Intra-Articular Injection of Hyaluronic Acid Following Arthroscopic Partial Meniscectomy of the Knee

Abstract

The short-term recovery period post-arthroscopic meniscectomy is characterized by pain and impaired function most likely related to the irrigation of synovial fluid from the knee intraoperatively. Consequently, along with removal of harmful debris, the irrigation fluid dilutes the hyaluronic acid layer covering the joint tissues. Hyaluronic acid contributes to the homeostasis of the joint environment and is an important component of synovial fluid and cartilage matrix. Hence, the instillation of hyaluronic acid after the procedure may relieve symptoms. This prospective, single-blind, randomized, controlled study evaluated clinical outcome after hyaluronic acid injection to patients who underwent arthroscopic meniscectomy of the knee. Patients with ligamentous injuries or severe chondral damage were excluded. Fifty-six patients with a mean age of 34 years (range, 17-44 years) were injected with Viscoseal (TRB Chemedica International S.A., Geneva, Switzerland) or normal saline immediately post-arthroscopy and divided into the Viscoseal group or control group, respectively. Patients were evaluated for pain, swelling, and function at 1, 4, and 12 weeks postoperatively. Patients in the control group reported more pain at week 1, with a mean visual analog score (VAS) of 43, than did patients in the Viscoseal group, with a mean VAS of 28 (P=.006). At 4 weeks postoperatively, none of the Viscoseal patients had consumed analgesics, where 9 (of 28) in the control group reported acetaminophen intake (P=.039). No significant difference in knee function was found between groups. Intra-articular injection of Viscoseal after arthroscopic meniscectomy reduced pain in the short-term recovery period.

Efficacy of hyaluronic acid after knee arthroscopy: A systematic review and meta-analysis

“…One included RCT reported that hyaluronic acid treatment was capable of substantially alleviating pain and symptoms within 2 days after arthroscopic anterior cruciate ligament reconstruction (18). Another RCT also reported that statistically significant pain reduction was found one week postoperatively in arthroscopic surgery (26). In our meta-analysis, hyaluronic acid was revealed to significantly reduce pain on motion in knee arthroscopy, but had no influence on pain control 2, 6 and 12 weeks after the arthroscopic surgery.…”

“…There were similar characteristics between the hyaluronic acid group and the control group at baseline. One RCT reported knee arthroscopy for anterior cruciate ligament reconstruction (18), 2 RCTs reported knee arthroscopy for meniscus tear (26,27), 2 RCTs reported arthroscopic debridement for knee osteoarthritis (19,21), and 1 RCT reported arthroscopic knee joint lavage, or in combination with cartilage debridement (20). (20,27).…”

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

“…Early viscosupplementation in arthroscopic partial meniscectomy was found to have conflicting results and a possible improvement in short-term pain is not showed in all level I studies [178][179][180] . Different studies on viscosupplementation after ACL reconstruction evidenced inflammation, swelling and pain reduction only in the immediate post-operative period, without any difference in the longterm 69,181,182 .…”

Hyaluronic Acid Instillation following Arthroscopic Anterior Cruciate Ligament Reconstruction: A Double-Blinded, Randomised Controlled Study

“…4 During the first 4 weeks, patients with viscoseal following arthroscopic meniscectomy achieve better pain control and reduced analgesic use than controls do. 16,17 Nonetheless, the sample sizes in the 2 studies were small (40 and 56 patients). Our sample size was also small.…”