Hyaluronic Injection Research Articles

Recurrent delayed hypersensitivity reaction to a hyaluronic acid soft-tissue filler following COVID-19 vaccination: a case report

Hyaluronic acid soft-tissue fillers are the second most widely used injectable agents in cosmetic surgery. During the coronavirus disease 2019 (COVID-19) pandemic, a few cases of delayed hypersensitivity reactions to hyaluronic acid filler injections have been reported following COVID-19 infection or vaccination against the virus. A 61-year-old woman visited the emergency room with swelling and redness on the entire face that started on the nasolabial area. She had received hyaluronic acid filler injections in her nasolabial area 8 months previously and had completed the primary series of vaccinations and received a booster dose of the mRNA Pfizer-BioNTech COVID-19 vaccine 1 month before the swelling episode. A corticosteroid was added to the antibiotic regimen because of the nonsignificant effect of the antibiotics. The symptoms then resolved, and corticosteroid use was tapered over the course of 2 weeks. Four months later, swelling and redness recurred on both nasolabial folds and chin, but the symptoms were more localized than before. The renewed symptoms regressed with surgical drainage and corticosteroid and antibiotic treatment. This study discusses this extremely rare case of a recurrent delayed hypersensitivity reaction to a hyaluronic acid soft-tissue filler following COVID-19 vaccination.

Case series of tongue necrosis from vascular complications after chin augmentation with hyaluronic acid: Potential pathophysiology and management

Even though the chin is considered a safe injection area for facial filler augmentation, tongue necrosis is a rare complication in this area. Our aim was to present case series of rare complications from chin filler augmentation with possible pathophysiology and management. From our thorough literature search found only one case report of tongue necrosis from chin filler augmentation. We present case series of unilateral tongue necrosis from vascular occlusion following hyaluronic acid injection in the chin, which was successfully treated with a high-dose hyaluronidase injection resulting in complete recovery in all patients. Variation in vascular anastomosis leads to a possible cause of vascular occlusion. The lingual artery is the primary arterial supply for the tongue, which is an exclusive target for embolism. Two main responsible arteries and branches are the deep lingual and sublingual arteries. The submental artery variation was previously described as the cause of this event. We proposed potential pathophysiology of the occlusion, not only the variation of vasculature but bone. The midline lingual foramen, an anatomical bone variation on the surface of the midline inferior jaw, was found to be another possible cause. This foramen contains a branch of the submental and sublingual artery, which includes the perforating artery, median perforating artery, or both. Filler injection with a sharp needle on the bone can potentially increase the risk of this vascular incident. A high dose of hyaluronidase administered with multiplane injections was accomplished with complete recovery. Tongue necrosis from vascular complications after hyaluronic acid filler injection can occur. Not only vessels but bone variation pathology were possible causes.

Infraorbital mass long after dermal filler injection: A report of two cases.

Hyaluronic acid fillers have been increasingly used throughout the world in the management of aging skin in the periocular region and other areas. To evaluate very late-term orbital mass formation secondary to Hyaluronic acid filler injection into the inferior eyelid. We report two cases that presented with a subcutaneous palpable mass localized at the right medial lower infraorbital area. Following clinical and radiological examination, surgical excision was required for the differential diagnosis of tumor. After pathologic examination and the finding of a foreign-body granulomatous reaction, both patients recalled that hyaluronic acid filler had once been injected into their lower eyelids approximately 10 years prior. This is consistent with the fact that dermal-filler-related granuloma formation may occur even years later in the differential diagnosis of mass lesions. It is suggested that patients be informed about the possible but rare mass effect in the infraorbital region. Clinicians should also attend to delayed hypersensitivity reactions, since patients may not recall details due to the length of time since injection.

Effect of local application of hyaluronic acid gel on marginal bone loss and stability of dental implants

ABSTRACT Aim: To evaluate and compare the crestal bone loss and implant stability with and without hyaluronic acid gel delivery at osteotomy site. Materials and Methods: This is a Prospective randomized controlled clinical trial. Eleven patients with 30 edentulous sites were randomly divided into two groups. Test (15 sites with hyaluronic acid gel injection) and Control (15 sites without hyaluronic acid gel injection). Peri-implant crestal bone loss around the implant and stability were measured at baseline and three months. Statistical analysis was done using Mann-Whitney U test and Wilcoxson Signed-Rank test. Results: Primary stability scores for the test and control groups were 70.45 ± 1.49 and 69.53 ± 1.69, respectively and was not statistically significant. Secondary stability scores for the test and control group were 72.37 ± 1.42and 70.63 ± 1.61 respectively and was statistically significant, mean crestal bone loss for the test and control groups was 0.83 ± 0.31 and 1.27 ± 0.32, respectively. which was statistically significant (p-value < 0.05). Conclusion: Within the study’s limitations, the results showed that the local injection of osteotomy sites with hyaluronic acid showed a significant increase in stability and reduction in crestal bone loss.

The use of Google Trends and Twitter data as a tool for evaluating public interest in hyaluronic acid eyelid filler

Google Trends and the Twitter Academic Research Product Tract (TARPT) are free, online tools that can be used to evaluate public interest in plastic surgery procedures. The aim of the study was to evaluate the correlation between online public interest in hyaluronic acid eyelid filler on two popular web platforms (Google and Twitter) and hyaluronic acid filler procedure volumes in the United States. The Google Trends database and the TARPT tool were used to calculate the number of annual Google searches and Twitter tweets, respectively, related to 10 search terms associated with hyaluronic acid eyelid filler injections from January 2010 to December 2020. Annual procedure volumes for hyaluronic acid filler injections were obtained from the American Society of Plastic Surgery (ASPS). Univariate linear regression was used to correlate Google searches to ASPS procedure volumes and Twitter tweet volumes to ASPS procedure volumes. Significant positive correlations were found between Google Trends data and ASPS procedure volumes for 8/10 search terms and between Twitter tweet volumes and ASPS procedure volumes for 6/10 search terms, respectively. Online public interest in eyelid filler related search terms increased significantly over time according to an exponential model (P < 0.0001). We observed statistically significant positive associations between public interest related to eyelid filler on two online platforms, Google and Twitter, and hyaluronic acid soft-tissue filler procedure volumes. The Google Trends and TARPT databases represent free information sources for surgeons that may be used to inform marketing and advertising decisions and to anticipate patient inquiries during the patient encounter. Information provided by the Google Trends and TARPT tools can be used by surgeons to (1) inform marketing and advertising strategies and (2) gain insight into which procedures patients are researching during a given time period, preparing them to best address the evolving needs of patients.

Retracted: Effect of Tongluozhitong Prescription-Assisted Intra-Articular Injection of Sodium Hyaluronate on VAS Score and Knee Lysholm Score in Patients with Knee Osteoarthritis.

[This retracts the article DOI: 10.1155/2021/3210494.].

An Innovative Approach for Nasal Reshaping using Hyaluronic Acid Intradermal Injections.

Nasal reshaping using hyaluronic acid (HA) filler has become a widespread technique and injections are usually performed in deep layers. As an alternative, we propose an innovative approach where HA is injected into the dermis, the so called MesoRhinoFiller. The aim of this study was to describe our injection technique using a smooth, cohesive, and slightly viscous HA filler injected in the dermis. A retrospective review of the author's clinical experience from March 2017 to March 2020 was presented. A total of 280 consecutive patients were treated with HA injections to improve their nasal appearance. The mean volume was 0.5 cc HA filler/treatment. An average increase of 4.9 ± 3.4° was obtained for the nasofrontal angle, and of 7.0 ± 4.5° for the columella labial angle. Asymmetries in the nasal profile and alar rim were also corrected. All the patients were satisfied with the results and no complications occurred. Injecting HA fillers in the dermal plane is a versatile approach that provides very satisfactory results. This technique allows one to better correct aesthetical, post-traumatic, and post-surgical defects compared with the usual injection rhinoplasty procedures where the filler is injected deep onto the bone/cartilage in the midline of the nose.

Reversible Vision Loss Following Nonsurgical Filler Rhinoplasty

The increase in the frequency and popularity of aesthetic filler injections is accompanied by a high risk of complications, including ophthalmological sequalae. Of these, loss of vision is considered the most dangerous and, in most cases, irreversible. We present a case report of a patient who experienced acute vision loss due to suspected partial occlusion of the ophthalmic artery following nonsurgical rhinoplasty with hyaluronic acid filler injection. It differs from others in that treatment in the form of a combination of multiple subcutaneous hyaluronidase injections into the periocular region, a single retrobulbar injection of hyaluronidase, and hyperbaric oxygen therapy led to a significant recovery of ophthalmic symptoms with only residual visual field defects remaining.

Evaluation of the Anti-inflammatory Effect of Intra-articular Injection of Chondroitin Sulfate and Sodium Hyaluronate in Mechanically Induced Temporomandibular Joint Injury in Rabbits

BACKGROUND: Degenerative arthritis is the most common form of arthritis, usually affecting the hands, feet, spine, knees, and temporomandibular joint (TMJ) as well. TMJ degenerative arthritis causes symptoms of painful joints, loss of joint function, limited mouth opening, joint instability, and clicking. Non-surgical symptomatic treatments can successfully be used to treat patients with degenerative arthritis. AIM: This study aimed to evaluate the anti-inflammatory effect of intra-articular injection of chondroitin sulfate and sodium hyaluronate in mechanically induced acute injury in TMJ of rabbits. METHODS: An animal study was conducted, all rabbits received a mechanical injury using a contra-angle handpiece with a speed of 120 rpm of a fissure bur 4 mm in diameter and 4 mm in depth extending to subchondral bone. Thirty-two rabbits were randomized into four groups: Control group, sodium hyaluronate “SH” group, chondroitin sulfate “CS” group, and “CS-SH” group. After 7 days, rabbits in the control group, “SH” group, “CS” group, and “CS-SH” group were respectively treated with normal saline, sodium hyaluronate, chondroitin sulfate, or combination of CS&amp;SH injection in the TMJ. All animals were treated once weekly for 3 weeks. A histological evaluation was performed. RESULTS: Histological findings showed a significantly reduced inflammatory cell, bone resorption, and fibrosis in the CS-HA-treated group. CONCLUSION: CS-SH injection has an anti-inflammatory effect on TMJ degenerative arthritis and aids in the reparative process.

Efficacy and Safety of Hyaluronic Acid Intra-articular Injection after Arthroscopic Knee Surgery: A Systematic Review and Meta-analysis.

Hyaluronic acid (HA) intra-articular injection after arthroscopic knee surgery has been widely applied but its efficacy and safety remain controversial. The aim of this systematic review is to analyze the efficacy and safety of HA intra-articular injection after arthroscopic knee surgery, and to compare the efficacy of HA with different molecular weights. We conducted a systematic literature search in PubMed, Embase, Google scholar and the Cochrane library from inception to 16 September 2022 for English-written articles, in order to identify randomized controlled trials that evaluated the clinical efficacy and/or safety of HA intra-articular injection after arthroscopic knee surgery. Then we meta-analyzed the outcomes of patients given intra-articular HA injections postoperatively and control patients. We also evaluated the influence of HA with different molecular weights. In every calculation, sensitive analysis was performed. The visual analogue scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and adverse events were selected as the primary outcome measurements, while Lysholm, International Knee Documentation Committee (IKDC) and Tegner score were selected as the secondary outcome measurements. Publication bias of every outcome was evaluated using egger test. Fifteen studies involving 951 knees were included and 12 of them were used to performed the meta-analysis. The results showed no significant difference between the HA group and control group according to VAS, whether assessed at less (P=0.90) or more than 6 months (P=0.55). Besides, there were no statistical differences between the HA group and control group according to subgroup analysis (Ps=0.77, 0.91 and 0.81 in anterior cruciate ligament reconstruction, meniscectomy and overall groups, respectively). Compared to control group, the overall effect of WOMAC score showed no significant differences (P=0.25), nor did in two subgroups (P=0.37 and P=0.22). Outcomes measured by Lysholm (P=0.13), IKDC (P=0.86) and Tegner (P=0.42) scores showed no significant differences, either. The analysis of the risk of adverse events indicated no increase in HA groups (P=0.06). We found no significant differences between high- and low-molecular-weight HA at 6 (P=0.96) or 12months (P=0.93) postoperatively. Two studies failed to pass the sensitive analysis and the reasons were discussed detailly and acceptable publication bias was observed. Although HA injection after arthroscopic knee surgery is safe, the available evidence does not support its efficacy in pain relief and functional recovery. Therefore, the application of HA injection after arthroscopic knee surgery is not recommended.

Investigations into photoreceptor energy metabolism during experimental retinal detachment.

Retinal detachment is a sight-threatening disorder, which occurs when the photoreceptors are separated from their vascular supply. The aim of the present study was to shed light on photoreceptor energy metabolism during experimental detachment in rats. Retinal detachment was induced in the eyes of rats via subretinal injection of sodium hyaluronate. Initially, we investigated whether detachment caused hypoxia within photoreceptors, as evaluated by the exogenous and endogenous biomarkers pimonidazole and HIF-1α, as well as by qPCR analysis of HIF target genes. The results showed no unequivocal staining for pimonidazole or HIF-1α within any detached retina, nor upregulation of HIF target genes, suggesting that any reduction in pO2 is of insufficient magnitude to produce hypoxia-induced covalent protein adducts or HIF-1α stabilisation. Subsequently, we analysed expression of cellular bioenergetic enzymes in photoreceptors during detachment. We documented loss of mitochondrial, and downregulation of glycolytic enzymes during detachment, indicating that photoreceptors have reduced energetic requirements and/or capacity. Given that detachment did not cause widespread hypoxia, but did result in downregulated expression of bioenergetic enzymes, we hypothesised that substrate insufficiency may be critical in terms of pathogenesis, and that boosting metabolic inputs may preserve photoreceptor bioenergetic production and, protect against their degeneration. Thus, we tested whether supplementation with the bioavailable energy substrate pyruvate mitigated rod and cone injury and degeneration. Despite protecting photoreceptors in culture from nutrient deprivation, pyruvate failed to protect against apoptotic death of rods, loss of cone opsins, and loss of inner segment mitochondria, in situ, when evaluated at 3 days after detachment. The regimen was also ineffective against cumulative photoreceptor deconstruction and degeneration when evaluated after 4 weeks. Retinal metabolism, particularly the bioenergetic profiles and pathological responses of the various cellular subtypes still presents a considerable knowledge gap that has important clinical consequences. While our data do not support the use of pyruvate supplementation as a means of protecting detached photoreceptors, they do provide a foundation and motivation for future research in this area.

The effect of combined hyaluronic acid filler injection and radiofrequency treatment: A clinic histological analysis.

Hyaluronic acid (HA) filler injections have increased in popularity. They are usually performed in combination with other treatment modalities, including lasers and energy-based devices, to enhance cosmetic results. Theoretically, HA and other filler injections should be performed after laser- or energy-based device treatments. In some instances, however, practitioners are asked to administer laser- or energy-based device treatment after HA dermal filler injection. There is a concerning possibility of HA filler degradation as a result of bulk heating generated by lasers or energy-based devices, especially radiofrequency (RF). To evaluate the effect of RF treatment at different time points on HA degradation in vivo, using clinicohistological analysis. Fourteen volunteers were recruited and received intradermal HA filler injections in four sites on the abdomen. One site served as the control, and the other three sites were treated with monopolar RF on the same day after injection, at 14 and 28 days post-injection. Skin biopsies were performed at baseline and 56 days after HA injection. Histopathological sections were reviewed for residual filler in the tissue. The results showed that HA grading scores decreased in five (35.71%), one (7.14%), and one (7.14%) participants when RF was performed immediately, 14 and 28 days after injection, respectively. In conclusion, RF treatment after HA filler injection may affect the integrity of the HA filler in the tissue, especially if RF treatment was performed on the same day after HA injection.

Clinical Evaluation of Intra-Articular Injection of Chondroitin Sulfate and Sodium Hyaluronate in the Management of Degenerative Osteoarthritis of Temporomandibular Joint

AIM: This study aims to evaluate the effectiveness of intra-articular injection of chondroitin sulfate and sodium hyaluronate in cases of temporomandibular joint (TMJ) degenerative osteoarthritis. MATERIAL AND METHODS: Thirty patients ASA I of both sexes, who were selected from outpatient clinic of Oral Surgery Department, Faculty of Dentistry – Suez Canal University, complaining of painful TMJ, presence of unilateral or bilateral TMJ pain, impairment of jaw movements, and joint sounds. Clinical examination was performed to all patients and pre-operative measurements of visual analog scale (VAS) for morning pain, pain with movement and spontaneous pain, maximum mouth opening, and presence or absence of clicking. Patients were randomly divided into two groups; (a) Study group consisted of 15 patients, they had intra-articular injection of chondroitin sulfate and sodium hyaluronate once weekly for 3 weeks and (b) control group consisted of 15 patients, they had intra-articular injection of sodium hyaluronate once weekly for 3 weeks. Post-operative measurements of VAS for previous pain types, maximum mouth opening, and clicking were obtained at 1 month, 3 months, and 6 months post-injection. RESULTS: There was a statistically significant reduction of all types of pain in the study group compared to the control group at all time intervals (p ≤ 0.05), for maximum mouth opening, there was a significant improvement in mouth opening in the study group for all time intervals (p ≤ 0.05), but for the clicking, there was not statistically significant difference between the study and control groups after 1 month, 3 months, and 6 months. The difference between groups was barely statistically significant (p = 0.05). CONCLUSION: Intra-articular injection of a combination of chondroitin sulfate and sodium hyaluronate is an effective tool in reducing pain, clicking, limited mouth opening, and other symptoms associated with degenerative TMJ diseases.

Tear trough rejuvenation using Restylane Eyelight

Hyaluronic acid filler injection treatment represents the second most commonly performed non-surgical treatment worldwide behind botulinum toxin injections ( International Society of Aesthetic Plastic Surgery, 2020 ). This should come as no surprise, as dermal filler treatments represent a swift non-surgical technique with immediate and long-lasting results. Consequently, such treatments are gaining global acceptance ( Berguiga and Galatoire, 2017 ). It is known that periocular rejuvenation is one of the chief concerns for patients seeking aesthetic enhancement ( Eyelight, 2020 ). Therefore, it is the author's belief that possessing the expertise to carry out tear trough rejuvenation is an important skill to acquire in one's medical practice. To achieve ideal results, the aesthetic practitioner must have an innate knowledge of anatomy, as well as assessment and treatment techniques of the area. This article will review the evidence relating to hyaluronic acid dermal fillers and the clinical outcomes for patients who require tear trough treatment.

Good tolerance of hyaluronic acid filler injections during the COVID-19 pandemic.

The aim of our study was to identify and evaluate the complications related to hyaluronic acid during the COVID-19 pandemic. Twelve dermatologists participated in this study. A cohort and a non-cohort follow-up were ensured. (1) Cohort follow-up: 1041 patients. 8% had a COVID-19 infection, 27% had received COVID-19 vaccination. 2% had immediate side effects (edema, erythema, bruising). 0.5% had delayed side effects (two inflammatory nodules, one nodule without inflammation, one edema). None of these side effects occurred in the context of infection or COVID-19 vaccinations. (2) Non-cohort follow-up: 7900 syringes used. Two early side effects (inflammatory edema) were reported, of which one occurred 15 days after vaccination. Two cases of delayed side effects such as inflammation on the injected area and inflammatory nodules occurred of which one was in the context of vaccination and one during COVID-19 infection. We estimate the frequency of complications possibly attributable to the disease or to the COVID vaccination to be 0.06% in our population. Complications of HA injections in the context of COVID-19 disease or vaccination appear to be very rare but the frequency could be underestimated because of the low rate of vaccination/infection in our population. Our study shows a very good tolerance of hyaluronic acid injections during the COVID-19 pandemic.

Medium-Term Effect of Treatment with Intra-Articular Injection of Sodium Hyaluronate, Betamethasone and Platelet-Rich Plasma in Patients with Temporomandibular Arthralgia: A Retrospective Cohort Study.

Temporomandibular joint disorders are associated with pain and reduced jaw mobility. The aim of this study was to compare the long-term effect on pain of intra-articular TMJ injections of betamethasone, sodium hyaluronate and platelet-rich plasma. The sample was made up of 114 patients, who were randomly distributed into three groups at least three years ago and who achieved a total remission of pain after treatment. We found that the median number of months without pain was, according to each group, as follows: platelet-rich plasma: 33; sodium hyaluronate: 28; betamethasone: 19. Both platelet-rich plasma and sodium hyaluronate lead to significant pain-free time after treatment; when we compare bethametasone with the two other substances, it proved to be very ineffective.

Hyaluronic acid dermal filler injection increases the survival of rat dorsal skin flaps

Hyaluronic acid dermal filler injection increases the survival of rat dorsal skin flaps

Persistence of lower vocal intensity in vocal fold paralysis with cricothyroid impairment after hyaluronate injection.

Unilateral vocal fold paralysis (UVFP) affects the glottal gap, voice, and aerodynamics, whereas injection laryngoplasty (IL) using hyaluronate is an effective treatment for UVFP by decreasing the glottal gap to improve voice. Previous studies have shown that the involvement of cricothyroid (CT) muscle in UVFP patients further affects patients' aerodynamics, but it remains unclear whether the difference remains after IL. This study investigates whether the aerodynamic features observed in UVFP with CT involvement could still be observed after IL. This study recruited UVFP patients with dysphonia, and IL was performed within 6months of initial symptoms. All subjects received assessments including videolaryngoscopy, voice analysis, and aerodynamics at three time points: before IL, 1month after IL, and 6months after IL. The glottal gap, voice, and aerodynamics between patients with and without CT involvement (the CT+ and CT- groups) were compared, and the change (Δ) before and after IL and repeated-measures analysis of variance (ANOVA) were also compared between the two groups. A total of 71 patients with UVFP (22 in the CT+ group and 49 in the CT- group) were analyzed. After IL, the CT+ group showed a lower sound pressure level (SPL), higher Δair pressure, and smaller Δaerodynamic power than the CT- group. The CT+ group had a lower SPL, even after elevating air pressure to attempt to achieve a higher vocal intensity. The results suggest that although closure of the glottal gap was achieved by IL, the CT+ group still had a lower loudness and needed to sustain a higher peak air pressure when producing voice. Level 4.

Are Delayed Dermal Filler Granulomas More Common Since COVID-19?

PurposeGranuloma and delayed inflammatory reaction to hyaluronic acid (HA) facial esthetic fillers occurs rarely. More recently, these reactions have been reported with increasing frequency and have been associated with COVID-19 infection. The purpose of the study is to determine if delayed filler granulomas are more common after the start of the COVID-19 pandemic.MethdosA retrospective cohort study including of all patients treated with dermal filler at 4 offices of a single cosmetic surgery practice between August 1st, 2018 and October 31st, 2021 was performed. The primary outcome variable was granuloma formation. The primary predictor variable was time period, either pre-COVID (8/1/18-2/29/20) or post-COVID (3/1/20-10/31/21). Other study variables recorded were age, amounts of dermal fillers used, and types of dermal filler used. Data was analyzed using chi-squared, t-tests and logistic regression.ResultsOver the study period, 3,255 patients receiving 8,067 syringes of filler over 6,800 sessions were reviewed. The average patient age was 46.8 ± 13.7 years and 2,583 sessions were performed in the pre-COVID time period and 4,217 sessions in the post-COVID time period. There were 11 granulomas in 9 subjects receiving filler in the post-COVID time period and 0 granulomas in the pre-COVID time period (0.3% vs 0.0%, respectively, p = 0.009). Juvederm Vollure was used in 64% of patients who developed granulomas, but only accounted for 26% of filler administrations in the post-COVID time period and 28% in the cohort overall (p=0.02).ConclusionGranuloma formation is a rare complication of HA filler injection that appears to be occurring with more frequency following the COVID-19 pandemic. Practitioners who administer dermal fillers should be aware of this complication and its apparent increased incidence

Effectiveness of High-Intensity Laser Therapy Plus Ultrasound-Guided Peritendinous Hyaluronic Acid Compared to Therapeutic Exercise for Patients with Lateral Elbow Tendinopathy.

Lateral elbow tendinopathy (LET) is a common painful musculoskeletal disorder. Several treatments have been proposed to provide pain reduction and functional recovery, including laser therapy, hyaluronic acid peritendinous injection (Hy-A), and therapeutic exercise (TE). Our study aims to assess the effectiveness of a combined approach with high-intensity laser therapy (HILT) and Hy-A injections compared to TE on pain, muscle strength, and disability in patients with painful LET. A retrospective longitudinal study was carried out by consulting the medical records of patients with a diagnosis of painful LET formulated by clinical and instrumental findings that received functional evaluations, including the Patient-Rated Tennis Elbow Evaluation (PRTEE) and muscle strength measurement at least four times: T0 (“baseline”), 1-month (T1), 3-month (T2), and 6-month follow-ups (T3). Medical records of 80 patients were analyzed. In the HILT + HyA group, the Peak-strength (p < 0.001) and mean strength (p < 0.001) significantly increased compared to the TE group between study times. For the PRTEE-total-score as for the subscales, the HILT + HyA group reported statistically significant reductions only for the comparisons of baseline versus T1 and baseline versus T2. No serious adverse events occurred. Our findings suggest that Hy-A associated with HILT might be more effective than TE for people with LET in the short–medium term.