for quartiles 1 vs 4), and by WOMAC index (-17.9,-15.7,-13.1,-5.6, p¼0.03 for 1 vs 4), despite similar baseline pain scores for each quartile. The multi-week formulations (n¼27) of HA provided more relief than the single-injection products (n¼11), with improvements of þ15.7 vs þ9.9, p¼0.26 by KOOS pain and-15.4 vs-7.6, p¼0.11 by WOMAC index. The use of ultrasound guidance associated strongly with better relief, by KOOS pain (þ19.0 vs þ9.1, p¼0.05) and the WOMAC index (-19 vs-7.3, p¼ 0.01) Gender, anatomic injection technique (medial, lateral, anterior flexed) and prior HA injections had no effect on symptoms. Conclusions: In our preliminary data thus far, patients reporting more relief 2 months after HA injection were younger and had lower BMIs and less severe radiographic arthritis, while the use of ultrasound guidance and selection of drug administered over multiple weeks also associated with improved outcomes. These data, with further enrollment and longer followup, could help tailor future algorithms for more appropriate, successful, and cost-effective use of HA viscosupplementation in the non-operative management of KOA.

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