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Viscosupplementation for Knee Osteoarthritis: A Systematic Review.

Divine, Jon G MD, FACSM*,†; Zazulak, Bohdanna T DPT, MS, OCS‡,§; Hewett, Timothy E PhD, FACSM*,†

Section Editor(s): Spindler, Kurt P MD, Guest Editor; Wright, Rick W MD, Guest Editor

Clinical Orthopaedics & Related Research: February 2007 - Volume 455 - Issue - pp 113-122
doi: 10.1097/BLO.0b013e31802f5421
SECTION I: SYMPOSIUM: Evidence-based Medicine in Sports Medicine

Due to the rising number of patients affected by osteoarthritis (OA), appropriate management decisions for minimizing pain and improving physical function for patients with OA are important. Hyaluronic acid (HA) knee injections have become a common tool for the management of OA of the knee, and the number of randomized controlled trials on the efficacy and safety of this treatment is growing. We performed a systematic review of the five published meta-analyses, which include single- or double-blinded randomized trials performed at one center or multiple centers (Level I evidence). Within each meta-analysis, a quality assessment tool for each trial was used based on outcome measures of OA-related pain, disease severity, trial period, and mean efficacy. We analyzed and compared the data collection and qualitative analysis methods, outcomes, and conclusions presented for each meta-analysis. Although they used different strategies, each used scientifically sound methods for analysis of many of the same trials; however, each used a different measure of trial quality and heterogeneity. Despite these differences, all come to a similar conclusion that when the strictest quality tools and interpretation of heterogeneity are used, Level I evidence demonstrates that the use of HA in patients with OA results in modest improvement in validated outcomes.

Level of Evidence: Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

From the *Cincinnati Children's Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH; the †University of Cincinnati College of Medicine, Departments of Pediatrics, Orthopaedic Surgery, Biomedical Engineering, and Rehabilitation Sciences, Cincinnati, OH; the ‡Yale New-Haven Hospital, Department of Rehabilitation Services, New Haven, CT; and the §Quinnipiac University, Department of Physical Therapy, Hamden, CT.

One or more of the authors (TEH) has received funding from the National Institutes of Health (Grant R01-AR049735-01A1).

Correspondence to: Timothy E. Hewett, PhD, Director, Sports Medicine Biodynamics Center, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229. Phone: 513-636-4366; Fax: 513-636-0516; E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.