Surface modification of extrasynovial tendon by chemically modified hyaluronic acid coating

We investigated a method for chemically binding hyaluronic acid (HA) to extrasynovial tendon and the effect of chemically modified HA on the gliding resistance of tendon. Canine peroneus longus (PL) tendons were immersed into one of three different solutions (saline, 1% HA, or 1% chemically modified HA) for 2 h. The gliding resistance of treated PL tendons was measured at 1, 5, 10, 20, 50, and 100 cycles in a saline bath. After treatment with unmodified HA and chemically modified HA, the gliding resistance of the PL tendons decreased significantly compared with the saline-treated tendons (p < 0.05), and this effect of the two HA treatments persisted through 10 cycles. For cycles 20-100, the gliding resistance of PL tendons treated with chemically modified HA remained significantly lower than that of tendons treated either with saline or unmodified HA (p < 0.01). The effect of paratenon removal on gliding resistance was neither statistically significant for repetitions beyond 10 cycles, nor was it an independent predictor of gliding resistance, as the effect (higher resistance after paratenon removal) was mainly seen in the saline-treated tendons. Chemically modified HA-treated extrasynovial tendons may improve gliding of tendon graft and reduce adhesion postoperatively, compared with traditional grafts.