Effectiveness of Sodium Hyaluronate and ADCON-T/N for the Prevention of Adhesions in Hand Flexor Tendon Surgery: A Systematic Review and Meta-Analysis.

Abstract

PURPOSE\nA common complication after digital flexor tendon repair in the hand is postoperative adhesions that can cause loss of motion and compromise hand function. The aim of this review of relevant published literature was to assess the effectiveness of locally administered sodium hyaluronate or ADCON-T/N for the prevention of adhesions after hand flexor tendon repair.\n\n\nMETHODS\nA literature search was conducted in June 2020 in multiple databases for randomized controlled trials . Our primary outcome was measurement of active finger motion. Follow-up was defined as short-term (< 12 weeks), mid-term (12 weeks to 6 months) and long-term (> 6 months). Mean differences (MD) and standardized mean differences (SMD) of total active motion (TAM) of the interphalangeal joints (IPJs) and active motion of the IPJs separately were calculated where results were meta-analyzed.\n\n\nRESULTS\nSix randomized controlled trials were included. For ADCON-T/N, no benefits were detected for TAM of the IPJs (MD 1.71 [-21.54, 24.96]) or active motion of the IPJs separately (proximal: MD 4.77 [-4.47, 14]; distal: MD 1.17 [-10.33, 12.66]) in the short-/mid-term. The mid-term benefit in TAM of sodium hyaluronate over standard care (placebo/no treatment) did not reach statistical significance (SMD 0.31 [0, 0.63]); however, a subgroup comparison of repeated administration of sodium hyaluronate versus standard care was both statistically and clinically significant (SMD 0.55 [0.11, 0.98]).\n\n\nCONCLUSIONS\nRepeated administration of sodium hyaluronate at the tendon repair site may be effective in improving postoperative active finger motion after primary hand flexor tendon repair in the mid-term.\n\n\nTYPE OF STUDY/LEVEL OF EVIDENCE\nTherapeutic II.