Reliability of combination of hyaluronic acid application and early rehabilitation in prevention of postoperative adhesions after primary tendon repair


  • Medhat S. Hassan Department of Plastic, Reconstructive and Burn Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Alaa A. Labeeb Department of Natural Medicine and Rheumatology, Faculty of Medicine, Menoufia University, Egypt



Adhesions, Hyaluronic, Tendon


Background: The aim of the study was to evaluate the efficacy of hyaluronic acid application after tendon repair in prevention of postoperative adhesions, and to clarify the best circumstances that must be fulfilled to obtain this goal. Tissue adhesion usually happens due to injury, foreign-body reaction, bleeding, or infection but is considered an important factor for wound healing. As a result, tendons repair after injury is usually complicated due to limited postoperative movement. Several methods were used to try to prevent postoperative adhesions but most of them did not give satisfactory results as the mechanism of adhesion formation is still unclear.

Methods: Fifty patients were included in this prospective study performed at department of plastic, reconstruction and burn surgery, faculty of medicine, Menoufia University over the period of approximately two years (January 2016 to November 2017).

Results: Close follow up of the function of the repaired tendons was evaluated repeatedly over the period of 6 months. 40 patients showed excellent progress in regaining function with less possibility of performing adhesions, these patients also expressed satisfaction and comfort toward the regained function. 10 patients showed reasonable progress and were mildly satisfied.

Conclusions: Application of hyaluronic acid in addition to a well-planned rehabilitation plan is a good and reliable method against adhesions when performing primary tendon repair.

Author Biographies

Medhat S. Hassan, Department of Plastic, Reconstructive and Burn Surgery, Faculty of Medicine, Menoufia University, Egypt

Lecturer of plastic , reconstruction and burn surgery , department of plastic , reconstruction and burn surgery

Alaa A. Labeeb, Department of Natural Medicine and Rheumatology, Faculty of Medicine, Menoufia University, Egypt

Associate professor at Department of natural medicine & rheumatology, Faculty of Medicine,      Menoufia University


Riccio M, Battiston B, Pajardi G, Corradi M, Passaretti U, Atzei A, et al. Efficiency of Hyaloglide® in the prevention of the recurrence of adhesions after tenolysis of flexor tendons in zone II: a randomized, controlled, multicentre clinical trial. J Hand Surg. 2010;35(2):130-8.

Ozgenel GY, Etöz A. Effects of repetitive injections of hyaluronic acid on peritendinous adhesions after flexor tendon repair: a preliminary randomized, placebo-controlled clinical trial. Ulus Travma Acil Cerrahi Derg. 2012;18(1):11-7.

Corradi M, Bellan M, Frattini M, Concari G, Tocco S, Pogliacomi F. The four-strand staggered suture for flexor tendon repair: in vitro biomechanical study. J Hand Surg. 2010;35(6):948-55.

Andia I, Sanchez M, Maffulli N. Tendon healing and platelet-rich plasma therapies. Expert Opin Biolo Therapy. 2010;10(10):1415-26.

Foland JW, Trotter GW, Powers BE, Wrigley RH, Smith FW. Effect of sodium hyaluronate in collagenase-induced superficial digital flexor tendinitis in horses. Am J Veterin Res. 1992;53(12):2371-6.

Umeda H. Studies on the adhesion of the digital flexor tendon. Part 3: tendon healing and adhesion releasing process from its surrounding tissues. J Jpn Orthop Assoc. 1976;50:391-400.

Hagberg L, Heinegård D, Ohlsson K. The contents of macromolecule solutes in flexor tendon sheath fluid and their relation to synovial fluid: a quantitative analysis. J Hand Surg: Bri Eur Volume. 1992;17(2):167-71.

Abate M, Pulcini D, Iorio AD, Schiavone C. Viscosupplementation with intra-articular hyaluronic acid for treatment of osteoarthritis in the elderly. Curr Pharma Desi. 2010;16(6):631-40.

Rutjes AW, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Annal Inter Med. 2012;157(3):180-91.

Gelberman RH, Manske PR. Factors influencing flexor tendon adhesions. Hand Clin. 1985;1(1):35-42.

Weeks PM. Management of acute hand injuries. St. Louis. Mosby; 1978: 183-6.

St RO, Weiss C, Denlinger JL, Balazs EA. A preliminary assessment of Na-hyaluronate injection into" no man's land" for primary flexor tendon repair. Clin Orthopaed Related Res. 1980;(146):269-75.

Thomas SC, Jones LC, Hungerford DS. Hyaluronic acid and its effect on postoperative adhesions in the rabbit flexor tendon. A preliminary look. Clin Orthopaed Related Res. 1986;(206):281-9.

Akasaka T, Nishida J, Araki S, Shimamura T, Amadio PC, An KN. Hyaluronic acid diminishes the resistance to excursion after flexor tendon repair: an in vitro biomechanical study. J Biomech. 2005;38(3):503-7.

Percival NJ, Sykes PJ. Flexor pollicis longus tendon repair: a comparison between dynamic and static splintage. J Hand Surg: Bri Eur Volume. 1989;14(4):412-5.






Original Research Articles