Intra-Articular Injections in Knee Osteoarthritis: A Review of Literature

Abstract

Knee osteoarthritis (OA) is a chronic, degenerative, and progressive disease of articular cartilage, producing discomfort and physical disability in older adults. Thirteen percent of elderly people complain of knee OA. Management options for knee OA could be divided into the following categories: conservative, pharmacological, procedural, and surgical. Joint replacement is the gold standard, reserved for severe grades of knee OA, due to its complications rate and increased risk of joint revision. A nonsurgical approach is the first choice in the adult population with cartilage damage and knee OA. Yearly, more than 10% of knee OA-affected patients undergo intra-articular injections of different drugs, especially within three months after OA diagnosis. Several molecules, such as corticosteroids injection, hyaluronic acid (HA), and platelet-rich plasma (PRP), are managed to reduce the symptoms of patients with knee OA. The aim of this review was to offer an overview of intra-articular injections used for the treatment of OA and report the conventional pharmacological products used.

Anti-Inflammatory Therapeutic Approaches to Prevent or Delay Post-Traumatic Osteoarthritis (PTOA) of the Knee Joint with a Focus on Sustained Delivery Approaches

“…Due to the short-termed joint residence time and fast clearance of TCA from the joint [ 19 , 20 ], polyester amide (PEA) [ 77 , 78 ] and poly lactic-co-glycolic acid (PLGA) [ 79 ] microsphere-mediated sustained-release TCA systems were developed. PEA and PLGA microspheres resulted in a burst release of TCA followed by a steady-state release of TCA in PBS for 40–60 days [ 77 , 78 ].…”

“…For these reasons, injectable HA formulations were assessed for clinical use in OA (e.g., Hyalgan, HYADD4-G). However, it is important to note that a wide array of HA preparations are commercially available, which are derived from different sources, have different molecular weights and different degrees of cross-linking making joint residence times, rheological properties and cross-comparisons difficult [ 20 , 84 ].…”

“…This suggests that these therapeutic approaches may enable better or prolonged control of early PTOA pathology. A single administration of sustained delivery drug systems can overcome the rapid clearance from the synovial space [ 19 , 20 ], avoid repeated injections that damages articular cartilage [ 68 ], and mutually allow targeted therapeutic delivery. Still, only a few studies have addressed early disease prevention using such approaches.…”

“…anti-inflammatory treatments that can (i) control inflammation, (ii) prevent articular cartilage damage, (iii) reduce cell death, but also (iv) promote the regeneration of the articular cartilage of the knee joint. Sustained delivery of anti-inflammatory drugs over a longer period of time may overcome problems such as temporary effects due to short half-lives and rapid efflux from the knee joint into the systemic circulation that are associated with both current clinically approved disease-modifying OA drugs (DMOADs), including dexamethasone and triamcinolone acetonide [ 19 , 20 ], and not yet clinically approved drug candidates [ 21 , 22 , 23 , 24 ]. Therefore, this review also discusses sustained delivery approaches that were tested in the knee joint or in articular cartilage injury/inflammatory models.…”

A Comparison of the Capacity of Mesenchymal Stromal Cells for Cartilage Regeneration Depending on Collagen-Based Injectable Biomimetic Scaffold Type

“…The application of autologous mesenchymal stem cells (MSCs) [4] may serve as an alternative therapeutic approach to the restoration of the cartilage tissue. The MSCs are multicomponent cells capable of differentiating into various types of cells, including chondrocytes, which allows to use them in the process of creating cartilage-like structures as substitutes for damaged areas [5,6].…”