PMID- 34461219
OWN - NLM
STAT- MEDLINE
DCOM- 20220310
LR  - 20220311
IS  - 1526-3231 (Electronic)
IS  - 0749-8063 (Linking)
VI  - 38
IP  - 3
DP  - 2022 Mar
TI  - Estimated Time to Maximum Medical Improvement of Intra-articular Injections in 
      the Treatment of Knee Osteoarthritis-A Systematic Review.
PG  - 980-988.e4
LID - S0749-8063(21)00777-5 [pii]
LID - 10.1016/j.arthro.2021.08.026 [doi]
AB  - PURPOSE: The purpose of the current study is to perform a systematic review of 
      the literature and evaluate maximum medical improvement and minimal clinically 
      important difference (MCID) of different injectables in the treatment of 
      symptomatic knee osteoarthritis. METHODS: A systematic review was performed to 
      evaluate maximum medical improvement and MCID in patients undergoing injections 
      of different modalities for knee osteoarthritis. Demographic factors of the 
      patients being reviewed were analyzed, with patient-reported outcomes as reported 
      by visual analog scale (VAS) and Western Ontario and McMaster Universities 
      Arthritis Index (WOMAC) being used to evaluate the clinical trajectory of 
      patients receiving intra-articular injections. RESULTS: Overall, 79 (level of 
      evidence I: 79) studies met inclusion criteria, with 8761 patients. 
      Corticosteroid (CS) injections, middle molecular weight hyaluronic acid (MMW-HA), 
      and leukocyte-rich platelet rich plasma (LR-PRP) injections reached their maximum 
      pain control at 4 to 6 weeks after injection, as measured by VAS. The lowest VAS 
      scores were reached for low molecular weight hyaluronic acid (LMW-HA), high 
      molecular weight hyaluronic acid (HMW-HA), and leukocyte-poor platelet rich 
      plasma (LP-PRP) by 3 months after injection. Similarly, the WOMAC scores were 
      lowest at 4 to 6 weeks after CS and MMW-HA injections, and at 3 months after 
      HMW-HA and LP-PRP injections. LR-PRP demonstrated the most prolonged pain relief 
      relative to the other injection types, with the lowest VAS score of all groups 
      measured at final follow-up. LP-PRP showed the lowest WOMAC scores at final 
      follow-up, one year post-injection. CONCLUSION: PRP injections provide continued 
      pain relief at up to 1 year after injection. Corticosteroids and hyaluronic acid 
      have good efficacy and are suitable for many patients but lack this longevity. 
      LEVEL OF EVIDENCE: Level I, a systematic review of Level I studies.
CI  - Copyright (c) 2021 Arthroscopy Association of North America. Published by Elsevier 
      Inc. All rights reserved.
FAU - Mojica, Edward S
AU  - Mojica ES
AD  - New York University Langone Health, Department of Orthopaedic Surgery, New York, 
      New York, U.S.A.
FAU - Markus, Danielle H
AU  - Markus DH
AD  - New York University Langone Health, Department of Orthopaedic Surgery, New York, 
      New York, U.S.A.
FAU - Hurley, Eoghan T
AU  - Hurley ET
AD  - New York University Langone Health, Department of Orthopaedic Surgery, New York, 
      New York, U.S.A.. Electronic address: eoghanhurley@rcsi.ie.
FAU - Blaeser, Anna M
AU  - Blaeser AM
AD  - New York University Langone Health, Department of Orthopaedic Surgery, New York, 
      New York, U.S.A.
FAU - Jazrawi, Laith M
AU  - Jazrawi LM
AD  - New York University Langone Health, Department of Orthopaedic Surgery, New York, 
      New York, U.S.A.
FAU - Campbell, Kirk A
AU  - Campbell KA
AD  - New York University Langone Health, Department of Orthopaedic Surgery, New York, 
      New York, U.S.A.
FAU - Strauss, Eric J
AU  - Strauss EJ
AD  - New York University Langone Health, Department of Orthopaedic Surgery, New York, 
      New York, U.S.A.
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20210827
PL  - United States
TA  - Arthroscopy
JT  - Arthroscopy : the journal of arthroscopic & related surgery : official 
      publication of the Arthroscopy Association of North America and the International 
      Arthroscopy Association
JID - 8506498
RN  - 9004-61-9 (Hyaluronic Acid)
SB  - IM
MH  - Humans
MH  - Hyaluronic Acid
MH  - Injections, Intra-Articular
MH  - *Osteoarthritis, Knee/drug therapy
MH  - *Platelet-Rich Plasma
MH  - Treatment Outcome
EDAT- 2021/08/31 06:00
MHDA- 2022/03/11 06:00
CRDT- 2021/08/30 20:13
PHST- 2021/04/04 00:00 [received]
PHST- 2021/08/09 00:00 [revised]
PHST- 2021/08/11 00:00 [accepted]
PHST- 2021/08/31 06:00 [pubmed]
PHST- 2022/03/11 06:00 [medline]
PHST- 2021/08/30 20:13 [entrez]
AID - S0749-8063(21)00777-5 [pii]
AID - 10.1016/j.arthro.2021.08.026 [doi]
PST - ppublish
SO  - Arthroscopy. 2022 Mar;38(3):980-988.e4. doi: 10.1016/j.arthro.2021.08.026. Epub 
      2021 Aug 27.