Hyaluronan therapy for joint arthritis and other sports injuries

Hyaluroanon is used in injection form for treatment of knee (and other joint) arthritis.

Hyaluronic acid is normally secreted by synoviocytes but in osteoarthritis there is decreased concentration and molecular weight of hyaluronic acid

Intraarticular injection of Hyaluronan may affect synoviocyte production and have analgesic and chondroprotective effect.

Two varieties available in Australia: Osteoartz (low molecular weight, cheaper per injection, fewer allergies) and Synvisc (higher molecular weight, ?greater effect per injection but more expensive). Osteoartz has had more treatments worldwide although Synvisc has been on the Australian market longer.

Both preparations are derived from rooster combs. 1% incidence of side effects (inflammatory reactions) for Synvisc, lower in Osteoartz

Wang et al 2004 meta-analysis of RCT : Effect of hyaluronic acid on OA of the knee

• Single blind, single center trials had higher estimates in efficacy of hyaluronic acid
• Acetaminophen use decreased overall perceived effectiveness
• Severe OA has decreased benefit with use
• Concluded hyaluronic acid decreases pain and improves function but further study needed

  Cochrane Database of Systematic Reviews

• March 2005
• 63 Trials
• Pain significantly decreased, function modestly increased
• Efficacy about equal to NSAIDs, safer
• Longer term benefit compared to corticosteroids
• “Effective treatment for OA of the knee”

Review article in American Family Physician (including patient handout)

Surgical Synergies website

Review by Wikipedia

Abstract:
Objectives: To determine the efficacy and safety of periarticular hyaluronic acid injections in acute lateral ankle sprain during 9 months at a sports injuries center.

Design: Randomized controlled prospective trial.

Setting: Primary sport medicine and emergency practice.

Patients: One hundred fifty-eight consecutive competitive athletes who suffered acute grade 1 or 2 lateral ankle sprains were randomized within 48 hours of injury.

Interventions: Patients were randomized at baseline to periarticular injection with hyaluronic acid (HA) + standard of care [rest, ice, compression, and elevation (RICE)] or placebo injection (PL) + standard of care (RICE) treatment at baseline assessment and on day 4 after injury.

Outcomes Measures: Assessments at baseline and days 4, 8, 30, and 90 included Visual Analogue Scale (VAS; 0-10 cm) pain on weight bearing and walking 20 m, patient global assessment of ankle injury (five-point categorical scale), patient satisfaction with treatment (five-point categorical scale), time to return to pain-free and disability-free sport, and adverse events. Differences between groups were determined using an intent-to-treat analysis of variance.

Results: About 30% of the ankle sprains were "first" events, and no differences in clinical assessments with those presenting but not volunteering for the study (n = 341) were observed. Time to intervention was 39 +/- 4 hours, with no difference between groups. No serious adverse events were recorded during the 8-day treatment period. No difference in concomitant treatment or physical therapy was observed between groups. A significant reduction in VAS pain on both weight bearing and walking was observed at day 8 for HA compared with PL (P < 0.05). Significantly greater patient satisfaction was observed for HA versus PL at days 4 (P < 0.05), 8 (P < 0.001), 30 (P < 0.001), and 90 (P < 0.05). Patient global assessment of ankle injury was significantly better compared with baseline in the HA group at day 8, but this was not different between groups. Time to pain-free and disability-free return to sport was 11 (+/-8) versus 17 (+/-8) days for HA and PL, respectively (P < 0.05).

Conclusion: HA treatment for acute ankle sprain was highly satisfactory in the short term and the long term versus PL. This was associated with reduced pain and more rapid return to sport, with few associated adverse events.