Effects of intra-articular hyaluronic acid injections on pain and function in patients with knee osteoarthritis: An umbrella review of systematic reviews and meta-analyses of randomized placebo-controlled trials.

Introduction This pilot study investigated the potential clinical benefits of a compression knee sleeve containing Far-Infrared Ray (FIR) emitting particles in patients with knee Osteoarthritis (OA). Methods We conducted a retrospective cohort study at a single institution. Among 48 patients initially fitted with FIR knee sleeves, 22 patients (30 sleeves) had complete one-month follow-up data and were included in the analysis. Two groups were identified: (1) patients who received only the FIR knee sleeve (HA-/Sleeve+), and (2) patients who received both the FIR sleeve and Hyaluronic Acid (HA) injection concurrently (HA+/Sleeve+). Patient-Reported Outcome Measures (PROMs) were collected at baseline and one-month follow-up, including the Knee Injury and Osteoarthritis Outcome Score, JR (KOOS JR), Numeric Pain Rating Scale (NPRS), and a Five-Point Likert Satisfaction Scale. Results At one month, both groups demonstrated improvement in knee health, pain, and satisfaction. KOOS JR scores improved by 12.27 points in the HA-/Sleeve+ group and 9.809 points in the HA+/Sleeve+ group. Pain scores decreased by 3 points and 2 points, respectively. Satisfaction scores increased by 1.416 points in the HA-/Sleeve+ group and 0.278 points in the HA+/Sleeve+ group. Improvements were greater in the HA-/Sleeve+ group across all measures. Discussion Limitations include a small sample size, an inability to ensure knee sleeve compliance, and the need for further research to explore potential synergies between knee compression, injections, and other treatments. Conclusion This preliminary study suggests that a FIR-emitting compression knee sleeve may improve symptoms in patients with knee OA. The greater improvements observed in patients who did not receive HA injections may warrant further investigation. Larger prospective, randomized studies are necessary to validate these findings and define optimal use cases for this emerging nonoperative therapy.

Efficacy of Single Intra-articular 2% Sodium Hyaluronate versus Corticosteroid Injection in Isolated Patellofemoral Osteoarthritis: A Double-Blind, Randomized Controlled Trial.

Aging leads to facial volume loss, particularly in the forehead, resulting in a flat appearance and static wrinkles. Effective forehead rejuvenation aims to restore volume while minimizing risks associated with filler injections. Hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) fillers are commonly used, with recent interest in hybrid techniques that combine both to optimize aesthetic outcomes. This study evaluates the efficacy and safety of a premixed hybrid filler approach for forehead rejuvenation. A multicenter retrospective cohort study analyzed 111 patients (108 females, 3 males) aged 18-43, who received hybrid injections of CaHA (Radiesse®) and HA (Belotero® Volume) at varying ratios based on forehead contour. The injection volumes and product ratios were customized according to the patients' needs. Follow-ups were conducted at 2 weeks, 3 months, 6 months and 12 months. Primary outcomes were adverse events (AEs) classified per Kadouch criteria; secondary outcomes included patient satisfaction. The cohort consisted of 108 women (97.2%) and 3 men (2.7%), mean age 30.5 years. The average injected volume was 3.11mL. Two transient minor AEs (1.8%) were reported: localized hematoma and periorbital edema, both resolving with conservative management. No cases of vascular compromise, nodules, migration, or long-term complications were observed. High patient satisfaction was reported across all evaluations. The combination of CaHA and HA fillers administered via a retrograde fanning injection technique in the deep forehead fat plane proved to be both safe and effective in improving frontal depressions, with no adverse events reported during the 12 month observation period. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Purpose: This study aimed to evaluate the effectiveness of different injection therapies for temporomandibular joint disorders (TMD) and answer the research question: how do botulinum toxin (onabotulinumtoxinA, Botox) and hyaluronic acid (HA) injections affect symptoms of temporomandibular joint disorder (TMD)? Methods: An electronic search of three databases was performed using the search terms “Treatment of TMD or TMJ” and one of the following: 1) “Hyaluronic Acid Injection” or 2) “Intramuscular Botox Injection”. Based on studies done with human patients, the effects of both hyaluronic acid and Botox injections as treatments for TMD were observed and analyzed. Inclusion criteria were: full articles in English, studies conducted in North America or Europe, and articles published from 2015 to the present. Review articles and abstract-only articles were excluded. Results: A total of 20 sources were found and analyzed; eight related to Botox and 12 related to HA. Of the eight Botox articles, six showed a reduction of pain based on the visual analogue scale (VAS) score, and two showed an increased range of motion. Out of the 12 articles related to HA, 12 showed a reduction in pain based on the VAS scores, and 11 showed an increased range of motion. Conclusions: About half of the studies indicate that Botox can reduce pain and increase joint range of motion. Compared to HA, almost all studies showed decreased pain and increased range of motion. This indicates that both treatment methods were associated with successful treatment of TMD symptoms. However, HA was most effective in treating symptoms of TMD.

To compare the therapeutic effects of IA polynucleotide (PN) and hyaluronic acid (HA) injections in small-breed dogs with osteoarthritis. A multicenter, prospective, comparative, randomized, blinded clinical study was conducted from February 2024 to January 2025 at a university veterinary hospital and 3 veterinary clinics. Client-owned small-breed dogs (< 15 kg) with hindlimb osteoarthritis, confirmed by clinical signs and radiographic findings, were assigned to receive 2 IA injections of either HA or PN at a 1:2 ratio, with a 2-week interval. Clinical outcomes were evaluated at weeks 0, 2, 4, 8, and 12 using 2 validated clinical metrology instruments, the Canine Orthopedic Index (COI; function, gait, stiffness, and quality of life) and Canine Brief Pain Inventory (CBPI; pain severity score [PSS] and pain interference score [PIS]). Of the 34 enrolled dogs, 27 completed the study (HA, n = 9; PN, 18). The mean age was 6.3 years, with a median weight of 4.8 kg. The PN group showed significantly greater improvements in COI, stiffness, CBPI, and PIS compared with the HA group at week 12. The PN-treated dogs also experienced earlier or more sustained improvements in COI, stiffness, gait, CBPI, PSS, and PIS. The COI-defined success was observed from weeks 4 to 12 in the PN group and at week 8 in the HA group. The IA PN injections resulted in earlier, greater, and more sustained clinical improvements than HA in dogs with osteoarthritis. Injections of PN may offer a more effective alternative to HA for managing canine osteoarthritis.

Acne is a common skin condition that often leads to atrophic scars, a major concern for patients. Treatments for these scars include fractional CO2 laser, subcision, and regenerative therapies like platelet-rich plasma (PRP) and hyaluronic acid injections. PRP, which concentrates platelets from the patient's blood to release growth factors for enhanced healing, is prepared through centrifugation. Hyaluronic acid products provide hydration and have anti-inflammatory, antibacterial, and antioxidant benefits. This study investigates the effectiveness of PRP, non-cross-linked hyaluronic acid, and their combination in treating acne scars, addressing the significant impact of these scars on patients' quality of life. Between 2023 and 2024, a double-blind, randomized clinical trial was conducted involving 15 patients aged 18 to 65 with atrophic acne scars at a dermatology clinic. Participants were divided into three groups: one group received a combination of platelet-rich plasma (PRP) and non-cross-linked hyaluronic acid on one side of the face, while the opposite side received either PRP alone, hyaluronic acid alone, or normal saline as a placebo. Two therapy sessions were held, with evaluations conducted at baseline, one month after the first session, and three months later, using biometric and ultrasound measurements to assess treatment efficacy. Results indicated that while no significant differences were found in colorimetry, tewametry, and corneometry across groups, the PRP group had higher erythema and melanin indices in the third evaluation (three months after the first treatment session) compared to the PRP+non-cross-linked hyaluronic acid (HA) group. Conversely, the non-cross-linked HA group demonstrated superior scores in tewametry and melanin index compared to the PRP+HA group. In post-treatment evaluations, both patients and physicians reported higher satisfaction rates for the PRP+HA group compared to the PRP alone or the non-cross-linked HA group, highlighting a preference for the combination treatment. The combination of platelet-rich plasma and non-cross-linked hyaluronic acid presents a promising approach for the treatment of atrophic acne scars, demonstrating enhanced satisfaction rates and biometric improvements over individual treatments. Further studies are warranted to solidify these findings and refine treatment protocols. Therapeutic study This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ABSTRACT Objectives To describe the injury profile of a Portuguese professional football team over one competitive season, focusing on the type, severity, mechanism, timing, and management of time-loss injuries. Design This is a retrospective, observational study based on a single professional team from the Portuguese first football league. The study was conducted over one full competitive season (2024/2025). Methods All time-loss injuries resulting in missed official matches were included. Collected data included player demographics, injury type, anatomical location, mechanism (traumatic or overuse), recurrence, time-loss duration, and the use of image-guided interventional procedures. Injuries were diagnosed using clinical evaluation and confirmed by imaging (ultrasound, X-ray or Magnetic Resonance Imaging). Descriptive statistics were used. Results A total of 26 injuries were recorded, corresponding to an overall incidence of 48.7 injuries per 1000 h of exposure (training: 33.3/1000 h; match: 148.1/1000 h; incidence rate ratio = 4.45). Muscle injuries of the hip and thigh were most common (n = 14, 53.8%), particularly hamstring (n = 6) and adductor strains (n = 4). Traumatic mechanisms accounted for 92.3% (n = 24) of cases, while 2 were overuse injuries. Sixteen injuries (61.5%) occurred during training and 8 (30.8%) during matches. The mean time-loss was 20.8 days, corresponding to 4.2 matches missed per injury. Injury peaks were observed in February and April. Defenders were the most affected (n = 15, 57.7%). Four players underwent ultrasound-guided procedures, including three platelet-rich plasma (PRP) injections and one corticosteroid plus hyaluronic acid injection, all with favorable outcomes and return to play. Conclusions This study reinforces the importance of context-specific surveillance to guide injury prevention and treatment. The predominance of traumatic training injuries and successful application of image-guided interventions highlight key considerations for elite football medical teams.

Periorbital complications from hyaluronic acid (HA) fillers are common due to the region's unique anatomy. Hyaluronidase is widely used for management, but dosing remains empirical with no standardized protocol. This study aimed to assess the safety and efficacy of a high-dose, single-session hyaluronidase approach for treating such complications. A retrospective study was conducted on 54 patients presenting with periorbital HA-related complications between August 2020 and May 2024. Four main types of complications were identified: persistent edema, tear trough bulging, under-correction, and subcutaneous nodules. The average interval from the first HA injection to presentation was 25.8 months (range 1.5-72 months). Injection points were determined through visual inspection and palpation, marked at the most prominent areas, and spaced approximately 7-10mm apart. A vertical bolus injection technique was used to administer 30-90 IU (0.1-0.3mL) of hyaluronidase per point, totaling 150-600 IU per lower eyelid. The mean follow-up was 52.9 days (range 14-474 days). All patients responded successfully to one session of high-dose hyaluronidase. The mean dose per lower eyelid was 350.3 IU. No cases required retreatment. Nineteen patients (35.2%) achieved satisfactory outcomes without further intervention, while the remaining 35 (64.8%) underwent subsequent lower eyelid blepharoplasty. High-dose, single-session hyaluronidase injection is a safe, effective, and efficient approach for treating a broad range of HA-related periorbital complications, even in complex cases involving multiple previous treatments or long filler retention time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Internal derangement is a disruption within the internal aspects of the temporomandibular joint (TMJ). Treatment modalities consist of conservative management (medication, modification of habits, physical therapy, splint therapy, laser therapy and ultrasound), minimally invasive (arthrocentesis with lavage, hyaluronic acid injection, and prolotherapy) and surgical management. Thus, evaluation of efficacy of occlusal splint as compared to other treatment modalities is done in this systematic review. The focused question was formulated based on the PRISMA guidelines. Articles published in English between 1 January 2000 and 31 December 2021 involving randomised controlled clinical trials performed on human subjects diagnosed with either unilateral or bilateral internal derangement of TMJ; and treatment provided with occlusal splints comparing other treatment modalities for the same were searched through databases, PubMed and Google scholar. A total of eight studies were included. Three studies evaluated occlusal splint in comparison to arthrocentesis and hyaluronic acid injection, three studies evaluated occlusal splint in comparison with control group (no active treatment), two studies evaluated occlusal splint in comparison with arthrocentesis and hyaluronic acid injection, and, one study compared occlusal splint with only arthrocentesis. One study each evaluated occlusal splint in comparison with medical therapy; prolotherapy; fixed orthodontic appliance; ultrasound, and high-intensity laser therapy (HILT); low-level laser therapy (LLLT); and, single and double hyaluronic acid injection respectively. Hyaluronic acid injection and stabilisation (occlusal) splint therapy benefits patients with painful TMJ disc displacement with reduction. However, in patients with disc displacement without reduction, arthrocentesis is a better treatment modality as compared to occlusal splints. Generalised comment on other treatment modalities namely HILT, LLLT, ultrasound and prolotherapy cannot be made due to limited study as per the inclusion criteria for this systematic review. CRD42021285027.

Assessing Injectate Volume in Injection Laryngoplasty Using Low-Cost Handheld Ultrasonography: Feasibility Study in an Ex Vivo Porcine Model.

Background:Initial and early swelling post injection of hyaluronic acid (HA) filler are considered to affect outcomes and complications in patients; however, the contribution of HA filler type to swelling postinjection remains undetermined. Here, initial and early swelling post injection of HA fillers manufactured via different crosslinking technologies was evaluated in mice.Methods:Mice received injections of HA fillers or controls: High Concentration Equalized (HICE), Stabilized High Concentration Equalized (S-HICE), High molecular Ideal, VYCROSS, NASHA, HICE control, non-HICE control, or no HA control. Initial and early swelling were evaluated via magnetic resonance imaging and collagen deposition via histological evaluation over 28 days.Results:Mice (N = 65) were allocated to 13 groups (per group, n = 5) to receive subcutaneous injections of HA filler or control. Maximum swelling in descending order was High molecular Ideal, 290%; non-HICE control, 256%; VYCROSS 1, 249%; S-HICE 2, 248%; S-HICE 1, 238%; S-HICE 3, 226%; VYCROSS 2, 210%; HICE 1, 203%; HICE 2, 184%; NASHA 1, 174%; HICE control, 159%; NASHA 2, 148%; and no HA control, 100.0%. The mean (SD) collagen area in the residual substance ranged from 2525 (3612) µm2/HPF (high-power field [×400]) for NASHA 2 to 18,870 (4544) µm2/HPF for S-HICE 2. The mean (SD) collagen area around the substance ranged from 9879 (2923) µm2/HPF for VYCROSS 1 to 15,248 (7005) µm2/HPF for S-HICE 3.Conclusions:HA fillers manufactured via different crosslinking technologies may lead to different levels of initial and early swelling and collagen stimulation over 28 days.

Objective: To compare the effectiveness of intra-articular hyaluronic acid injections with and without addedcorticosteroid in patients with knee osteoarthritis.Study Design: Retrospective cohort study.Place and Duration of Study: This study was conducted at the Department of Orthopedic Surgery, Dr. ZiauddinHospital (North Nazimabad Campus) in Karachi, Pakistan from 1st February 2025 to 30th April 2025.Methods: A total of 150 adults (aged 30–70) with symptomatic knee osteoarthritis who received a single intraarticular knee injection were identified: 75 patients received a 6 mL injection of cross-linked sodiumhyaluronate alone, and 75 patients received 6 mL of the same hyaluronic acid combined with 8g triamcinolonehexacetonide. Pain was assessed by the Visual Analog Scale (VAS) at baseline and at 3, 12, and 24 weeks postinjection. Knee symptoms and function were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and 12 weeks. SPSS version 23 was used for data analysis.Results: At 3 weeks, mean VAS pain was 4.35 in the hyaluronic acid and corticosteroid group vs 5.97 in thehyaluronic acid group (P=0.001). This advantage persisted at 12 weeks (P=0.001) and 24 weeks (P=0.001). Bothgroups showed significant improvement from baseline in WOMAC scores at 12 weeks. WOMAC pain decreasedby 0.57 points in hyaluronic acid and corticosteroid vs 0.44 in hyaluronic acid only (P=0.001 for within-groupimprovements), and WOMAC function scores improved by 7.07 vs 5.46 points, respectively (both P=0.001within-group).Conclusion: Hyaluronic acid and corticosteroid co-injection can be a valuable option for more rapid symptomrelief, while hyaluronic acid alone remains beneficial for longer-term management. How to cite this: Shahid S, Munshi N, Siddiqui AM, Azmatullah U, Azizi A, Aziz A. Intra-articular Hyaluronic Acid with Versus without Corticosteroids for Knee Osteoarthritis Among Patients Presenting at Dr. Ziauddin Hospital, Karachi, Pakistan: A Retrospective Cohort Study. Life and Science. 2025; 6(4): 448-454. doi: http://doi.org/10.37185/LnS.1.1.982

The shape and size of ears significantly influence facial aesthetics. In many Asian cultures, lying ears are not perceived favorably in Asian culture, leading individuals to seek surgical interventions to correct this issue. Also, due to the Ebbinghaus effect, prominent ears create a illusion of a smaller face, which is highly desired in Asians. However, surgeries to create prominent ears are invasive, can involve complications and necessitate a period of recovery. To address this concern, the authors have developed a technique utilizing hyaluronic acid (HA) injections of MAILI range (Sinclair Pharma) to enhance the appearance of lying ears. HA injections were performed at the auriculocephalic sulcus and the helix to increase the cranioauricular angle (CA) and correct lying ears. Patients showed improvements in ear prominence. The cranioauricular angle (CAA) and ear projection (EP) increased immediately after the procedure. No serious complications were noted. The injection of hyaluronic acid (HA) into the ears successfully addressed the issue of lying ears and enhanced the overall facial profile. In addition, it provided a lifting effect that contributed to a more youthful and refined appearance. This minimally invasive procedure did not necessitate any recovery time, and the results were long-lasting and highly satisfactory. Level V.

To compare the efficacy of intra-articular administration of platelet-rich plasma (PRP), hyaluronic acid (HA), corticosteroids (CS), and nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with knee osteoarthritis. This retrospective study analyzed 205 knees of 150 patients with Kellgren–Lawrence grade 2 to 3 knee osteoarthritis treated between 2016 and 2021. Patients received intra-articular injections of PRP, HA, CS, or NSAIDs. Visual analog scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Kellgren–Lawrence grades were assessed at baseline and final follow-up (6–12 months). All groups showed significant improvements in the VAS and WOMAC scores from baseline to the final follow-up. PRP demonstrated the greatest pain reduction (3.2 point VAS decrease) and functional improvement (20-point WOMAC decrease). HA provided moderate but consistent benefits to the patients. The CS showed rapid early improvement that diminished over time. NSAIDs showed minimal improvement. Radiographic progression was minimal in all the groups. No major adverse events were observed. PRP offered the most sustained improvement in pain and function in knee osteoarthritis, followed by that of HA. CS provide short-term relief but have limited long-term benefits. NSAIDs were the least effective treatment. These findings support a tailored approach to knee osteoarthritis treatment, using PRP and HA as promising options for long-term management. The datasets generated and/or analyzed during the current study are not publicly available but can be obtained from the corresponding author upon reasonable request. The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.Level of evidence: Diagnostic Level 3 (retrospective cohort study).

We aimed to evaluate the modification of cardiovascular risk factor parameters after intra-articular injection with hyaluronic acid in patients with symptomatic hip and knee osteoarthrtitis. This was a retrospective cohort study of 101 patients meeting the clinical and radiological criteria of the American College of Rheumatology for hip and knee osteoarthritis, Kellgren-Lawrence grades I-IV. Patients received four intra-articular injections of hyaluronic acid in the knee and/or hip in the period of study. After the injections, changes in weight and BMI, pain using the visual analogue scale, consumption of pain medications, and physical activity were recorded at each follow-up visit. Analytical variations in blood glucose, HbA1c, total cholesterol, LDL, HDL, and triglycerides were also evaluated. Over the 24-month study period, weight and BMI were stabilised. A reduction in pain of 1.2 points (p<0.001), a 20,76% reduction in analgesic consumption (p<0.001), and a 19.81% increase in physical activity (p<0.001) and a 21.8% increase in frequency (p=0.001) were observed. Total cholesterol (p=0.002), LDL (p=0.009), HDL (p=0.023), and triglycerides (p=0.021) showed a significant decrease in all cases when analysed in patients whose baseline levels were pathological. Intra-articular viscosupplementation with hyaluronic acid in symptomatic hip and knee osteoarthritis achieves a decrease in pain, potentially allowing patients to increase their physical activity levels, which helps control weight and BMI. Secondarily it could influence the improvement of CVRF analytical outcomes in the medium term in those patients who had altered levels.

Hyaluronic acid injection to treat symptoms of vulvovaginal atrophy and improve sexual function in postmenopausal women: A 52-week long-term follow-up.

Comparing the efficacy of combining ozone therapy with hyaluronic acid versus using hyaluronic acid alone for pain relief in patients with knee osteoarthritis: A randomized clinical trial.

Morphea is a chronic autoimmune condition characterized by sclerosis and scar-like changes in the skin and underlying tissues. En coup de sabre represents a rare and severe linear variant of morphea, primarily affecting the frontoparietal scalp and forehead, with a higher prevalence among children and women. The disease often leads to significant cosmetic and functional impairments, posing therapeutic challenges due to its unpredictable course and varying responses to conventional treatments. Current management strategies include topical steroids, calcineurin inhibitors, systemic therapies, such as methotrexate, and ultraviolet (UV) therapy. Additionally, interventions like fat grafting and hyaluronic acid injections have demonstrated some efficacy in restoring tissue volume and improving skin texture. This case report explores an innovative approach using autologous fibroblast cell injection combined with platelet-rich plasma (PRP) as a novel therapeutic option for a 40-year-old woman diagnosed with inactive-phase en coup de sabre. After harvesting fibroblast cells from a superficial skin biopsy and isolating PRP through centrifugation, the combined solution was administered via three monthly subcutaneous injections. No adverse effects were observed throughout the treatment period. At a 3-month follow-up, significant improvements were noted in skin elasticity, hydration, and overall cosmetic appearance. Ultrasound imaging revealed enhanced dermal thickness and density, while cutometric and colorimetric assessments confirmed increased skin viscoelastic properties and brightness. The promising results observed in this case suggest that the combination of autologous fibroblasts and PRP may offer a safe, effective, and minimally invasive therapeutic alternative for managing en coup de sabre morphea. However, larger studies and controlled clinical trials are essential to validate these findings, optimize treatment protocols, and further understand the underlying mechanisms driving tissue regeneration and repair in morphea.

Medialization Thyroplasty with Tensor Fascia Lata for Immunocompromised or Irradiated Patients.