الفهرس 
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Abstract
A
mong all the cases presenting to the emergency departments in almost every hospital, tendon injuries represent a major part with various causes and mechanisms of injuries with incidence up to 54.8% of patients with a small hand lacerations and 92.5% of patients with deep injuries.
Post-operative tendon adhesions remain an annoying and disappointing complication of flexor tendon repair. Several advances have been made to prevent adhesion formation, including improved surgical techniques, new suture material, and the addition of various pharmaceutical agents in an effort to inhibit scarring or lower friction along the tendon surface, therefore, we had to study new techniques to achieve better results and more satisfactory outcomes.
However, the implementation of the new techniques has met some limitations, the most important was the poor compliance of the patients to the rehabilitation programs, and the second most important limitation was the significant rate of infections in group (A) subjects.
The study we have performed revealed that the repeated injection of hyaluronic acid as an adjunct treatment in the flexor tendon repair surgeries was indeed successful in reducing the post-operative adhesions, improving tendon gliding. group (A) patients received three injections of HA, intra-operatively, one week and two weeks post-operatively. group (B) received placebo injections with the same frequency. All cases were operated by the same surgeon, same technique; cruciate repair with epitendeous sutures and introduced to the same rehabilitation program.
Hyaluronic Acid has been shown to have a positive effect on tendon healing which is based on the anti-inflammatory activity of HA, enhanced cell proliferation, and collagen deposition, besides the lubricating action on the sliding surface of the tendon.
There are various rehabilitation programs that were also thoroughly analyzed in many studies. The proper choice and application of the right method for every specific injury and every specific patient will lead to successful therapy. We used the program of early active mobilization in our study, which is recently being recommended in many hand surgery centers worldwide. This is a difficult job that needs a dedicated therapist and a highly motivated patient, but the final outcome of a perfectly functioning hand well deserves the effort.