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.
Highlights
Hyaluronic acid (HA) is an important component of articular cartilage; it is present as a coat around chondrocytes, where it bounds to aggrecan monomers, which imbibe water and are responsible for the resilience of cartilage [1]
The biological activities of HA are very complex: (a) it inhibits matrix metalloproteinases (MMPs) and the phagocytic activity of macrophages and leukocytes; (b) it promotes the release of prostaglandins and the production of tissue inhibitor of MMP-1 and favours the normalization of native hyaluronan synthesis; (c) it acts as free radicals scavenger and stimulates proteoglycans synthesis by chondrocytes; (d) it is provided of protective effects on chondrocytes or cartilage explants from degradation by enzymes [1]
Experimental research and pivotal clinical trials suggest that HA is effective in preventing adhesions after flexor tendons surgery
Summary
Hyaluronic acid (HA) is an important component of articular cartilage; it is present as a coat around chondrocytes, where it bounds to aggrecan monomers, which imbibe water and are responsible for the resilience of cartilage (i.e., resistance to compression) [1]. Several clinical trials have shown that viscosupplementation therapy with HA is safe and effective in the management of osteoarthritis (OA) resistant to conventional therapies [2] This treatment has been approved by Food and Drug Administration for knee osteoarthritis, whereas for the other joints there are very promising results but not conclusive evidence. HA is actively secreted by the tendon sheath and, as for joints, it is an important component of the synovial fluid, which allows a smooth tendon gliding, and provides nutrition to tendon itself [3]. It is an important component of tendon structure, being largely present in extracellular space
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