AMSSM scientific statement concerning viscosupplementation injections for knee osteoarthritis: importance for individual patient outcomes.

Document Type


Publication Date



Sports Medicine

Journal Title

British journal of sports medicine

MeSH Headings

Osteoarthritis, Knee Drug Therapy; Hyaluronic Acid Therapeutic Use; Adrenal Cortex Hormones Therapeutic Use; Injections, Intraarticular; Sports Medicine Organizations; Medical Organizations Standards; United States; Medical Practice, Evidence-Based; Medline; Embase; Cochrane Library; Clinical Assessment Tools; Questionnaires; Systematic Review; Meta Analysis; Confidence Intervals; P-Value; Data Analysis Software; Middle Age; Aged; Female; Male; Human; Middle Aged: 45-64 years; Aged: 65+ years; Female; Male


Objective: Osteoarthritis (OA) is a disabling disease that produces severe morbidity reducing physical activity. Our position statement on treatment of knee OA with viscosupplementation injection [hyaluronic acid (HA)] versus steroid [intra-articular corticosteroid (IAS)] and placebo [intra-articular placebo (IAP)] is based on the evaluation of treatment effect by examining the number of subjects within a treatment arm that met the Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) criteria, which is different and more relevant than methods used in other reviews which examined if the average change across the treatment groups was clinically different. Data Sources: We performed a systematic literature search for all relevant articles from 1960 to August 2014 in the MEDLINE, EMBASE, and Cochrane CENTRAL. We performed a network meta-analysis (NMA) of the relevant literature to determine if there is a benefit from HA as compared with IAS and IAP. Main Results: Eleven articles met the inclusion criteria from the search strategy. On NMA, those subjects receiving HA were 15% and 11% more likely to respond to treatment by the OMERACT-OARSI criteria than those receiving IAS or IAP, respectively (P < 0.05 for both). Conclusions: In light of the aforementioned results of our NMA, the American Medical Society for Sport Medicine recommends the use of HA for the appropriate patients with knee OA.

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