Outcomes of hyaluronic acid injections for glenohumeral osteoarthritis: a systematic review and meta-analysis

Zhang, Betty; Thayaparan, Aarabi; Horner, Nolan S.; Bedi, Asheesh; Alolabi, Bashar; Khan, Moin

doi:10.1016/j.jse.2018.09.011

Cited by 43 publications

(36 citation statements)

References 38 publications

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“…82 In 2019, Zhang et al completed a meta-analysis on the outcomes of HA injections for GH OA; they reported on 15 studies involving 1,594 patients with levels of evidence ranging from I to IV (Table 3). 83 For the HA group, they found a significant pooled average reduction in VAS pain at 3 and 6 months following injection, as well as improvements on other validated PRO instruments. However, significant improvements were also found in the control groups across the included studies, which included corticosteroid and/or saline injections.…”

Section: Orthoregenerative Treatments In Nonoperative Managementmentioning

confidence: 91%

Nonoperative and Operative Soft-Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Shoulder: An Orthoregeneration Network (ON) Foundation Review

Kester

Tokish

Zumstein

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electro-magnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the shoulder including the rotator cuff tendons, glenohumeral articular cartilage, glenoid labrum, the joint capsule, and bone. Promising and established treatment modalities include hyaluronic acid (HA); platelet-rich plasma (PRP) and platelet rich concentrates (PRC); bone marrow aspirate (BMA) comprising mesenchymal stromal cells (MSCs alternatively termed medicinal signaling cells and frequently, misleadingly labelled "mesenchymal stem cells"); MSC harvested from adipose, umbilical, or placental sources; factors including vascular endothelial growth factors (VEGF), basic fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), transforming growth factor-beta (TGFb), bone morphogenic protein (BMP), and matrix metalloproteinases (MMPs); prolotherapy; pulsed electromagnetic field therapy; microfracture and other marrow-stimulation techniques; biologic resurfacing using acellular dermal allografts, allograft Achilles tendons, allograft lateral menisci, fascia lata autografts, and porcine xenografts; osteochondral autograft or allograft); and autologous chondrocyte implantation (ACI). Studies involving hyaluronic acid, platelet rich plasma, and medicinal signaling cells of various origin tissues have shown mixed results to-date as isolated treatments and as surgical adjuncts. Despite varied results thus far, there is great potential for improved efficacy with refinement of current techniques and translation of burgeoning preclinical work. Level of Evidence: Level V, expert opinion.

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Section: Orthoregenerative Treatments In Nonoperative Managementmentioning

confidence: 91%

Nonoperative and Operative Soft-Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Shoulder: An Orthoregeneration Network (ON) Foundation Review

Kester

Tokish

Zumstein

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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show abstract

“…It is known that pain measurements in clinical trials are difficult, possibly contributing to the exaggeration of treatment effects. Pain, stiffness and other studied endpoints are largely subjective, which means that a great part of the treatment successes can be attributed to the placebo effect [69][70][71][72]. There are many studies and reviews reporting the efficiency of chondroprotective drugs compared to placebo, but reliability is often questionable due to declared or non-declared conflicts of interest.…”

Section: Glycosaminoglycans For the Treatment Of Osteoarthritismentioning

confidence: 99%

Scientific Papers and Patents on Substances with Unproven Effects. Part 2

Jargin

2020

DDF

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: Several examples are discussed in this review, where substances without proven effects were proposed for practical use within the scope of evidence-based medicines. The following is discussed here: generalizations of the hormesis concept and its use in support of homeopathy; phytoestrogens and soy products potentially having feminizing effects; glycosaminoglycans for the treatment of osteoarthritis and possibilities of their replacement by diet modifications; flavonoids recommended for the treatment of chronic venous insufficiency and varicose veins; acetylcysteine as a mucolytic agent and its questionable efficiency especially by an oral intake; stem cells and cell therapies. In conclusion, placebo therapies can be beneficial and ethically justifiable but it is not a sufficient reason to publish biased information. Importantly, placebo must be devoid of adverse effects, otherwise, it is named pseudo-placebo. Therapeutic methods with unproven effects should be tested in high-quality research shielded from the funding bias. Some issues discussed in this review are not entirely clear, and the arguments provided here can initiate a constructive discussion.

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“…Long-term use of glucocorticoid may cause several side effects such as immunodeficiency, osteoporosis, peptic ulcer disease or gastrointestinal bleeding [24,25]. Viscosupplementation with hyaluronic acid through intra-articular injection helps to reduce OA caused pain through its lubricating action, but recent clinical studies showed that the use of hyaluronic acid did not improve clinical outcomes compared to the placebo group significantly [26,27].…”

Section: Traditional Treatments For Cartilage Injury or Osteoarthritismentioning

confidence: 99%

Cartilage Tissue Engineering: An Update on Multi-Component Approach

2019

J Orth Rheumatol

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Cartilage injury and osteoarthritis are big clinical challenges as self-healing potential of cartilaginous tissue is very limited. The need for a multi-disciplinary approach in order to establish new strategies for cartilage healing has been addressed by many scientists from the fields of orthopaedic surgery or biomedical engineering in the last two decades. With a focus on the very preclinical research in this field, this review covers the multitude of approaches, ranging from cellbased to scaffold-based strategies and also including growth factors, precondition approach, mechanical stimulation-that have been combined to assess their potential to develop effective concepts for the treatment of cartilage injury or osteoarthritis.

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Outcomes of hyaluronic acid injections for glenohumeral osteoarthritis: a systematic review and meta-analysis

Cited by 43 publications

References 38 publications

Nonoperative and Operative Soft-Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Shoulder: An Orthoregeneration Network (ON) Foundation Review

Nonoperative and Operative Soft-Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Shoulder: An Orthoregeneration Network (ON) Foundation Review

Scientific Papers and Patents on Substances with Unproven Effects. Part 2

Cartilage Tissue Engineering: An Update on Multi-Component Approach

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