Efficacy and safety of hyaluronic acid (500-730kDa) Ultrasound-guided injections on painful tendinopathies: a prospective, open label, clinical study

Fogli, Marco; Giordan, Nicola; Mazzoni, Gianni

doi:10.11138/mltj/2017.7.2.388

Cited by 17 publications

(5 citation statements)

References 27 publications

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“…HA is widely believed to combat chronic and degenerative articular cartilage injury through various pathways, including controlling inflammation and promoting regenerative processes [ 25 ]. For this reason, the utility of HA has now expanded to treatment of CSTI [ 26 ] where primary pathology involves poor tissue healing [ 27 ]. However, the large ES for HA reported in this study should not be regarded as definitive evidence of efficacy as it was derived from only three RCTs and the wide CI suggested high uncertainty.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis

et al. 2021

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Introduction Prolotherapy and other injections, primarily acting on pathways associated with maladaptive tissue repair, are recommended for recalcitrant chronic soft tissue injuries (CSTI). However, selection of injection is challenging due to mixed results. This network meta-analysis (NMA) aimed to compare prolotherapy with other therapies, particularly injections, for CSTI and establish robustness of the results. Methodology Pubmed, Medline, SPORTDiscus and Google scholar were searched from inception to 4th January 2021 for randomised controlled trials (RCTs) involving injection therapies (e.g. blood derivatives, corticosteroid, hyaluronic acid, botulinum toxin) for CSTI. The primary and secondary outcomes were pain and function, respectively, at (or nearest to) 6 months. Effect size (ES) was presented as standardised mean difference with 95% confidence interval (CI). Frequentist random effect NMA was used to generate the overall estimates, subgroup estimates (by region and measurement time point) and sensitivity analyses. Results A total of 91 articles (87 RCTs; 5859 participants) involving upper limb (74%), lower limb (23%) and truncal/hip (3%) injuries were included. At all time points, prolotherapy had no statistically significant pain benefits over other therapies. This observation remained unchanged when tested under various assumptions and with exclusion of studies with high risk of bias. Although prolotherapy did not offer statistically significant functional improvement compared to most therapies, its ES was consistently better than non-injections and corticosteroid injection for both outcomes. At selected time points and for selected injuries, prolotherapy demonstrated potentially better pain improvement over placebo (<4 months: shoulder [ES 0.65; 95% CI 0.00 to 1.30]; 4–8 months: elbow [ES 0.91; 95% CI 0.12 to 1.70]; >8 months: shoulder [ES 2.08; 95% CI 1.49, to 2.68]). Injections generally produced greater ES when combined with non-injection therapy. Conclusion While clinical outcomes were generally comparable across types of injection therapy, prolotherapy may be used preferentially for selected conditions at selected times.

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Section: Discussionmentioning

confidence: 99%

Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis

et al. 2021

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“…US-guided HA injection is a safe and feasible treatment for PT pain [68]. US-guided peritendinous injections of HA performed on three occasions 1 week apart were safe, showing pain relief, a decrease in tendon thickness, and decreasing neovascularization at 3 weeks [69]. In a small series, 3 weeks of HA peritendinous injections showed a reduction in swelling and tenderness without adverse events [70].…”

Section: Level Of Evidencementioning

confidence: 99%

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part V, knee

et al. 2021

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Objectives Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. Methods We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. Results A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. Conclusions Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. Key Points • A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. • Strong consensus with 100% agreement was obtained for all statements. • Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.

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“…Several preclinical and clinical studies have reported on the therapeutic applications of hyaluronan in managing fasciopathies, tendinopathies, and osteoarthritis, all of which share important pathophysiological mechanisms [ 18 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 ]. In an animal model of osteoarthritis, administration of hyaluronan to isolated medial articular nerves dramatically lowered both ongoing and movement-evoked nerve activities, indicating a therapeutically important antinociceptive activity in inflamed joints through an elastoviscous, rheological effect on nociceptive afferent fibers [ 147 ].…”

Section: Therapeutic Considerations Of Hyaluronan In Myofascial Diseasementioning

confidence: 99%

“…At three months post-treatment, pain ratings indicated that two peritendinous hyaluronan injections were more effective than conventional extracorporeal shock wave therapy in treating patients with Achilles’ midportion tendinopathy for ≥6 weeks [ 153 ]. In patients with lateral elbow, Achilles, and patellar tendinopathy, ultrasound-guided peritendinous injections of lower-molecular-weight hyaluronan (500–730 kDa) were safe, well-tolerated, and associated with significant pain improvement and reduction in ultrasound-assessed tendon thickness and neovascularization [ 141 ]. In a recent study comparing ultrasound-guided injections with low molecular weight (500–730 KDa) and high molecular weight (>2000 KDa) hyaluronan, Mohebbi et al found that while both hyaluronan types had similar efficacy in the treatment of rotator cuff tendinopathy, patients tolerated low-molecular-weight injections better [ 154 ].…”

Section: Therapeutic Considerations Of Hyaluronan In Myofascial Diseasementioning

confidence: 99%

Pathophysiological and Therapeutic Roles of Fascial Hyaluronan in Obesity-Related Myofascial Disease

Ugwoke

Cvetko

Umek

2022

IJMS

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Myofascial disease is an important complication associated with obesity and one of the leading causes of physical disability globally. In the face of limited treatment options, the burden of myofascial disorders is predicted to increase along with the escalating prevalence of obesity. Several pathological processes in obesity contribute to modifications in fascial extracellular matrix mechanical and biological properties and functions. Changes in adipose tissue metabolism, chronic inflammatory phenotype, oxidative stress, and other mechanisms in obesity may alter the physiochemical and biomechanical properties of fascial hyaluronan. Understanding the pathophysiological importance of hyaluronan and other components of the fascial connective tissue matrix in obesity may shed light on the etiology of associated myofascial disorders and inform treatment strategies. Given its unique and favorable pharmacological properties, hyaluronan has found a broad range of clinical applications, notably in orthopedic conditions such as osteoarthritis and tendinopathies, which share important pathophysiological mechanisms implicated in myofascial diseases. However, while existing clinical studies uniformly affirm the therapeutic value of hyaluronan in myofascial disorders, more extensive studies in broader pharmacological and clinical contexts are needed to firmly validate its therapeutic adaptation.

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Efficacy and safety of hyaluronic acid (500-730kDa) Ultrasound-guided injections on painful tendinopathies: a prospective, open label, clinical study

Cited by 17 publications

References 27 publications

Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis

Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part V, knee

Pathophysiological and Therapeutic Roles of Fascial Hyaluronan in Obesity-Related Myofascial Disease

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