Hyaluronic Acid Injection
• Hyaluronic acid (HA) is a naturally occurring substance (glycosaminoglycan) found in the synovial fluid surrounding joints.
• Acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads.
• Increases mechanical and viscoelastic properties of the synovial fluid in the affected region and increasing overall joint lubrication
• Patients with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints.
• Adding hyaluronic acid to the arthritic joint will facilitate movement and reduce pain.
• Hyaluronic acid has shown inconsistent effects on inflammation
Outcomes of Hyaluronic Acid Injection
• Some patients will not be helped by visco–supplementation
• May take several weeks to notice an improvement.
• HA effectiveness typically last 6 months to 1 year
• Treatment can be repeated every 6 months.
• Hyaluronic Acid alone has never been shown to reverse the arthritic process or re-grow cartilage.
• Most effective for osteoarthritis in its early stages (mild to moderate).
Benefits of Combining Hyaluronic Acid with PRP Therapy
PRP can be combined with Hyaluronic Acid to effectively treat conditions affecting the joint such as osteoarthritis. PRP involves modulation of the intra-articular environment by introducing autologous platelets and growth factors in the joint, which can lead to reduced inflammatory distress and promote chondrogenesis. Multiple studies have shown the antinociceptive and cell-proliferative properties of PRP to be effective inhibitors of the osteoarthritis process.
• Increases cell resistance to anti-oxidative stress thereby reducing loss of chondrocytes and mesenchymal stem cells (MSCs) (Miki et al., 2010; Sánchez et al., 2016).
• Reduces the production of extra cellular matrix (ECM) degrading enzymes such as matrix metalloproteinases (Satin et al., 2019; Sundman et al., 2014; Wang et al., 2015; Yang et al., 2016).
• Combination of PRP and HA has an additive effect and reduced expression of enzymes that contribute to the breakdown of the cartilage ECM (Satin et al., 2019).
• Generates a temporary fibrin scaffold at the injection site that attracts cells needed for the regeneration process.
• Combination of PRP and HA may result in a more stable scaffold that allows the controlled or enhanced release of growth factors into the surrounding milieu, as well as binding extracellular matrix proteins such as fibronectin, and the migration of cells needed for cartilage repair (Andia and Abate, 2014; Lio et al., 2016; Martino et al., 2013).
• Increase production of proteins needed for cartilage repair, such as proteoglycan, collagen type II, and aggrecan, which is a key component of the articular ECM as it provides cartilage with its load bearing properties (Satin et al., 2019[…]”