Summary

Intra-articular hyaluronic acid injections for ankle osteoarthritis show no significant benefit over placebo in terms of clinical outcomes or complication rates at short-term follow-up, though they remain a safe option for pain relief.

Abstract

Introduction

Ankle osteoarthritis is a progressive, degenerative pathology that is most commonly preceded by trauma. Conservative management entails physical therapy, shoe-wear modification and intra-articular injections of corticosteroids, biological adjuvants and viscosupplements. Hyaluronic acid is a low molecular weight glycosaminoglycan that aims to restore viscoelasticity through the replacement of dysfunctional synovial fluid and modulation of the early inflammatory response. However, no consensus has been reached regarding the efficacy of intra-articular HA injections for ankle osteoarthritis to date. The purpose of this systematic review and meta-analysis was to compare clinical outcomes in RCTs between patients who received intra-articular hyaluronic acid (HA) injections and those who did not receive intra-articular HA injection for ankle osteoarthritis.

Methods

During April 2024, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify RCTs comparing outcomes between patients who received intra-articular hyaluronic acid (HA) injections and those who did not receive intra-articular HA injection for ankle osteoarthritis. Data regarding injection characteristics, subjective clinical outcomes, complications and secondary surgical procedure rates were extracted and analysed. In total, 6 RCTs were included in this review.

Results

In total, 145 patients (149 ankles) received an intra-articular hyaluronic acid (HA) injection and 129 patients (138 ankles) did not receive an intra-articular HA injection for the management of ankle osteoarthritis. The weighted mean follow-up time in the HA cohort was 5.1±3.0 months and the weighted mean follow-up time in the control cohort was 5.3±3.0 months. The most common Kellgran-Lawrence grade of ankle osteoarthritis was 3. Improvement in American orthopedic foot and ankle osteoarthritis (AOFAS) scores and visual analog scale (VAS) scores was reported in both cohorts. There was no statistically significant difference in AOFAS scores (SMD = 0.1004; [-0.6658, 0.8666]; p = 0.8298) nor VAS score (SMD = -0.0546; [-0.3509,0.2416], p = 0.7177). No difference in complication rates was noted between the 2 cohorts.

Discussion And Conclusion

This systematic review and meta-analysis found no difference in subjective clinical outcomes and complication rates at final follow-up between patients who received intra-articular HA injections and those who did not receive intra-articular HA injections for the management of ankle osteoarthritis at short-term follow-up. Despite the lack of superiority over placebo, intra-articular injections of HA was demonstrated to be a safe and reliable method for short-term relief of pain in patients with ankle osteoarthritis. Further RCTs with larger patient cohorts and longer follow-up times are warranted to determine the optimal role of intra-articular HA injections in patients with ankle osteoarthritis.