AAC releases new guidance on Intra-articular injections for knee osteoarthritis

Written by Hina Zahid Published On 2019-09-16T19:00:38+05:30 | Updated On 16 Sept 2019 7:00 PM IST

Arthroscopy Association of Canada has released a position statement on Intra-articular Injections for Knee osteoarthritis. A key component of nonoperative strategies is intra-articular injections. The injections available in Canada include corticosteroids, hyaluronic acid (HA), platelet-rich plasma (PRP), and cellular-based therapies, including bone marrow aspirate concentrate (BMAC). In light of emerging evidence, the AAC endeavoured to synthesize the most relevant and up-to-date data pertaining to the use of these agents in the treatment of knee OA.

Following are the major recommendations:

Corticosteroids

Recommendation: Intra-articular corticosteroid injections provide short-term, moderate pain relief and the restoration of function and offer a cost-effective treatment option in patients with early knee OA. Strength of recommendation: Good – A

Hyaluronic Acid

Recommendation: Intra-articular injections of HMW HA provide improved pain relief and the restoration of function compared with placebo and can be considered in patients with mild to moderate knee OA. Strength of recommendation: Good – A

Platelet-Rich Plasma

Recommendation: Platelet-Rich Plasma injection has the potential to provide improvements in pain and functional outcomes up to 1 year after the injection in patients with mild to moderate knee OA. Evidence of efficacy in advanced OA is lacking. Given the heterogeneity of the evidence as well as the lack of consensus on the ideal PRP preparation method and composition, we cannot recommend for or against the use of PRP until further high-quality clinical studies become available. Strength of recommendation: Cf

Cellular-Based Therapies: BMAC

Recommendation: There is insufficient evidence to support the use of MSCs or BMAC in the treatment of knee OA. As such, MSC and BMAC injections should be limited to registered controlled trials, and we cannot recommend their use in routine clinical practice until further evidence becomes available. Strength of recommendation: Insufficient – I

Combination Therapies

Recommendation: (1) Intra-articular injections of combined HA and corticosteroids in the setting of knee OA can provide significant improvement in pain outcomes and may provide a more rapid onset and longer duration of action than either therapy alone. Strength of recommendation: Fair – B

(2) There is insufficient evidence to support other combinations of intra-articular injection therapy. Strength of recommendation: Insufficient – I

For more details click on the link: https://doi.org/10.1177/2325967119860110

Cellular-based therapiesCombination TherapiescytokinesFood and Drug AdministrationHA concentrationhyaluronic acidIntra-articular InjectionsKnee OsteoarthritislymphocytesMesenchymal Stem Cellsmethylprednisoloneplatelet-rich plasmasynovial fluidSynthetic corticosteroidstriamcinolone

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Hina Zahid