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

Abstract

Background: Adhesion formation following tendon injuryis a serious clinical problem.Aims: In this experimental study, the effects of thecombination of sodium hyaluronate (HA) and chondroitinsulfate (CS) on peritendinous adhesion and tendonhealing were evaluated.Study Design: Animal experimentation.Methods: Twenty-one mature Sprague Dawley male ratswere randomly divided into three equal groups. The rats'Achilles tendons were cut and repaired with a modifiedKessler technique. About 0.25 and 0.50 mL of the HA andCS (HA+CS) combination were injected subcutaneouslyinto the repair site of the rats in groups 1 and 2, respectively,on days 0, 3, 7, and 10. The subjects in group 3were used as the control group. At 6 weeks, all rats wereeuthanized. The tenotomy site was examined macroscopicallyin all animal subjects. Four samples were assignedto the histopathological examination group, and the otherswere assigned to the biomechanical assessment group.Results: Inflammation and adhesion in both treatmentgroups were observed at a lower rate than in the controlgroup. The collagen filaments in both treatmentgroups were regular and the number was low whencompared to the control group. However, there wasno statistically significant difference between group 1and the control group. The quantity, quality, and gradeof the adhesions were statistically significantly lowerin group 2 when compared with the other groups. Themean maximum stress strength in group 2 was statisticallysignificantly higher than that in group 1 and thecontrol group.Conclusion: Local administration of the HA+CS combinationsolution is a valid tool for preventing peritendinousadhesion after extrasynovial tendon repair suchas Achilles tendon, and is a treatment option in suchcases.