hyaluronic acid infiltration and tendinopathies

Another application of hyaluronic acid in orthopedic surgery is the treatment of tendinopathies through hyaluronic acid infiltration. Remember that tendons are "cord-like" structures that connect bones to muscles, transmitting the contractile force of the muscle to the bone and joints, causing their movement. These tendons often suffer from overload or overuse, leading to deterioration and degeneration (tendinopathies).

Degenerated tendons show structural changes: increased cell death of tendon cells (tenocytes), alteration of collagen fibers with decreased production of type I collagen (the predominant type of collagen in healthy tendons), disordered increase in the production of type III collagen (collagen that displaces type I collagen in diseased tendons), and ineffective neoangiogenesis (aberrant blood vessel growth that contributes significantly to the chronic pain of tendinopathies).

Tendon sheaths contain synovial cells identical to those of the synovial membrane of joints. Therefore, the tendon sheath actively produces hyaluronic acid and, similar to what happens in joints, as an important component of synovial fluid, it aids smooth gliding and nourishes the tendon. Literature supports hyaluronic acid as an effective tool in the treatment of various tendinopathies.

Hyaluronic acid may have several tendinopathy-modifying effects, such as increased tenocyte regeneration, a balanced type I/type III collagen ratio, reduced cell death, and improved neoangiogenesis.

The efficacy and safety of ultrasound-guided peritendinous hyaluronic acid injections to reduce pain in patients with epicondylopathy, Achilles tendinopathies, or patellar tendinopathies have been evaluated in several studies. The results of these studies show a significant reduction in pain and sagittal thickness in all types of tendinopathies studied. Neovascularization decreased for each treated tendon between 2 and 8 weeks.

This demonstrates that ultrasound-guided peritendinous hyaluronic acid injections provide significant pain relief and reduce the thickness of the affected tendon and its aberrant neovascularization, in a safe and well-tolerated manner.

Other studies have demonstrated the beneficial effects of hyaluronic acid treatment in tendinopathies, in terms of reducing the peripheral inflammatory response and promoting contact repair through the involvement of tendon cells.

Hyaluronic acid injections are performed directly into the affected joint or around the diseased tendon, usually in the office setting. The procedure is relatively quick and generally does not require general anesthesia. However, local anesthesia may be administered to minimize any discomfort.

It is important to note that, in some cases, hyaluronic acid is not a permanent solution, and the effects are often temporary.

Typically, a course of several injections over a period of time is recommended for best results. The duration of the effects may vary by patient, but benefits are generally expected to last several months.

It is essential that any decision regarding the use of hyaluronic acid in orthopedic surgery be made in consultation with an orthopedic specialist. The doctor will evaluate the patient's specific condition, symptoms, disease severity, and other relevant factors to determine if hyaluronic acid treatment is appropriate for each individual case.

Dr. Jordi Jiménez performs ultrasound-guided hyaluronic acid injections in Palma de Mallorca. Make an appointment with Dr. Jordi Jiménez. He will see you in the center of Palma de Mallorca and help you regain your quality of life.