Ultrasound-Guided Multiple Saline Injections for Prevention of Tendon Adhesion: A Randomized Controlled Trial

NCT ID: NCT07184658

Last Updated: 2025-09-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

136 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-01

Study Completion Date

2026-03-31

Brief Summary

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This prospective randomized controlled trial aims to evaluate the efficacy and safety of ultrasound-guided repeated normal saline injections for the prevention and treatment of tendon adhesion following flexor tendon repair. Tendon adhesion is a common complication after tendon injury, leading to pain, stiffness, and impaired hand function. Conventional anti-adhesion strategies, such as physical barrier membranes, may induce local inflammation or have limited effectiveness.

In this study, patients undergoing tendon repair will be randomly assigned to receive either ultrasound-guided peritendinous saline injections at 7, 14, and 21 days after surgery (intervention group) or no injection (control group). The primary outcome is total active motion (TAM-%) at 3 months after surgery. Secondary outcomes include TAM-% at 6 weeks, pain scores (VAS), Michigan Hand Questionnaire (MHQ) scores, infection rate, and tendon rupture rate. A total of 136 patients will be enrolled (68 in each group).

The findings of this trial will help to establish whether repeated saline injections under ultrasound guidance can effectively prevent tendon adhesion, improve pain and functional outcomes, and ensure tendon healing with minimal complications.

Detailed Description

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Tendon adhesion is one of the most common complications following flexor tendon repair, with an incidence of up to 60%. Adhesion significantly impairs hand function, often leading to a cycle of adhesion formation, surgical release, and recurrent adhesion, which causes long-term disability and high healthcare costs. Current preventive measures mainly rely on physical barrier materials, such as membranes or gels, but these approaches may induce aseptic inflammation and pain, and their long-term effectiveness remains limited.

Our previous research suggested that early peritendinous injection therapy may be more effective than intraoperative application in preventing tendon adhesion. Using dynamic ultrasound, we successfully localized tendon adhesion sites and demonstrated the feasibility of delivering precise peritendinous injections under ultrasound guidance. Based on these findings, we hypothesize that repeated ultrasound-guided saline injections at early postoperative stages can reduce adhesion formation while minimizing the impact on tendon healing.

This is a prospective, single-center, randomized controlled clinical trial enrolling 136 patients (68 per group) after flexor tendon repair. Patients in the intervention group will undergo ultrasound-guided peritendinous injections of 1 mL normal saline on postoperative days 7, 14, and 21. The control group will receive standard care without injections. Patients will be followed up at 6 weeks and 3 months after surgery. The primary endpoint is total active motion (TAM-%) at 3 months. Secondary endpoints include TAM-% at 6 weeks, visual analog scale (VAS) pain scores, Michigan Hand Questionnaire (MHQ) scores, infection rate, tendon rupture rate, and wound healing time.

Safety will be assessed through physical examinations, laboratory tests (blood count, C-reactive protein, erythrocyte sedimentation rate), and adverse event monitoring. Statistical analysis will be performed using appropriate parametric or non-parametric methods, with significance set at P \< 0.05.

The successful completion of this study is expected to provide clinical evidence supporting ultrasound-guided saline injections as a safe, effective, and low-cost strategy for preventing tendon adhesion, improving hand function, and reducing complications.

Conditions

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Tendon Adhesion

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This is a prospective, single-center, randomized controlled trial with parallel assignment. Patients undergoing flexor tendon repair will be randomly allocated to either the intervention group (ultrasound-guided saline injections) or the control group (no injection).
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

This is an open-label study; no masking will be applied.

Study Groups

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Intervention Group - Ultrasound-guided Saline Injection

Patients will undergo ultrasound-guided peritendinous injections of 1 mL normal saline at the tendon repair site on postoperative days 7, 14, and 21. The goal is to prevent tendon adhesion and improve functional outcomes.

Group Type EXPERIMENTAL

Ultrasound-guided peritendinous saline injection

Intervention Type PROCEDURE

Under ultrasound guidance, 1 mL of sterile normal saline will be injected peritendinously at the tendon repair site at 7, 14, and 21 days after surgery to reduce adhesion formation and preserve tendon healing.

Control Group - Standard Care

Patients will receive standard postoperative care after tendon repair without saline injection.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Ultrasound-guided peritendinous saline injection

Under ultrasound guidance, 1 mL of sterile normal saline will be injected peritendinously at the tendon repair site at 7, 14, and 21 days after surgery to reduce adhesion formation and preserve tendon healing.

Intervention Type PROCEDURE

Other Intervention Names

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Normal saline injection

Eligibility Criteria

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Inclusion Criteria

Age between 18 and 60 years. Diagnosed with flexor tendon rupture. Scheduled for surgical tendon repair.

Exclusion Criteria

Associated vascular or nerve injury. History of diabetes mellitus. History of non-steroidal anti-inflammatory drug (NSAID) treatment. History of cardiac insufficiency. History of hematologic diseases. History of hepatic or renal dysfunction. History of rheumatologic or autoimmune diseases. History of radiotherapy or chemotherapy. History of corticosteroid treatment. Pregnancy. Currently participating in another clinical trial.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Kai Wang

OTHER

Sponsor Role lead

Responsible Party

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Kai Wang

Principal Investigator, Department of Orthopaedics

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Shen LIU, MD

Role: PRINCIPAL_INVESTIGATOR

Shanghai 6th Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine Department of Orthopaedic Surgery

Locations

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Shanghai 6th People's Hospital

Shanghai, Shanghai Municipality, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Shen LIU, MD

Role: CONTACT

+86-21-64369181

Kai WANG, MD

Role: CONTACT

+8619821288715

Facility Contacts

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Kai WAHG, MD

Role: primary

+86 19821288715

References

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Franssen AJPM, Degens JHRJ, Daemen JHT, Laven IEWG, Hulsewe KWE, Vissers YLJ, de Loos ER. Mediastinal staging by thoracic surgeons: are we close to a paradigm shift? J Thorac Dis. 2023 Jan 31;15(1):10-13. doi: 10.21037/jtd-22-1420. Epub 2023 Jan 6. No abstract available.

Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 35122339 (View on PubMed)

Yasmeen R, Zahid B, Alyas S, Akhtar R, Zahra N, Kouser S, Hashmi AS, Athar M, Tayyab M, Anjum AA. Ameliorative effects of Lactobacillus against Aflatoxin B1. Braz J Biol. 2021 Dec 20;84:e250517. doi: 10.1590/1519-6984.250517. eCollection 2021.

Reference Type BACKGROUND
PMID: 34932626 (View on PubMed)

Sueiras M, Sahuquillo J, Garcia-Lopez B, Sanchez-Guerrero A, Poca MA, Santamarina E, Riveiro M, Fabricius M, Strong AJ. [Cortical spreading depolarization phenomena in patients with traumatic and ischemic brain injuries. Results of a pilot study]. Med Intensiva. 2014 Oct;38(7):413-21. doi: 10.1016/j.medin.2013.09.008. Epub 2013 Dec 15. Spanish.

Reference Type BACKGROUND
PMID: 24342071 (View on PubMed)

Roy V, Sahni P, Gupta P, Sethi GR, Khanna A. Blood levels of pyrazinamide in children at doses administered under the Revised National Tuberculosis Control Program. Indian Pediatr. 2012 Sep;49(9):721-5. doi: 10.1007/s13312-012-0164-8. Epub 2011 Jan 17.

Reference Type BACKGROUND
PMID: 22317983 (View on PubMed)

Kim HT, Oh JS, Lee JS, Lee TH. Z-lengthening of the Achilles tendon with transverse skin incision. Clin Orthop Surg. 2014 Jun;6(2):208-15. doi: 10.4055/cios.2014.6.2.208. Epub 2014 May 16.

Reference Type BACKGROUND
PMID: 24900904 (View on PubMed)

Related Links

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Other Identifiers

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82425035

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2025-119

Identifier Type: -

Identifier Source: org_study_id

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