Effect of hyaluronic acid gel sheet as a bioresorbable barrier on adhesion prevention in an animal model

Hyaluronic acid (HA) has been examined as both a biochemical agent and a physiological barrier to prevent adhesion, and the effectiveness of exogenous administration of sodium HA for adhesion prevention in the case of flexor tendons has been demonstrated in many studies. However, it is difficult to retain the sodium HA as a physiological barrier at the traumatized surfaces in the joint cavity for periods of up to a few weeks during adhesion formation. Recently, hyaluronic acid-carboxylmethylcellulose (HA-CMC) combined into a resorbable membrane has been used in the fields of gynecological surgery or abdominal surgery and a reduction in adhesion formation has been shown in some clinical studies in those fields. HA-CMC is a non-toxic, non-immunogenic and biocompatible hydropholic gel, but it contains carbodiimide as a chemical regent and is thus not the same as naturally occurring HA. Now, a new product, HA gel sheet, has been developed, which is obtained from HA solution and which is composed of HA alone. The aim of this study is to examine the effectiveness of these materials in preventing adhesion in vivo. For this purpose, the biomechanical and histological characterizations of adhesion were evaluated in a rabbit knee model.