title: Effect of hyaluronic acid on the excursion resistance of tendon graft: a biomechanical in vitro study in a modified human model.
abstract: BACKGROUND
  Adhesion between the tendon and tendon sheath after flexor tendon graft inhibits restoration of excursion and strength of the grafted tendons, so post-operative finger function is occasionally unsatisfactory. Early setting rehabilitation is one important factor to prevent the adhesion, and another factor may be a lubricant. We considered the possibility of utilizing hyaluronic acid as a lubricant. The goal of this study is to investigate the in vitro effect of hyaluronic acid on tendon excursion resistance against a digital pulley in a modified human model.
  
  
  METHODS
  The excursion resistance between grafted intrasynovial and extrasynovial tendons and A2 pulley were evaluated, and compared before and after soaking in 10 mg/ml hyaluronic acid.
  
  
  RESULTS
  The resistance increased after extrasynovial tendon graft, and then it decreased after soaking hyaluronic acid solution.
  
  
  CONCLUSIONS
  The evidence we collected suggests that some style of administration of the hyaluronic acid might reduce the excursion resistance in the tendon-pulley unit, facilitating post-operative rehabilitation and limiting adhesion, after tendon graft and possibly improve the clinical outcome of flexor tendon graft.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Akasaka
authors.forename: Jun
authors.initials: J
authors.lastname: Nishida
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Imaeda
authors.forename: Tadashi
authors.initials: T
authors.lastname: Shimamura
authors.forename: Peter C
authors.initials: PC
authors.lastname: Amadio
authors.forename: Kai-Nan
authors.initials: KN
authors.lastname: An
mesh_terms: D000276:Adjuvants, Immunologic / Q000494:pharmacology*; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D013708:Tendon Injuries / Q000473:pathology*; D013710:Tendons / Q000187:drug effects* / Q000473:pathology* / Q000637:transplantation; D013718:Tensile Strength; D000267:Tissue Adhesions
chemical_list: D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid