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Review
. 2021 Nov 9;10(11):3081.
doi: 10.3390/cells10113081.

The Impact of Hyaluronic Acid on Tendon Physiology and Its Clinical Application in Tendinopathies

Francesco Oliva  1   2 , Emanuela Marsilio  1   2 , Giovanni Asparago  1   2 , Antonio Frizziero  3 , Anna Concetta Berardi  4 , Nicola Maffulli  1   5   6
Affiliations
Review

The Impact of Hyaluronic Acid on Tendon Physiology and Its Clinical Application in Tendinopathies

Francesco Oliva et al. Cells. .

Abstract

The physical-chemical, structural, hydrodynamic, and biological properties of hyaluronic acid within tendons are still poorly investigated. Medical history and clinical applications of hyaluronic acid for tendinopathies are still debated. In general, the properties of hyaluronic acid depend on several factors including molecular weight. Several preclinical and clinical experiences show a good efficacy and safety profile of hyaluronic acid, despite the absence of consensus in the literature regarding the classification according to molecular weight. In in vitro and preclinical studies, hyaluronic acid has shown physical-chemical properties, such as biocompatibility, mucoadhesivity, hygroscopicity, and viscoelasticity, useful to contribute to tendon healing. Additionally, in clinical studies, hyaluronic acid has been used with promising results in different tendinopathies. In this narrative review, findings encourage the clinical application of HA in tendinopathies such as rotator cuff, epicondylitis, Achilles, and patellar tendinopathy.

Keywords: biology; degeneration; effect; hyaluronic acid; hygroscopic; inflammation; receptor; structure; tendinopathy; tendon; viscoelastic.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Type I collagen in tenocytes, harvested from degenerated human supraspinatus tendon, stimulated for 14 days with 1000 μg/mL (>500 KDa) of HA; (B) untreated cells.
Figure 2
Figure 2
Effects of HA on tenocytes.
Figure 3
Figure 3
(A) Injection of HA in a dorsolateral approach of Achilles tendon; (B) US visualisation (5–12 MHz linear probe and PRF set at 0.5 kHz) of the needle (22-gauge) introduced at a 30-degree angle in the mesotendon, with the probe in a transverse plane.
See this image and copyright information in PMC

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