Abstract
PurposeRotator cuff tendinopathy is associated with decreased function and restricted range of motion (ROM) of the shoulder. Hyaluronic acid(HA) injections have been used for the management and pain relief. The objective of this study is to compare the efficacy of HA with steroids, Placebo(normal saline), physical therapy, Lignocaine, PRP, and ESWT. MethodsPRISMA guidelines were followed for the literature search. The literature search was done on PubMed, Embase and Cochrane, using multiple search terms or derivatives until 20th March 2023. 18 RCTs meeting the eligibility criteria were included. Quality assessment was done using the Newcastle Ottawa score and GRADE criteria and risk assessment using risk of bias 2 tool. Quantitative analysis was done on VAS and constant murphy score whereas Qualitative analysis was done on ROM, DASH, UCLA and ASES. The follow-up period was up to 12 months. ResultsEighteen studies (1773 rotator cuffs) were pooled in the Systematic Review and Meta-analysis. GRADE assessment had high quality for VAS and Constant score. The Newcastle Ottawa Score ranged from 4 to 6. Significant improvement (p < 0.05) in VAS and constant murphy score was seen on comparing HA with Physical therapy and PRP on short-term follow-up(1 & 3 months) with insignificant results on comparing HA with placebo(normal saline) and steroids. Significant improvement in DASH scores on comparing HA with physiotherapy. No significant change was seen in ROM, UCLA and ASES scores on comparing HA with steroid injections. ConclusionIntra-articular HA injection in RC tendinopathy is associated with improved VAS score and functional outcome score. HA as well as steroids both are found to be effective with no significant difference. But the risk of complications is more with steroids as suggested by the literature. More specific RCT between the two might be needed to provide a clear picture in terms of both efficacy and complications. Level of evidenceTherapeutic Level I. Study designSystematic Review and Meta-analysis.
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