## 4 Discussion  
Tenolysis is a common inflammatory response resulting in scar tissue formation and inhibits synovial sheath regeneration, which will subsequently impede the gliding function of the tendon and restrict related movements, e.g., digital flexion [42]. Over the last 25 years, researchers have been striving to overcome this clinical challenge, with positive advances in wound healing research regarding the molecules and cells related to the healing process. Hence, characterization of the growth factors involved in tendon wound healing is paving the way towards a new era of potential anti-adhesion treatments. Numerous studies have evaluated the efficacy of HA on adhesions, gliding resistance, and tendon healing [42; 43; 44]. Different in vitro models have been used, including animals (dog, chicken, rabbit, rat, and horse) [21; 22; 23; 45], tendons [46; 47], and procedures of induced tendon damage (surgical, collagenase, or steroid lesion). So far, numerous studies have evaluated in vitro responses in animal models regarding the effect of various growth factors or the impact of the same growth factor inhibitors to monitor the healing process and acquire adhesion-free tendons [48; 49; 50; 51; 52]. Nevertheless, a limited number of pre-clinical studies have led to clinical trials, and to date, no favorable clinical outcomes have been obtained regarding adhesion reduction, although some adhesion barriers have demonstrated satisfactory clinical efficacy. An absorbable autocross-linked hyaluron-based gel (Hyaloglide(r)) [3] is an adhesion barrier. Herein, we reported the efficacy of Hyaloglide(r) application post tenolysis in a rabbit model to prevent post-surgical perientendinous adhesions. The data herein contributes to and extends existing knowledge concerning the restoration of neighbouring tendons (synovial tendon sheaths). Noteworthy is the avoidance of adherence, which induces improved synovial regeneration as illustrated in the ultrastructural analysis. Our findings suggest that Hyaloglide(r) application prevents perientendinous adhesions after tenolysis. This process is attributable to the facilitating role of the treatment in reorganizing the tendon sheaths. Hyaloglide(r) and specifically the sodium hyalurone component of the gel [20] compensate for the loss of synovial fluid [53] commonly occurring after tenolysis and is imperative for the restoration of perientendinous sheaths. Hyaloglide(r) was not observed upon macroscopic examination during the explants nor was it observed upon microscopic examination after histological staining with [PERSON]&[PERSON] and [PERSON]'s trichrome staining. Numerous quantitative and qualitative procedures have been used in histological investigations. Adhesions were classified into four grades by [PERSON] [36] as follows: no adhesions, few adhesions, moderate adhesions, and severe adhesions. This  
Figure 7: Real-time PCR analysis of proteins related to growth factors, miRNA, and enzymes involved in tendon regeneration and repair. The results for each experiment were obtained from triplicate experiments and values are expressed as the mean \(\pm\) SD. grading considered the presence of adhesions, the extending length of adhesions, and the density of filamentous fibers. [PERSON] and [PERSON] [54] classified adhesions into two different groups: (i) loose adhesions, which may be released by physical activity to improve the tendon glide, and (ii) dense adhesions, which are generally difficult to release. Furthermore, the authors noted that the adhesive tissues resulting from the subcutaneous tissue and the fat would become loose adhesions and adhesive tissues from the palmar fascia, volar plate, tendon sheath, and periosteum would become dense adhesions. Biochemical examination of adhesion tissue specimens was conducted in each group.