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How are hyaluronic acid or hyaluronate injections used to treat knee osteoarthritis?

ANSWER

Also called viscosupplements, this treatment tries to restore synovial fluid, which is a slippery substance that helps lubricate joints. A major component of synovial fluid is called hyaluronate. For more than 20 years, doctors have tried to restore mobility and curb pain by injecting hyaluronate directly into the knee joint. But even after years of use, studies about the treatment have disagreed. One analysis, published in 2016 in the journal Systematic Reviews, noted that while there is general agreement that injections can help, there’s still debate over whether the possibility of serious side effects outweigh the benefits.

SOURCES:

Journal of Pharmacy and Bioallied Sciences : “Current interventions in the management of knee osteoarthritis.”

Maturitas : “Clinical settings in knee osteoarthritis: Pathophysiology guides treatment.”

Clinics in Geriatric Medicine : “Nonsurgical Management of Osteoarthritis Knee Pain in the Older Adult.”

Osteoarthritis and Cartilage : “OARSI guidelines for the non-surgical management of knee osteoarthritis.”

Cochrane Reviews : “Joint corticosteroid injection for knee osteoarthritis.”

Arthritis.org.

Annals of Physical and Rehabilitation Medicine : “Evidence and recommendations for use of intra-articular injections for knee osteoarthritis.”

Annals of Internal Medicine : “Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis.”

Clinical Rheumatology : “Intra-articular and soft tissue injections, a systematic review of relative efficacy of various corticosteroids.”

Orthop.washington.edu.

Uptodate.com.

The Journal of Arthroplasty : “No Difference Between Intra-Articular Injection of Hyaluronic Acid and Placebo for Mild to Moderate Knee Osteoarthritis: A Randomized, Controlled, Double-Blind Trial.”

Cartilage : “Safety of Repeated Injections of Sodium Hyaluronate (SUPARTZ) for Knee Osteoarthritis: A Systematic Review and Meta-Analysis.”

Annals of Internal Medicine: “Viscosupplementation for Knee Osteoarthritis.”

American Academy of Orthopaedic Surgeons.

Arthroscopy : The Journal of Arthroscopic and Related Surgery: “Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review.”

Journal of Sports Medicine and Physical Fitness : “Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial.”

American Journal of Sports Medicine : “Platelet-Rich Plasma Intra-articular Knee Injections Show No Superiority Versus Viscosupplementation: A Randomized Controlled Trial.”

Stem Cells and Cloning : “Mesenchymal stem cell therapy for osteoarthritis: current perspectives.”

BMC Musculoskeletal Disorders : “Mesenchymal stem cell therapy in the treatment of osteoarthritis: reparative pathways, safety and efficacy – a review.”

Frontiers in Surgery : “Bone Marrow Aspirate in the Treatment of Chondral Injuries.”

Orthopaedic Journal of Sports Medicine : “Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee.”

Pubmed Health.

FDA.

Maturitas : “Chondrocyte and mesenchymal stem cell-based therapies for cartilage repair in osteoarthritis and related orthopaedic conditions.”

American Journal of Sports Medicine : “Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Two-Year Follow-up of a Prospective Randomized Trial.”

Annals of Physical and Rehabilitation Medicine : “Evidence and recommendations for use of intra-articular injections for knee osteoarthritis.”

Bone Joint Spine : “Usefulness of intra-articular botulinum toxin injections. A systematic review.”

Mycoolief.com.

15th Annual Pain Medicine Meeting, San Diego, Nov. 17-19, 2016: “Cooled Radiofrequency Ablation of the Genicular Nerves for Chronic Pain due to Knee Osteoarthritis: 6- month Outcomes and Predictors of a Successful Treatment Response.”

American Journal of Physical Medicine and Rehabilitation : “Water-Cooled Radiofrequency Provides Pain Relief, Decreases Disability, and Improves Quality of Life in Chronic Knee Osteoarthritis.”

Reviewed by David Zelman on January 18, 2017

SOURCES:

Journal of Pharmacy and Bioallied Sciences : “Current interventions in the management of knee osteoarthritis.”

Maturitas : “Clinical settings in knee osteoarthritis: Pathophysiology guides treatment.”

Clinics in Geriatric Medicine : “Nonsurgical Management of Osteoarthritis Knee Pain in the Older Adult.”

Osteoarthritis and Cartilage : “OARSI guidelines for the non-surgical management of knee osteoarthritis.”

Cochrane Reviews : “Joint corticosteroid injection for knee osteoarthritis.”

Arthritis.org.

Annals of Physical and Rehabilitation Medicine : “Evidence and recommendations for use of intra-articular injections for knee osteoarthritis.”

Annals of Internal Medicine : “Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis.”

Clinical Rheumatology : “Intra-articular and soft tissue injections, a systematic review of relative efficacy of various corticosteroids.”

Orthop.washington.edu.

Uptodate.com.

The Journal of Arthroplasty : “No Difference Between Intra-Articular Injection of Hyaluronic Acid and Placebo for Mild to Moderate Knee Osteoarthritis: A Randomized, Controlled, Double-Blind Trial.”

Cartilage : “Safety of Repeated Injections of Sodium Hyaluronate (SUPARTZ) for Knee Osteoarthritis: A Systematic Review and Meta-Analysis.”

Annals of Internal Medicine: “Viscosupplementation for Knee Osteoarthritis.”

American Academy of Orthopaedic Surgeons.

Arthroscopy : The Journal of Arthroscopic and Related Surgery: “Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review.”

Journal of Sports Medicine and Physical Fitness : “Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial.”

American Journal of Sports Medicine : “Platelet-Rich Plasma Intra-articular Knee Injections Show No Superiority Versus Viscosupplementation: A Randomized Controlled Trial.”

Stem Cells and Cloning : “Mesenchymal stem cell therapy for osteoarthritis: current perspectives.”

BMC Musculoskeletal Disorders : “Mesenchymal stem cell therapy in the treatment of osteoarthritis: reparative pathways, safety and efficacy – a review.”

Frontiers in Surgery : “Bone Marrow Aspirate in the Treatment of Chondral Injuries.”

Orthopaedic Journal of Sports Medicine : “Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee.”

Pubmed Health.

FDA.

Maturitas : “Chondrocyte and mesenchymal stem cell-based therapies for cartilage repair in osteoarthritis and related orthopaedic conditions.”

American Journal of Sports Medicine : “Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Two-Year Follow-up of a Prospective Randomized Trial.”

Annals of Physical and Rehabilitation Medicine : “Evidence and recommendations for use of intra-articular injections for knee osteoarthritis.”

Bone Joint Spine : “Usefulness of intra-articular botulinum toxin injections. A systematic review.”

Mycoolief.com.

15th Annual Pain Medicine Meeting, San Diego, Nov. 17-19, 2016: “Cooled Radiofrequency Ablation of the Genicular Nerves for Chronic Pain due to Knee Osteoarthritis: 6- month Outcomes and Predictors of a Successful Treatment Response.”

American Journal of Physical Medicine and Rehabilitation : “Water-Cooled Radiofrequency Provides Pain Relief, Decreases Disability, and Improves Quality of Life in Chronic Knee Osteoarthritis.”

Reviewed by David Zelman on January 18, 2017

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How are platelet-rich plasma injections used to treat knee osteoarthritis?

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