Hyaluronic Acid Injection Research Articles

A Randomized, Evaluator-Blinded, Multicenter Study to Compare Injectable Poly-D,L-Lactic Acid vs Hyaluronic Acid for Nasolabial Fold Augmentation.

Injectable poly-D,L-lactic acid (PDLLA), under the brand name of AestheFill (REGEN Biotech, Inc., Seoul, South Korea), is a biocompatible, biodegradable, and biostimulatory product utilized to correct soft tissue volume loss. Its efficacy and safety have not been fully studied in a large cohort. The aim of the study was to evaluate the efficacy and safety of a novel dermal filler injectable, poly-D,L-lactic acid. This was an evaluator-blinded, multicenter, randomized controlled trial to compare the efficacy and safety of PDLLA vs hyaluronic acid in the correction of the nasolabial fold. Two hundred and sixty patients with moderate to severe nasolabial folds were enrolled and randomized to the treatment group (PDLLA) or control group (hyaluronic acid). Each patient received a PDLLA or hyaluronic acid injection for nasolabial fold augmentation and was followed for 52 weeks. The Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale (GAIS) were applied to evaluate topical nasolabial fold augmentation and overall improvement, respectively. At 24 weeks, 67.6% of patients in the PDLLA group had an at least 1-grade improvement on the WSRS, compared to 60.9% of patients in the control group with an at least 1-grade improvement on the WSRS (P < .05). At each visit, the PDLLA group showed more improvement on the baseline WSRS than the control group. PDLLA was safe and well tolerated, with no severe adverse events. PDLLA shows noninferior efficacy in correcting nasolabial folds compared to hyaluronic acid.

Effects of supplementing extracorporeal shockwave therapy (ESWT) to hyaluronic acid (HA) injection among patients with rotator cuff lesions without complete tear: A prospective double-blinded randomized study.

The study investigates the combined efficacy of subacromial hyaluronic acid (HA) injections and extracorporeal shockwave therapy (ESWT) in managing rotator cuff lesions without complete tears. Eligible patients were randomized into three groups: 3 HA injections combined with 2 sham ESWT (HA), 3 HA injections combined with 1 ESWT and 1 sham ESWT (HA + 1 ESWT), or 3 HA injections combined with 2 ESWT (HA + 2 ESWT) with an allocation ratio of 1:1:1. Visual Analogue Scale (VAS), Constant-Murley Score (CMS), range of motion (ROM), and muscle power of shoulder abduction (MP) were assessed pre-intervention and at 1, 3, 6, and 12 months post-initial HA injection. Shoulder magnetic resonance imaging (MRI) was conducted before and twelve months after the intervention. All pertinent parameters showed no significant between-group differences at baseline but demonstrated significant within-group improvement throughout the study. The HA + 1 ESWT group demonstrated superior improvements in MP (P=0.011) and CMS (P=0.018) at 1 month, and in MP (P=0.014) and CMS (P=0.005) at 6 months, compared to the HA group. The HA + 2 ESWT group showed greater improvements in FF (P=0.027), IR (P=0.019), and SROM (P=0.025) at 1 month, and in ABD (P=0.022) at 6 months, compared to the HA group. Notably, the HA + 2 ESWT group exhibited greater improvements in FF (P=0.013), IR (P=0.019), and SROM (P=0.025) at 1 month, and in FF (P=0.007) at 3 months, than the HA + 1 ESWT group. Moreover, no deterioration in tendinopathy grading or tear status occurred in the HA + 1 ESWT group on MRI scans. ESWT provides additional benefits when combined with HA injections for patients with rotator cuff lesions lacking complete tears.

Super-Selective Intra-arterial Thrombolytic Therapy for Peripheral Facial Paralysis After Postauricular Hyaluronic Acid Injection for the Esthetic Correction of Lying Ears.

Hyaluronic acid (HA) injection in the auricular base is one of the most popular and non-surgical cosmetic procedures for correcting lying ears and optimizing the facial profile because of its minimal invasiveness, immediate effect and safety (Li et al. in Aesthet Surg J 44: 746-75, 2024). But we have recently discovered that this treatment may lead to a new and rare complication called peripheral facial paralysis that has never been reported before. Until now, the etiology, clinical traits, treatment strategies, outcomes and possible reversibility have not been characterized. In the present study, we enrolled 4 patients with peripheral facial paralysis after subcutaneous postauricular HA filler injection. Preoperative digital subtraction angiography revealed a vascular embolism. Then, the patients underwent super-selective facial arterial thrombolytic therapy via hyaluronidase and papaverine injections. Simultaneously, general symptomatic treatment and nutritional therapy were performed. The patients were relieved of their clinical symptoms and the significant improvement was observed in terms of motor function in her left facial areas after treatment. The auricular skin necrosis of all patients was restored to near normal appearance. Our results indicate that super-selective facial arterial thrombolytic therapy is feasible for patients with peripheral facial paralysis induced by HA embolism. It was also beneficial in the recovery from skin necrosis. The therapy was shown to be worthy of clinical application. 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 .

Intra-articular interventions in osteoarthritis: Navigating the landscape of hyaluronic acid, mesenchymal stem cells, and platelet-rich plasma

Osteoarthritis (OA) poses a substantial burden on patients, leading to pain, functional decline, and reduced quality of life. While conventional treatments focus on symptom management, disease-modifying interventions are yet to be established. This review explores the efficacy of intra-articular interventions, particularly hyaluronic acid (HA), mesenchymal stem cells (MSCs), and platelet-rich plasma (PRP), in the context of OA management. HA injections, with diverse formulations like Hylan G-F20, sodium hyaluronate, and hyaluronan, present varying outcomes, necessitating a nuanced understanding of their effectiveness and timing. MSC therapy, derived from adipose tissue, umbilical cord, or bone marrow, shows promising results in clinical improvement, with adipose-derived MSCs demonstrating efficacy in maintaining benefits over 6 mo. Conversely, bone-marrow-derived MSCs show limited effectiveness, highlighting the need for source-specific considerations. PRP has emerged as a superior option for long-term pain reduction and quality of life improvement, with leukocyte-poor formulations and a critical platelet count of 10 billion demonstrating optimal results. This comprehensive analysis underscores the potential of intra-articular interventions in OA management, emphasizing the need for personalized and evidence-based approaches to enhance treatment efficacy and patient outcomes.

Comparison of Intralesional Injection of Hyaluronic Acid with Triamcinolone and Triamcinolone Alone in Treatment of Oral Lichen Planus at Tertiary care Oral &amp; Maxillofacial Center

Objective: To compare the outcome of intralesional injection of Hyaluronic acid with Triamcinolone and Triamcinolone alone in the management of Oral Lichen Planus. Methodology: This randomized controlled trial, conducted in the Oral &amp; Maxillofacial Surgery department at Punjab Dental Hospital(PDH), Lahore, included 30 patients aged 20-70 years with histopathologically confirmed Oral Lichen planus (0.5-4 cm), using a Split mouth technique. One side of the lesion received intralesional Triamcinolone (40 mg/ml), while the other side received a combination of Hyaluronic acid and Triamcinolone. Pain and lesion size were assessed using a Visual Analogue Scale and measured at 2 and 12 weeks. Data was analyzed in SPSS version 20.0, with significance at P &lt; 0.05, comparing mean pain scores and lesion disappearance between groups using t-tests and Chi-square tests. Results: Total 30 patients were included. The mean age of the patients was 48.76±14.67 year. Oral health assessment revealed that 9(30%) patients had good oral hygiene, and 15(50%) average hygiene. At baseline and 2nd week mean pain score in Intervention group was 5.7±1.08, 1.60 ±0.62 and in control patients was 5.6±1.03 and 2.10±0.99. Disappearance of lesion showed no significant difference between groups. Although in intervention group rate of disappearance of lesion was higher. i.e. Intervention: 73.3% vs. Control: 50%, p-value=0.063 Conclusion: The conclusion of the study is that intralesional injection of Hyaluronic acid plus Triamcinolone is more effective than Triamcinolone alone for treating Oral Lichen Planus in terms of pain reduction and lesion disappearance

The Exosomes of Stem Cells from Human Exfoliated Deciduous Teeth Suppress Inflammation in Osteoarthritis.

Hyaluronic acid injection is commonly used clinically to slow down the development of osteoarthritis (OA). A newly developed therapeutic method is to implant chondrocytes/stem cells to regenerate cartilage in the body. The curative effect of stem cell therapy has been proven to come from the paracrine of stem cells. In this study, exosomes secreted by stem cells from human exfoliated deciduous teeth (SHED) and hyaluronic acid were used individually to evaluate the therapeutic effect in slowing down OA. SHED was cultured in a serum-free medium for three days, and the supernatant was collected and then centrifuged with a speed difference to obtain exosomes containing CD9 and CD63 markers, with an average particle size of 154.1 nm. SW1353 cells were stimulated with IL-1β to produce the inflammatory characteristics of OA and then treated with 40 μg/mL exosomes and hyaluronic acid individually. The results showed that the exosomes successfully inhibited the pro-inflammatory factors, including TNF-α, IL-6, iNOS, NO, COX-2 and PGE2, induced by IL-1β and the degrading enzyme of the extrachondral matrix (MMP-13). Collagen II and ACAN, the main components of the extrachondral matrix, were also increased by 1.76-fold and 2.98-fold, respectively, after treatment, which were similar to that of the normal joints. The effect can be attributed to the partial mediation of SHED exosomes to the NF-κB pathway, and the ability of exosomes to inhibit OA is found not inferior to that of hyaluronic acid.

Treatment of temporomandibular joint internal derangement using MESNA injection

IntroductionThe development of temporomandibular disorders specifically emphasizes the biochemical changes occurring in the synovial fluid at different stages of temporomandibular joint disease. Research has indicated that inflammation may be a primary reason behind the pain and dysfunction in temporomandibular joint diseases. Since its clearance several years ago, MESNA (sodium 2-mercaptoethanesulfonate) has been used in various formulations as a mucolytic drug in the respiratory domain. It operates by disrupting the disulfide bonds present between polypeptide chains within mucus. MESNA exhibits minimal tissue distribution, with the material being swiftly and thoroughly eliminated via the kidneys.ObjectivesTo assess the efficacy of injecting MESNA directly into the Temporomandibular Joint to treat internal derangement.Materials and methodsA randomized clinical trial was conducted on sixty patients who exhibited non-responsiveness to conventional treatment and were diagnosed with TMJ anterior disc displacement with reduction. The patients were chosen from the outpatient clinic of the Oral and Maxillofacial Surgery Department at Tanta University Faculty of Dentistry. Two equal groups of patients were randomly assigned to each other. Group I (Mesna group) received intra-articular injection with MESNA solution. Group II (Standard group) received arthrocentesis with lactated ringer solution followed by injection of Hyaluronic Acid (HA). The data was gathered by functional examinations such as maximum interincisal opening (MIO) and clicking. A Visual Analogue Scale (VAS) assessed pain severity before and after treatments.ResultsBoth MESNA and HA showed significant improvement up to six months of the follow-up compared to preoperative status, as evidenced by better mouth opening, lateral excursion, lower clicking, and reduced pain score in patients with TMDs. MESNA showed significant improvement during follow-up compared to HA.ConclusionCompared to HA, MESNA showed a more noticeable improvement during the follow-up period.

Predictors of Patient-Reported Outcomes After Hyaluronic Acid Injections: Effect of Expectations and Psychological Stress.

Hyaluronic acid (HA) injections are a common nonsurgical treatment of knee osteoarthritis (OA). Patient expectations and psychological stress are believed to affect outcomes after orthopaedic procedures. This was a prospective cohort study seeking to identify factors predictive of greater patient-reported outcomes after HA injections, particularly expectations and psychological stress. 250 patients receiving a series of HA injections for knee OA were enrolled, with 196 being included for analysis. Demographics, surgical history, and preoperative Kellgren-Lawrence severity scores were collected, and patients completed the Knee Osteoarthritis Outcome Score (KOOS) questionnaire, a modified KOOS questionnaire assessing their 6-month postinjection expectations, and the Perceived Stress Scale before the first injection. Outcomes were assessed at 3 weeks and 3 and 6 months after the final injection. KOOS scores improved from preinjection to 6-month follow-up but did not meet patients' expectations or minimal clinically important difference. Expectations correlated with 6-month KOOS pain, activities of daily living, sport, and quality of life subscales (ρ = 0.19 to 0.34), but not the symptom subscale (P = 0.10). Expectations (ρ = 0.31 to 0.37), younger age (ρ = -0.17 to -0.18), and greater perceived stress (ρ = 0.23) correlated with greater improvement from baseline KOOSs. Lower body mass index (ρ = -0.19 to -0.22), male sex (ρ = -0.17), and greater preinjection function (ρ = 0.37 to 0.46) correlated with greater 6-month outcomes. Stress measured on the Perceived Stress Scale did not correlate with 6-month KOOSs (P ≥ 0.27). Lower Kellgren-Lawrence severity score was weakly associated with greater 6-month KOOS activities of daily living and sport scores (ρ = -0.15 to -0.16) and greater improvement in the KOOS symptom score (ρ = -0.15). This study identified that higher expectations, lower body mass index, younger age, male sex, lower radiographic severity, greater preinjection function, and greater perceived stress are associated with greater patient outcomes after HA injection. Physicians should consider these factors when counseling patients with knee OA about viscosupplementation. Prospective Cohort Study (Level of Evidence II).

Nonoperative Management of Trapeziometacarpal Joint Arthritis: A Systematic Review of the Clinical Trials.

This systematic review evaluates nonoperative treatments for trapeziometacarpal joint osteoarthritis (TMJO), a common degenerative condition in postmenopausal females causing pain, reduced mobility, and diminished grip strength.Following PRISMA guidelines, a search was conducted across PubMed, Cochrane, Embase, and MEDLINEfor randomized controlled trials (RCTs) assessing pain outcomes with nonoperative interventions over at least a six-month follow-up, using the visual analog scale (VAS) for pain measurement. Eleven RCTs yielded moderate-quality evidence for the following: (1) corticosteroid (CSI) and hyaluronic acid (HA) injections exhibit comparable mean delta pain scores after six months, with CSI offering early relief at two to three weeks. After 12 months, CSI led to a continued decrease in pain, with a mean delta pain score of 1.0 (p<0.05), contrasting with hyaluronic acid (HA) injections, which presented a modest though nonsignificant improvement, demonstrating a mean delta pain score of 0.5 (p=0.16). (2) Relatively novel therapies for TMJO, such as platelet-rich plasma (PRP) and dextrose, appear to surpass CSI in long-term effectiveness, with dextrose showing a mean delta pain score of 3.8 (p<0.001) at six months and PRP achieving a mean delta pain score of 5.5 (p=0.005) at 12 months. (3) Various hand therapies, notably standard hand exercises and extracorporeal shockwave therapy (ESWT), demonstrated significant pain reduction, with the former achieving a mean delta pain score of 1.5 (p=0.019) and the latter a score of 4.2 (p<0.001). (4) The use of orthoses substantially decreases pain levels, demonstrating a mean delta pain score reduction of 2.6 at a 180-day follow-up (p=0.023) and 2.2 at a 12-month follow-up (p=0.002). In conclusion, nonoperative treatments for TMJO, including intra-articular injections, hand therapy, and orthoses, provide significant pain relief at a minimum of six months follow-up. The synergistic effect of combined nonoperative management, as well as the effect size of each, is unknown.

Mesenchymal Stem Cells Injection Is More Effective Than Hyaluronic Acid Injection in the Treatment of Knee Osteoarthritis With Similar Safety: A Systematic Review and Meta-Analysis

PurposeTo evaluate the Efficacy and safety of intra-articular injection of mesenchymal stem cells (MSCs) versus Hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA). MethodsEligible randomized controlled trials (RCTs) were identified through a search of Pubmed, Embase, the Cochrane Library, Web of science, SinoMed and CNKI databases from inception to March 2024. For meta-analysis, data on clinical outcomes were measured using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and data on cartilage repair were measured using the Whole-Organ Magnetic Resonance Imaging Score (WORMS); data on safety was evaluated by the incidence of adverse events. Two researchers independently read the included literatures, extracted data and evaluated the quality, and used Cochrane risk bias assessment tool for bias risk assessment, and RevMan5.3 software for Meta-analysis. Result：Ten RCTs involving 818 patients with KOA ranging from I-Ⅲ Kellgren – Lawrence grading scale were included in this meta-analysis. Meta results showed that compared with the HA control group, at 12months, the WOMAC total score [MD=-10.22, 95% CI (-14.86∼-5.59), P<0.0001, Z=4.32];VAS score[MD=-1.31, 95% CI (-1.90∼-0.73), P<0.0001, Z=4.40]; WORMS score [MD=-26.01,95% CI (-31.88∼-20.14),P<0.001,Z=8.69]of MSCs group all decreased significantly (P<0.05), and reached the minimum clinically important differences (MCID). Furthermore, there was no significant difference in the incidence of adverse events (RR=1.54, 95% CI= 0.85 ∼ 2.79, P=0.16, I2=0) between the two groups (P >0.05). ConclusionCompared to HA, intra-articular injection of MSCs therapy appears to effectively alleviate joint pain, improve clinical function of KOA patients. These benefits are observed to last for at least 12 months without an increase in adverse events. Due to limited, varied, and lacking MCID results in existing literature, further research is needed. Level of EvidenceLevel I, Meta-analysis of Level I studies.

Mapping High-Risk Arteries Using Doppler Ultrasound for Forehead Contouring in Korean Patients.

Forehead flatness is common in Korean populations, and one of the most straightforward techniques for adding volume and achieving a concave forehead is injecting hyaluronic acid (HA) filler. However, definitive guidelines for this procedure are lacking, and careful attention to the arterial anatomy is required to avoid vascular complications. The authors aimed to establish guidelines for performing forehead augmentation using Doppler ultrasound to identify vasculature before HA injection. Arterial mapping of the faces of 34 patients was performed using Doppler ultrasound. Each anatomic layer (skin, subcutaneous fat, and galea aponeurotica) of the forehead with blood vessels was identified. An average volume of 2.85 mL of HA filler was injected. Postoperative complications, such as infection, hematoma, bruising, nodules, skin necrosis, and blindness, were evaluated. Using Doppler ultrasound, the authors successfully traced all 3 blood vessels (supraorbital, supratrochlear, and frontal branch of the superficial temporal arteries) and avoided them during HA injection. None of the patients experienced arterial complications. Doppler ultrasound proves to be an effective technique for arterial mapping, enabling the identification and avoidance of the major blood vessels of the forehead before HA filler injection.

The Effect of Intra-Articular Injections of Hyaluronic Acid for the Treatment of Trapezio-Metacarpal Joint Osteoarthritis.

Osteoarthritis of the basal thumb joint is a debilitating disease with a high prevalence. Among pharmacological treatments, intra-articular injections of hyaluronic acid have been clinically applied. This study aimed to investigate the effectiveness and safety of intra-articular injections of hyaluronic acid for the treatment of trapezio-metacarpal joint osteoarthritis (TMOA), over a one-year period. Patients with TMOA were enrolled and treated with five consecutive intra-articular injections of hyaluronic acid (20 mg/2 mL, 500-750 KDa, HyalganBio) at weekly intervals. Primary outcomes were pain during different activities (changes in numerical rating scale) and function (pinch and grip strength), and secondary outcomes were safety (adverse events) and patient-reported outcomes (quick-DASH and SF-12). The outcomes were evaluated at baseline and 1-, 3-, 6-, and 12- months after the last injection. A total of 29 patients were included. All participants completed the five injective sessions and the first follow-up. A total of 15 patients completed the study. During the follow-up period, intra-articular injections of hyaluronic acid have significantly reduced spontaneous and provoked pain and improved disability. No severe systemic adverse events were reported. At a follow-up of up to 12 months, patients with TMOA treated with intra-articular hyaluronic acid injections reported improvements in pain relief and quality of life.

Hyaluronic acid and the relevance of its use in dysfunction of the temporomandian joint

To identify the most revealing studies in the field of non-cosmetic medical use of hyaluronic acid and determine its prospects for further use in the treatment of problems with the temporomandibular joint.The material for the work was the research of specialists from Mexico, Italy, the USA and Russia, analyzing the use of hyaluronic acid in various areas of joint treatment.An analysis was made of five large studies on this topic, during which patients with joint diseases received intra-articular injections of hyaluronic acid using samples. Patients, depending on the purpose of a particular study, were asked to take a course of hyaluronic acid and a placebo / other medicinal substance.As a result of the analysis, it was found that most of the above studies showed a positive effect of hyaluronic acid in the short and long term in the treatment of diseases of the temporomandibular joint. At the same time, in order to further expand the use of this substance, additional research is required in specific areas.

Orofacial Harmonization versus Facial Deformities: A Literature Review

In the current context, orofacial harmonization can serve as a complementary means to treat deformities, whether from an aesthetic or functional perspective. In this scope, the present study aims to evaluate the use of hyaluronic acid fillers and botulinum toxin in correcting facial defects. This study consists of a literature review based on the determination of the theme, using the databases PubMed, EBSCO, SciELO, and Google Scholar. The temporal delimitation was established from 2018 to the present. The MeSH descriptors used in the research were: "hyaluronic acid filler," "facial abnormalities," and "augmentation," adding respective descriptors for each topic (ocular, nasal, ear, and lip palate oral). Data were collected between March and April 2023. A final sample of eight articles was obtained, based on the inclusion criteria adopted, with the highest number of publications identified in 2021 (n=3; 37.5%). All the results were in English, predominantly from the PubMed and Google Scholar databases. Regarding the type of facial deformity, it was observed that cleft lip and palate and chin deformity were the majority of the studies analyzed. In terms of the type of orofacial harmonization approach, hyaluronic acid injection was the most used method. Therefore, it was concluded that orofacial harmonization can assist in the rehabilitation of patients with some facial deformity, whether congenital or acquired, thus being a viable treatment option for patients with facial deformities.

The Effectiveness of a Single Hyaluronic Acid Injection in Improving Symptoms and Muscular Strength in Patients with Knee Osteoarthritis: A Multicenter, Retrospective Study.

Knee osteoarthritis (KOA) is a progressive and multifactorial disease that leads to joint pain, muscle weakness, physical disability, and decreased quality of life. In KOA, the quantity of hyaluronic acid (HA) and the molecular weight (MW) are decreased, leading to joint pain due to increased wear of the knee articular cartilage. Arthrogenic muscle inhibition, which is usually found in patients with KOA, is associated with joint inflammation, pain, and swelling, also causing muscle atrophy, primarily of the anterior thigh muscles, and hindering the rehabilitation process. The aim of our work was to determine if a single HA infiltration could minimize the effects of arthrogenic muscle inhibition in patients with KOA in the short term, using isokinetic dynamometry to evaluate the strength of the knee extensor and flexor muscles of the thigh. Thirty patients with KOA who underwent both clinical and isokinetic assessment, and that received a single injection of HA, were retrospectively included. Our results showed that a single intra-articular injection of HA significantly reduces pain and improves joint function at four weeks, while non-statistically significant improvements were observed for the reference isokinetic parameter (maximum torque) at both 90°/s and 180°/s. Further high-quality studies are necessary to confirm the results of our study.

Clinical effectiveness of polynucleotide TMJ injection compared with physiotherapy: a 3-month randomised clinical trial

Joint visco-supplementation is an effective therapeutic approach against the degenerative signs and symptoms of osteoarthrosis/osteoarthritis of the mandibular condyle. Supplements of choice are usually delivered inside the temporomandibular joint (TMJ) by intra-articular infiltration. The present study aimed to assess the clinical effectiveness of pericapsular injection of polinucleotides (PN) and hyaluronic acid (HA). Sixty patients suffering from TMJ osteoarthrosis were recruited and divided into two groups (test group: n = 30, pericapsular injection; control group: n = 30, self-delivered physiotherapeutic exercises). For each patient, maximum opening, right and left lateral excursion, and visual analogue scale (VAS) scores were recorded at four different timepoints by a blinded investigator. Paired Student’s t tests were used to compare consecutive measurements of the parameters evaluated within the groups, and unpaired Student’s t tests were used for between-group comparisons. All investigated parameters displayed a progressive clinical improvement in both groups, which was more accentuated in the test group. The decrease in VAS score differed significantly between groups (p < 0.0001). Maximum opening showed a continuous increase from baseline (mean (SD) 37.70 (8.33) mm) to T3 (39.68 (7.64) mm), reflecting a progressive improvement, but it was not statistically significant (p = 0.089 at T3 with respect to T0). PN HA pericapsular injection is a minimally invasive treatment that effectively reduces pain and improves mandibular kinematics.

Comparative study between hyaluronic acid &amp; platelet rich plasma in treatment of knee osteoarthritis

: Knee osteoarthritis (OA) is a prevalent degenerative joint condition. This study aims to compare the therapeutic potential of Hyaluronic Acid (HA) and Platelet Rich Plasma (PRP) in its management.: A comparative study was conducted with patients receiving either HA or PRP injections. Outcome measures included VAS and WOMAC scores, safety profiles, patient satisfaction, and requirement for repeat injections.: PRP-treated patients exhibited superior improvement in VAS and WOMAC scores by the 12-month mark. Adverse reactions were minimal and comparable between groups. Notably, 92% of PRP recipients expressed a willingness for repeat treatment. PRP-treated patients also showcased prolonged therapeutic benefits, with fewer requiring subsequent injections.: PRP outperforms HA in multiple domains, emphasizing its potential as a more effective treatment for knee OA.

Lubricating adhesive hyaluronate patch promotes cartilage regeneration and functional restoration in osteoarthritis

Osteoarthritis (OA) is a common chronic degenerative joint disease characterized by gradual deterioration and pain. Viscosupplementation, involving hyaluronic acid (HA) injection into the affected joint, is a minimally invasive option to reduce pain by improving joint lubrication and potentially avoiding the need for replacement surgery. However, the low adhesion and rapid degradation of HA often lead to inadequate therapeutic effects. In this study, we present lubricating adhesive HA-based hydrogel patches designed to effectively treat OA. The HA patches, modified with pyrogallol, have high elastic and compressive moduli, delaying degradation when exposed to external stimuli. Furthermore, they securely adhere to cartilage tissue surfaces and efficiently lubricate damaged cartilage, leading to a reduced friction and wear. In addition to these benefits, our HA patches exhibit scavenging effect of reactive oxygen species and sustainably release an encapsulated anti-inflammatory drug (dexamethasone: Dex). These features further enhance their therapeutic potential for OA treatment. In a mouse OA model, the hydrogel patches loaded with Dex promote healing of damaged cartilage and restore its motor function. Overall, our bioinspired HA hydrogel patches present a promising treatment option for managing the debilitating joint disease by offering enhanced adhesion, lubrication for cartilage protection, antioxidant effect, and sustained drug release.

Limited Evidence to Support the Use of Intra-Articular Injection of Hyaluronic Acid for the Management of Hallux Rigidus: A Systematic Review.

The purpose of this systematic review was to evaluate outcomes following intra-articular injection of hyaluronic acid (HA) for the treatment of hallux rigidus. During April 2024, a systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data collected and analyzed were number of patients, patient age, follow-up, subjective clinical outcomes, complications, and failures. Five studies were included. In total, 218 patients (218 feet) underwent intra-articular injection of HA at a weighted mean follow-up time of 4.4 ± 1.4 months (range, 3-6). There was an improvement in postinjection visual analog scale (VAS) pain at rest scores, VAS pain during activity scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and Foot Health Status Questionnaire (FHSQ) scores. In total, 21 complications (10.0%) were observed, the most common of which was transient postinjection pain in 20 patients (9.6%). There were 7 patients (3.2%) who underwent secondary procedures (3.2%). One randomized control trial (RCT) demonstrated no difference in outcomes between an intra-articular injection of HA compared to an intra-articular injection of saline. One RCT demonstrated superior FHSQ scores following between an intra-articular injection of HA compared to an intra-articular injection of triamcinolone acetonide. This systematic review suggests that intra-articular injection of HA for the treatment of hallux rigidus may lead to improved clinical outcomes with a low complication rate at short-term follow-up. However, the low level and quality of evidence underscores the need for further high-quality studies to be conducted to identify the precise role of HA in the treatment of hallux rigidus.

Transcutaneous oxygen tension-guided hyperbaric oxygen therapy for preventing skin necrosis after hyaluronic acid filler injections.

Hyaluronic acid (HA) fillers, popular for facial cosmetic enhancements, pose risks of vascular complications like skin necrosis due to arterial blockage, necessitating effective treatments such as hyperbaric oxygen therapy (HBOT). This study presents a series of cases where measurements of transcutaneous oxygen pressure (TcPO2) informed the application of HBOT for skin necrosis induced by HA. In cases 1 and 3, following the injection of HA, potential skin necrosis was observed. In addition to standard treatment, TcPO2 revealed values below 40mmHg, indicating tissue hypoxia. Treatment with HBOT increased TcPO2 levels to above 200mmHg, suggesting that HBOT could correct the hypoxia. Monitoring TcPO2 levels also aided in determining the optimal time to discontinue HBOT. In cases 2 and 4, patients received standard treatment, resulting in TcPO2 levels above 40mmHg, indicating adequate tissue oxygenation, and no additional HBOT was administered. All four patients mentioned above showed good clinical recovery. This study investigates the application of TcPO2 measurement technology in aiding decisions on whether to utilize HBOT in the treatment of complications arising from HA fillers, as well as in optimizing HBOT protocols.