Hyaluronic acid injections are a therapeutic intervention designed to reduce pain and improve joint function in individuals with osteoarthritis. This condition, characterized by the degeneration of cartilage and synovial fluid, often leads to painful friction within the joint. HA injections aim to replenish the natural HA in the synovial fluid, restoring lubrication and cushioning to the joint.

While traditionally used for knee osteoarthritis, HA injections have proven effective for other joints, including the hip, hand, and foot. This broader application has been particularly beneficial for patients with osteoarthritis in these areas, where other treatment options might be limited or ineffective.

Hyaluronic acid’s role as a chondroprotector—substances that protect cartilage from degradation—is central to its effectiveness in treating osteoarthritis. HA works through several mechanisms to protect and repair cartilage:

• Lubrication: HA increases the viscosity of the synovial fluid, which enhances its lubricating properties and reduces friction between the cartilage surfaces.
• Anti-inflammatory Effects: HA inhibits the production of inflammatory mediators within the joint, thereby reducing pain and slowing the progression of osteoarthritis.
• Matrix Formation: HA promotes the formation of an extracellular matrix, providing a scaffold that supports the growth and repair of cartilage cells.
• Cellular Signaling: HA interacts with cellular receptors in the joint, stimulating the production of new cartilage and reducing the activity of enzymes that break down existing cartilage.

These chondroprotective effects make HA injections a valuable option not only for managing symptoms but also for potentially slowing the progression of osteoarthritis.

One of the latest advancements in HA therapy is the introduction of Sportvis, a new HA injectable specifically designed for treating musculoskeletal injuries, including acute and chronic tendon and ligament conditions.

Sportvis is officially indicated for use in the treatment of chronic Tennis elbow (lateral epicondylitis) and acute ankle sprain, but its off-label use has shown promise in managing sports injuries and inflammation of tendons and ligaments, including the elbow, knee, foot, hand, and shoulder.

Sportvis works by enhancing the viscoelastic properties of the synovial fluid and by restoring the function of damaged tendons with a focus on sports-related injuries and conditions. This dual functionality makes it an attractive option for both athletes and non-athletes suffering from soft tissue injuries and pain.

Recent studies have highlighted the effectiveness of Platelet-Rich Plasma (PRP) in treating osteoarthritis, often showing superior results compared to HA injections. PRP, which is derived from the patient’s blood, contains a high concentration of growth factors that promote the healing and regeneration of damaged tissues.

Research indicates that PRP injections provide better overall pain relief and improved joint function compared to HA, particularly over longer follow-up periods. For instance, a study by Sdeek et al. (2021) found that PRP offered significantly better pain relief and quality of life for patients with knee osteoarthritis after 36 months of treatment compared to HA. However, HA injections were found to be more beneficial for older adults, particularly those who may not be candidates for PRP therapy.

Combining PRP with HA has emerged as an even more effective treatment approach. This combination leverages the chondroprotective properties of HA and the regenerative effects of PRP, providing enhanced pain relief, improved joint function, and potentially longer-lasting results.

Hyaluronic acid injections work by altering the homeostasis within the joint, increasing the volume of synovial fluid, and improving its lubricating properties. This reduces friction, protects cartilage from further damage, and can even help in the regeneration of cartilage in mild to moderate cases of osteoarthritis. The matrix-forming capability of HA, where it acts as a scaffold for new cells, is particularly beneficial in promoting healing and maintaining the health of the joint.

In addition to these benefits, HA also has anti-inflammatory properties that can reduce pain and swelling in the joint, contributing to an overall improvement in joint function and quality of life.

Hyaluronic acid injections are primarily used in the treatment of musculoskeletal conditions, particularly those involving the joints. The key musculoskeletal applications of HA include:

• Osteoarthritis: HA injections are most commonly used to manage osteoarthritis, particularly in the knee, but are also effective in the hip, hand, and foot joints. By restoring the viscosity of the synovial fluid, HA reduces pain, improves mobility, and may help slow the progression of the disease.
• Tendinopathies: Sportvis, a new HA product, is specifically indicated for treating tendinopathies, conditions characterized by chronic tendon pain and degeneration. It provides cushioning and reduces friction around tendons, facilitating healing and reducing pain.
• Chronic Joint Pain: In addition to osteoarthritis, HA injections can be used to manage chronic joint pain in various joints, providing long-term relief and improving joint function.
• Post-Traumatic Joint Disorders: HA can be beneficial for joints that have been damaged due to injury, helping to restore normal function and reduce pain through its lubricating and anti-inflammatory properties.

The introduction of Sportvis has further expanded the scope of HA therapy, offering new hope for patients with musculoskeletal conditions, particularly those involving ligament and tendon pathology

While hyaluronic acid injections are generally considered safe, they do carry some risks and potential side effects, particularly when administered into joints affected by osteoarthritis. Patients considering HA injections should be aware of the following:

• Injection Site Reactions: Common side effects include pain, swelling, redness, and bruising at the injection site. These reactions are typically mild and resolve within a few days.
• Allergic Reactions: Although rare, some patients may experience an allergic reaction to the hyaluronic acid preparation, particularly if it contains animal-derived components or bacterial proteins. Symptoms may include rash, itching, and in severe cases, anaphylaxis.
• Infection: Any injection carries a risk of infection, which can be serious if not promptly treated. Sterile techniques and proper care of the injection site can minimize this risk.
• Tissue Necrosis: A rare but serious complication, tissue necrosis can occur if the HA is accidentally injected into a blood vessel, leading to a blockage that deprives the surrounding tissue of oxygen. This can be treated with hyaluronidase, an enzyme that breaks down hyaluronic acid.
• Triggering of Herpes Labialis (Cold Sores): Patients with a history of cold sores may experience a recurrence following HA injections, particularly if the injection is near the mouth area.
• Granulomatous Foreign Body Reaction: In some cases, the body may recognize HA as a foreign substance, leading to the formation of a granuloma, a mass of immune cells that can cause swelling and discomfort.
• Angioedema: This is a rare but serious allergic reaction that involves swelling beneath the skin, particularly around the eyes and lips.
• Muscle Cramps and Nausea: Some patients report muscle cramps or nausea following HA injections, though these symptoms are generally mild and temporary.

Hyaluronic acid injections continue to play a crucial role in the management of osteoarthritis, particularly in joints like the knee, hip, hand, and foot. With new advancements such as Sportvis and the growing evidence supporting the combination of HA and PRP, patients have more options than ever for managing their joint pain and improving their quality of life.

As research continues to evolve, HA injections are likely to remain a cornerstone of osteoarthritis treatment, offering both symptomatic relief and long-term protection for joint health.

Pamuk, Ç. “Comparison of Intra-articular Hyaluronic Acid and Platelet-Rich Plasma Injection in Knee Osteoarthritis: Do the Results Differ in Geriatric Patients?” Annals of Geriatric Medicine and Research, vol. 26, no. 4, 2022, pp. 340-346.

Sdeek, M., et al. “Intra-articular injection of Platelet-rich plasma versus Hyaluronic acid for moderate knee osteoarthritis.” Acta Orthopaedica Belgica, vol. 87, no. 4, 2021, pp. 729-734.

Sportvis Product Information

Tashiro, T., et al. “Chondroprotective effects of hyaluronic acid.” Osteoarthritis and Cartilage, vol. 25, no. 8, 2016, pp. 1235-1243.