Randomized Prospective Evaluation of Adjuvant Hyaluronic Acid Therapy Administered After Knee Arthroscopy

Intra-articular injections of hyaluronic acid products may eliminate pain, improve mobility and quality of life, and delay osteoarthritis progression. In this study, we evaluated the safety and efficacy of sodium hyaluronate injections given after knee arthroscopy. Forty-six patients with early osteoarthritis and a symptomatic meniscus tear were prospectively randomized into study (injection) and control groups and underwent knee arthroscopy. Study patients received 3 sodium hyaluronate injections after surgery. Study and control outcomes were compared 3 and 6 months after surgery. The injection patients had significantly less pain (visual analog scale) at 3-month followup and more flexion at 6-month follow-up. Tenderness, pain on motion, and crepitus were significantly more likely to be absent from injection patients at the 3- and 6-month follow-ups. Patients with osteoarthritis and a symptomatic meniscus tear may experience more pain relief and functional mobility after arthroscopic surgery plus hyaluronic acid injections than after arthroscopy alone. I t is widely accepted that patients with symptomatic meniscus tears can respond well to treatment with knee arthroscopy and partial meniscectomy, but some of these patients have chondromalacia of the knee noted before or during surgery. In some cases, preoperative magnetic resonance imaging (MRI) demonstrates chondromalacia in the same compartment as the meniscus tear as well as in other compartments of the knee; in other cases, preoperative MRI demonstrates only the meniscal pathology, and the surgery reveals the chondromalacia. In either scenario, the patient’s outcome may be adversely affected by early osteoarthritis, in spite of the treatment for the meniscus tear. Osteoarthritis, the most common form of arthritis, affects approximately 15.8 million US patients between the ages of 25 and 74. 1 Treatments for osteoarthritis vary widely, according to disease stage. Patients with osteoarthritis have a low concentration of hyaluronic acid in the synovial fluid, which makes them more susceptible to cartilage injury involving significant pain and swelling. 2 Treatment with sodium hyaluronate has been shown to increase the viscoelastic properties of the synovial fluid and repair the articular cartilage by improving cellular metabolism. 2-7 In patients who have osteoarthritis and symptomatic meniscus tears and who have not improved with standard treatment regimens, such as anti-inflammatory medications, physical therapy, weight loss, and exercise programs, viscosupplementation consisting of intra-articular injections of hyaluronic acid may be used. We conducted this randomized, prospective study to evaluate the safety and efficacy of combining knee arthroscopy with a series of sodium hyaluronate injections in patients with early osteoarthritis and meniscal pathology.