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Significant improvements seen using intra-articular injections of hyaluronic acid for ankle OA
Mei-Dan O. J Am Podiatr Med Assoc. 2010;100(2):93-100.
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Patients with arthritic ankles that were treated nonoperatively with consecutive intra-articular injections of hyaluronic acid experienced symptomatic relief which sometimes lasted for several months.
Investigators from Israel prospectively studied the effects of hyaluronic acid injections in 16 patients aged 31 to 79 years old who had symptomatic ankle osteoarthritis (OA). The duration of the patients’ OA symptoms ranged from 9 months to 27 years. Based on radiographic measures, their OA severity on the Kellgren and Lawrence scale was II, III or IV.
Each ankle received a 25 mg intra-articular injection of sodium hyaluronate once a week for 5 weeks.
The investigators examined the patients at 4, 8, 11, 17 and 32 weeks after treatment and performed a clinical evaluation and objective scoring of each patient’s ankle.
Based on the investigators’ global assessment, 13 of 15 patients who completed the study showed improvement, including a 20% improvement in ankle range of motion. Patients also experienced a statistically significant reduction in their pain according to changes in their Visual Analog Scale and ankle-hindfoot scores.
At 7 months post-treatment, the efficacy of the injections did not decrease.
Of the two patients whose global assessment did not improve from the injections, one did not complete the follow-up due to concurrent back surgery.
“There were significant improvements, in objective and subjective parameters, that lasted for more than 7 months,” the investigators wrote in their study abstract. “Ankle intra-articular injection of sodium hyaluronate is a valid conservative treatment for ankle OA.”
In 1997, the FDA approved intra-articular viscosupplementation and hyaluronic acid for OA of the knee. Hyaluronic acid is currently approved in Europe for use in the ankle with good results reported. The above article is small in number and the follow up is short, yet they do report significant improvement. These clinical findings back up a good body of basic science literature (Amiel, Woo, Akeson, and others) reporting that hyaluronic acid injections can stimulate hyaluronic acid syntheses within the matrices of the peri-articular connective tissue. If the spacing and lubricant properties of gylcosaminoglycans can be maintained, this may lead to more normal biochemical and biomechanical properties of the joint.
Carol C. Frey, MD
Orthopedics Today Foot and Ankle Section Editor
