Hyaluronic acid diminishes the resistance to excursion after flexor tendon repair: An in vitro biomechanical study

Akasaka, T.; Nishida, J.; Araki, S.; Shimamura, T.; Amadio, P.C.; An, K.-N.

doi:10.1016/j.jbiomech.2004.04.021

« Previous Next »Journal of Biomechanics
Volume 38, Issue 3 , Pages 503-507, March 2005

Hyaluronic acid diminishes the resistance to excursion after flexor tendon repair: An in vitro biomechanical study

T. Akasaka
- Department of Orthopaedic Surgery, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8585, Japan
J. Nishida
- Department of Orthopaedic Surgery, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8585, Japan
- Corresponding author. Tel.: +81-19-651-5111; fax: +81-19-626-3699
S. Araki
- Department of Orthopaedic Surgery, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8585, Japan
T. Shimamura
- Department of Orthopaedic Surgery, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8585, Japan
P.C. Amadio
- Department of Orthopaedics and Orthopaedic Biomechanics Laboratory, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
K.-N. An
- Department of Orthopaedics and Orthopaedic Biomechanics Laboratory, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Accepted 19 April 2004. published online 19 August 2004.

Abstract

Adhesion between the tendon and tendon sheath after primary flexor tendon repair is seen frequently, and postoperative finger function is occasionally unsatisfactory. A reduction of the friction may facilitate tendon mobilization, which in turn may reduce the risk of the adhesion and restriction of range of motion. We considered the possibility of utilizing the hyaluronic acid (HA) as a lubricant. To evaluate the effect of HA, the gliding resistance between the canine flexor digitorum profundus tendon repaired by a modified Kessler suture technique with running epitendinous suture and the annular pulley located on the proximal phalanx (corresponding to the A2 pulley in humans) was evaluated and compared before and after administration of HA. The HA solution measurement groups were identified as follows; intact tendon as a control; repaired tendon; tendon soaked in 0.1, 1, and 10mg/ml HA. The resistance increased after repairing, then it decreased after soaking in 10mg/ml HA solution. The results of this study revealed that HA diminishes the excursion resistance after flexor tendon repair. We believe that some style of administration of the HA might reduce the excursion resistance and prevent adhesion until the synovial surface is fully developed.