I.S.Mu.L.T. Hyaluronic acid injections in musculoskeletal disorders guidelines

Frizziero, Antonio; Vittadini, Filippo; Oliva, Francesco; Abatangelo, Giovanni; Bacciu, Serenella; Bernardi, Amelia; Bossa, M.; Buda, Roberto; Buonocore, Daniela; Calderazzi, Filippo; Carolla, F.; Ceccarelli, Francesco; Cipolla, Costantino; Dossena, Maurizia; Faldini, Cesare; Finotti, Paolo; Foti, Calogero; Frizzero, L.; Galletti, S.; Gasparre, Giuseppe; Via, Alessio Giai; Mahmoud, Ahmed Abdelaal Ahmed; Masiero, Stefano; Merolla, Giulia; Migliore, Alberto; Natali, Simone; Nicoletti, S.; Padolino, Antonio; Pellicciari, Leonardo; Piccirilli, Eleonora; Pintus, Eleonora; Porcellini, Giuseppe; Romiti, Davide; Terreni, Marco; Valent, Alessandro; Vannini, Francesca; Verri, Manuela; Vertuccio, M.; Vetrano, Mario; Vulpiani, M. C.; Maffulli, Nicola

doi:10.32098/mltj.03.2018.04

Cited by 18 publications

(19 citation statements)

References 105 publications

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“…Intra-articular administration of HA got the consensus for the conservative treatment of GA (3,22). In line with this notion, here we observed that HA not only attenuated the nociceptive response in arthrosic joints, but also seemed to positively affect cartilage condition.…”

Section: Discussionsupporting

confidence: 88%

Efficacy of a Treatment for Gonarthrosis Based on the Sequential Intra-Articular Injection of Linear and Cross-Linked Hyaluronic Acids

Barbieri

Capparucci

Mannello

et al. 2019

Muscle Ligaments and Tendons J

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Background. This study evaluates the clinical and biochemical effects of sequential intra-articular (IA) injections of linear (LHA) and cross-linked hyaluronic acid (CLHA) in patients with Gonarthrosis (GA). Methods. Thirty-nine (39) patients (age 64.89 ± 8.83) received first the LHA injection (0.8-1.2 MDa, 32mg/2ml) and after 1 week the CLHA (1.0 MDa and 2.0 MDa, 75mg/3ml) one; this round was repeated after 6 months. Clinical assessments-i.e. ultrasonography, visual analogic scale (VAS) for pain, range of motion (ROM) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index-were performed at baseline and at specific time points up to 12 months. Relevant markers were determined in blood and synovial fluid (SF) at selected intervals. SF from patients with recurrent effusion was subjected to proteomic analysis. Results. This schedule improved joint pain and function, and promoted a reduction of inflammatory cytokines (IL-1β, IL-9 and IL-17) in plasma and SF; cartilage thickness increased at 12 months and the increase negatively correlated with the baseline levels of C-telopeptide of type II collagen (CTX-II). SF proteomic revealed that proteins associated with inflammation (Apolipoprotein A-1, α-1 antitrypsin and IgK) decreased, while the IL-1 inhibitor Transthyretin increased. Conclusions. This schedule represents an effective treatment whose benefits persist up to 12 months after baseline.

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Section: Discussionsupporting

confidence: 88%

Efficacy of a Treatment for Gonarthrosis Based on the Sequential Intra-Articular Injection of Linear and Cross-Linked Hyaluronic Acids

Barbieri

Capparucci

Mannello

et al. 2019

Muscle Ligaments and Tendons J

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“…In addition, it is useful in the management of knee osteoarthritis via its chondroprotection, proteoglycan and glycosaminoglycan synthesis, and antiinflammatory, mechanical, subchondral, and analgesic actions [10]. Hyaluronic acid accelerates tendon-to-bone healing after rotator cuff repair and has shown potential in the treatment of enthesopathies such as lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy and plantar fasciitis [46].…”

Section: Discussionmentioning

confidence: 99%

“…These results confirmed our hypothesis that growth factors, cytokines, hyaluronic acid, and extracellular vesicles are present in the formulated Wharton's jelly. Several published basic science and preliminary clinical studies indicate that the combination of these factors may have added advantages for regenerative medicine applications [46]. For example, a co-injection of growth hormone and hyaluronic acid was more effective in treating osteoarthritis compared with injections of hyaluronic acid alone [52], demonstrating the advantage of different factors in one formulation.…”

Section: Discussionmentioning

confidence: 99%

Umbilical cord-derived Wharton’s jelly for regenerative medicine applications

Gupta

El-Amin²,

Levy

et al. 2020

J Orthop Surg Res

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Background: The last decade has seen an explosion in the interest in using biologics for regenerative medicine applications, including umbilical cord-derived Wharton's Jelly. There is insufficient literature assessing the amount of growth factors, cytokines, hyaluronic acid, and extracellular vesicles including exosomes in these products. The present study reports the development of a novel Wharton's jelly formulation and evaluates the presence of growth factors, cytokines, hyaluronic acid, and extracellular vesicles including exosomes. Methods: Human umbilical cords were obtained from consenting caesarian section donors. The Wharton's jelly was then isolated from the procured umbilical cord and formulated into an injectable form. Randomly selected samples from different batches were analyzed for sterility testing and to quantify the presence of growth factors, cytokines, hyaluronic acid, and extracellular vesicles. Results: All samples passed the sterility test. Growth factors including IGFBP 1, 2, 3, 4, and 6, TGF-α, and PDGF-AA were detected. Several immunomodulatory cytokines, such as RANTES, IL-6R, and IL-16, were also detected. Proinflammatory cytokines MCSFR, MIP-1a; anti-inflammatory cytokines TNF-RI, TNF-RII, and IL-1RA; and homeostatic cytokines TIMP-1 and TIMP-2 were observed. Cytokines associated with wound healing, ICAM-1, G-CSF, GDF-15, and regenerative properties, GH, were also expressed. High concentrations of hyaluronic acid were observed. Particles in the extracellular vesicle size range were also detected and were enclosed by the membrane, indicative of true extracellular vesicles. Conclusion: There are numerous growth factors, cytokines, hyaluronic acid, and extracellular vesicles present in the Wharton's jelly formulation analyzed. The amount of these factors in Wharton's jelly is higher compared with other biologics and may play a role in reducing inflammation and pain and augment healing of musculoskeletal injuries.

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“…Its diagnostic criteria consist of taut bands, hypersensitive spots, and referred pain over the affected area, and MTrPs are usually treated as the therapeutic targets [3]. Injection is an effective treatment for musculoskeletal disorders, and the commonly used injectates include corticosteroids, local anesthetics, hyaluronic acid, and high-concentration dextrose [4][5][6]. Botulinum toxin (BoNT) has been widely used in managing post-stroke spasticity, hemifacial spasm, and cervical dystonia.…”

Section: Study Identification and Selectionmentioning

confidence: 99%

Comparative Effectiveness of Botulinum Toxin Injection for Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials

Hsu

Han

et al. 2020

Toxins

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Botulinum toxin (BoNT) injection is regarded as a promising treatment for musculoskeletal pain. However, its efficacy for treating chronic shoulder pain remains unclear. We investigated the effectiveness of BoNT injections for chronic shoulder pain by conducting a systematic search of electronic databases up to March 2020 for randomized control trials (RCTs) that used BoNT injections for chronic shoulder pain treatment. The primary outcome was the between-group comparison of pain reduction, quantified by the standardized mean difference (SMD). Nine RCTs comprising 666 patients were included and divided into two groups: one group with shoulder joint pain (n = 182) and the other group with shoulder myofascial pain (n = 484). Regarding shoulder joint pain, the efficacy of BoNT injections was similar to that of the reference treatment (SMD: −0.605, 95% confidence level [CI]: −1.242 to 0.032 versus saline; SMD: −0.180, 95% CI: −0.514 to 0.153 versus corticosteroids) at one month post-intervention, and was superior (SMD: −0.648, 95% CI: −0.1071 to −0.225 versus corticosteroids) between one and three months. Likewise, in terms of shoulder myofascial pain, the effectiveness of BoNT injections did not differ from the reference treatment (SMD: −0.212, 95% CI: −0.551 to 0.127 versus saline; SMD: 0.665, 95% CI: −0.260 to 1.590 versus dry needling and SMD: 1.093; 95% CI: 0.128 to 2.058 versus lidocaine) at one month post- intervention, and appeared superior (SMD: −0.314, 95% CI: −0.516 to −0.111 versus saline) between one and three months. Our meta-analysis revealed that BoNT injections could be a safe and effective alternative for patients with chronic shoulder pain.

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I.S.Mu.L.T. Hyaluronic acid injections in musculoskeletal disorders guidelines

Cited by 18 publications

References 105 publications

Efficacy of a Treatment for Gonarthrosis Based on the Sequential Intra-Articular Injection of Linear and Cross-Linked Hyaluronic Acids

Efficacy of a Treatment for Gonarthrosis Based on the Sequential Intra-Articular Injection of Linear and Cross-Linked Hyaluronic Acids

Umbilical cord-derived Wharton’s jelly for regenerative medicine applications

Comparative Effectiveness of Botulinum Toxin Injection for Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials

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