Viscosupplementation in the management of ankle osteoarthritis: a review

Abstract

Viscosupplementation is used widely in knee OA and is included in the professional guidelines for treatment of the disease in this joint. The potential for treating osteoarthritis of the ankle joint by viscosupplementation has been suggested in the literature, however, no dosing studies have been published to date, and dosing in the ankle joint remains an area for discussion. Viscosupplementation could potentially provide an useful alternative in treating such patients with painful ankle OA.

Current Concepts in the Management of Ankle Osteoarthritis: A Systematic Review

“…Sun et al (11), in their prospective case series of unilateral ankle OA followed up for 6 months, showed significant American Orthopaedic Foot and Ankle Society (AOFAS) scale score improvements using 3 HA intra-articular injections at 1-week intervals. A systematic review found considerable differences among different studies in terms of the number of injections and follow-up length and that this and the paucity of randomized controlled trials meant that a full meta-analysis was not possible (12).…”

Hyaluronate for the Treatment of Ankle Osteoarthritis

“…To date, there are only 3 randomized controlled, double-blind trials ( Salt et al, 2006;Cohen et al , 2008;Karatosun et al, 2008) (Table 2) and a few case series in the search of the literature on viscosupplementation therapy for ankle OA (Table 3). Two recent reviews (Migliore et al, 2011;Sun et al, 2009) have provided an overview of clinical trials with hyaluronate therapy in ankle OA. Salk et al performed the first randomized, double-blind, saline solution-controlled trial in patients with grade 2, 3 and 4 (Kellgren-Lawrence) ankle OA (Salk et al, 2006), assessing the efficacy and safety of hyaluronate for the treatment of ankle OA.…”

Optimizing the effectiveness of viscosupplementation in non-knee osteoarthritis

“…As a result, published data do not form a sound basis on which to build an assessment of the effectiveness of viscosupplementation at sites other than the knee. In particular, the few published metaanalyses and systematic reviews provide no firm conclusions, for the reasons described above [3,4]. Nevertheless, a closer look at these studies teaches a number of very interesting lessons, which should help clinicians to make treatment decisions and to participate in developing high-quality, large-scale, controlled studies with sufficiently long follow-ups.…”