Treatment of osteochondritis dissecans of the ankle with hyaluronic acid injections: a prospective study.

BACKGROUND: No studies have evaluated the efficacy of hyaluronic acid (HA) in reducing pain caused by osteochondritis dissecans (OCD) of the ankle. We report our initial results with this treatment. MATERIALS AND METHODS: Fifteen subjects aged 18 to 60 treated for OCD of the talus were followed for 26 weeks, in a pre- and post-treatment repeated measurements design, after receiving three weekly injections of intra-articular HA. The efficacy of HA injections in reducing pain and improving function was assessed at each visit and adverse events were recorded. Efficacy was evaluated by comparing scores determined using a Visual Analog Scale for pain, stiffness and function over time with baseline values. In addition, frequency of symptoms and global function over time were assessed using questionnaires and the AOFAS Ankle-Hindfoot Scale. Data analysis was made using ANCOVA models and paired t-tests. All statistical tests were based on an alpha level of 0.05. RESULTS: The majority of subjects were male (60%) and had Grade 3 lesions (60%). Mean VAS scores, reported on a scale from 1 (e.g., no pain) to 10 (e.g., worst pain) decreased for pain (5.6 to 3.2), stiffness (5.1 to 2.9), and function (5.9 to 3.3) from baseline to week 26. Subjective global function scores, reported on a scale from 0 to 100 (with 100 representing healthy, pre-injury function), improved on average from 57.3 at baseline to 74.3 by week 26. All of these results were statistically significant, as was the decrease in frequency of pain reported by subjects at the end of the study. CONCLUSION: OCD of the ankle treated with intra-articular injections of HA caused a decrease in pain scores and increase in global functioning over a short period of time (within 12 weeks) which then lasted for more than 6 months with minimal adverse events.

Treatment of osteoarthritis of the ankle by intra-articular injections of hyaluronic acid: a prospective study.

BACKGROUND: Treatment of osteoarthritis of the ankle is similar to that of any other large joint and includes conservative and surgical options. Surgical treatment in severe cases is fusion or joint replacement, whereas conservative treatment is limited and includes mainly ankle supports and physiotherapy. Hyaluronic acid was discovered by Meyer and Palmer in 1934 and has recently been widely used in the treatment of knee osteoarthritis. We evaluated the efficacy of an intra-articular preparation containing sodium hyaluronate in the treatment of osteoarthritis of the ankle. METHODS: We studied 16 patients aged 31 to 79 years (mean age, 43 years) with symptomatic ankle osteoarthritis of 9 months' to 27 years' duration. The radiographic severity of the ankle osteoarthritis was graded II, III, or IV according to Kellgren and Lawrence. Arthritic ankles underwent intra-articular injections of 25 mg of sodium hyaluronate for 5 consecutive weeks. Follow-up visits were performed 4, 8, 11, 17, and 32 weeks after treatment and included clinical evaluation and objective scoring. RESULTS: Global assessment showed improvement in 13 of 15 patients who completed the study. There was improvement by 20% in range of motion and a significant reduction in pain assessed by visual analog scale and ankle-hindfoot scores, all statistically significant. Seven months after treatment, no decrease in efficacy was shown. Two patients did not show any significant improvement in global assessment after treatment. One patient was dropped from follow-up owing to concurrent back surgery. CONCLUSIONS: Symptomatic relief of signs and symptoms of osteoarthritis of the ankle was achieved by injection of an intra-articular preparation containing sodium hyaluronate. There were significant improvements, in objective and subjective parameters, that lasted for more than 7 months. Ankle intra-articular injection of sodium hyaluronate is a valid conservative treatment for ankle osteoarthritis.