Following testing, the residual HA on the tendon surface was evaluated by immunohistochemisty. The gliding resistance of the untreated PL tendons had a mean value of 0.087 AE 0.021 N. After surface treatment, there was no significant difference in friction due to HA concentration alone, but the concentration of EDC/NHS and the interaction between HA concentration and EDC/NHS concentration had a significant effect on friction. Regardless of HA concentration, the friction after 1000 cycles was significantly decreased in preparations which included a 1% concentration of EDC/ NHS. The tendons with lower gliding resistance presented a smoother surface on light microscopy and maintained more residual HA on the tendon surface. By varying the relative concentrations of HA, EDC, and NHS it is possible to optimize the effect of surface treatment on friction and durability in a canine extrasynovial tendon in vitro. ß

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Section: Introductionmentioning

confidence: 99%

Optimization of surface modifications of extrasynovial tendon to improve its gliding ability in a canine model in vitro

et al. 2006

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“…The effect of hyaluronic acid on flexor tendon repair has been investigated in experimental and clinical studies [25][26][27][28][29] . Some studies have suggested that exogenously applied hyaluronic acid may prevent formation of adhesions between the flexor tendon and the surrounding tissue following tendon repair without affecting healing [30][31][32][33] .…”

mentioning

confidence: 99%

Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid<sbt aid="1047845">An in Vivo Canine Model</sbt>

Zhao

Sun

Amadio

et al. 2006

J Bone Joint Surg Am

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Background-Clinical and experimental studies have demonstrated that restrictive adhesions and poor digital motion are common complications after extrasynovial tendon grafting in an intrasynovial environment. The purpose of this study was to test the hypothesis that surface modification of an extrasynovial tendon with use of a carbodiimide-derivatized hyaluronic acidgelatin polymer (cd-HA) improves gliding ability and digital function after tendon grafting in a canine model in vivo.

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“…Furthermore, there were less inflammatory infiltration and adhesion formation at the repair area in both treatment groups when compared to the control group; however, there was no statistically significant difference between group 1 and the control group. Few studies have been conducted on the use of HA+CS as local injections in orthopedic practices (21). Combination treatment of HA and CS in tendon repair has been demonstrated to decrease lymphocyte and macrophage infiltration, increase vasculogenesis, increase the number and maturity of tenocytes, and reduce adhesion formation.…”

Section: Features Of Adhesions (Points)mentioning

confidence: 99%

“…We hypothesized that the high dose of HA+CS is suitable for tendon healing and prevention of peritendinous adhesion as well as the best stress endurance strength after extrasynovial tendon repair. Meyers et al (21) thought that HA could cause tendon healing intrinsically rather than extrinsically and might block the extrinsic healing mechanism by inhibiting neutrophil migration and phagocytosis as well as fibroblast migration to the tendon, thus preventing adhesion. We think due to the positive results that HA+CS contributed to intrinsic tendon healing.…”

Section: Features Of Adhesions (Points)mentioning

confidence: 99%

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

et al. 2016

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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.

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Effect of hyaluronic acid/chondroitin sulfate on healing of full‐thickness tendon lacerations in rabbits

Cited by 53 publications

References 25 publications

Optimization of surface modifications of extrasynovial tendon to improve its gliding ability in a canine model in vitro

Optimization of surface modifications of extrasynovial tendon to improve its gliding ability in a canine model in vitro

Surface Treatment of Flexor Tendon Autografts with Carbodiimide-Derivatized Hyaluronic Acid<sbt aid="1047845">An in Vivo Canine Model</sbt>

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

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