Are intra-articular injections effective against ankle osteoarthritis?

Injections of hyaluronic acid (HA), platelet-rich plasma (PRP), or botulinum toxin Type A (BoNT-A) into the joints were not shown to be effective in treating patients with ankle osteoarthritis (OA), says a recent systematic analysis by Liam Paget and colleagues. The findings of this study were published in the Clinical Orthopaedics and Related Research.

In June 2021 and January 2022, respectively, Embase, PubMed, and the Cochrane Library were used to search for randomized controlled trials on intra-articular injections for the treatment of ankle OA. The search was valid from the day each database was created through January 2022. Earlier evaluations and reference lists from qualifying papers were manually examined. Independently, two reviewers determined the eligibility of the studies. There were seven studies total. Hyaluronic acid was compared with saline in three studies, exercise in one, four different HA regimens in another, platelet-rich plasma in another, and botulinum toxin type A in another.

There were 340 patients altogether, including 141 in the HA, 48 in the PRP, 38 in the BoNT-A, and 113 in the saline groups. The average patient age throughout all trials was 52 21 years, and 35% of them (119 out of 340) were female. Through the use of the Cochrane Risk of Bias 2.0 tool, methodological quality was evaluated. The risk of bias among the included studies was low in two, raised some questions in one, and was high in four. The Grading of Recommendations Assessment, Development, and Evaluation approach determined that the level of evidence for HA, PRP, and BoNT-A was extremely low, moderate, and low respectively.

The key findings of this study were:

1. At 3, 6, or 12 months, there were no clinically significant changes between the HA, PRP, and BoNT-A groups and their control groups.

2. In either therapy group, no trials documented any major side effects.

These therapies shouldn't be utilized in practice until or until additional high-quality trials provide evidence of efficacy, given the absence of observed efficacy in this systematic review.

Reference:

Paget, L. D. A., Mokkenstorm, M. J., Tol, J. L., Kerkhoffs, G. M. M. J., & Reurink, G. (2023). What Is the Efficacy of Intra-articular Injections in the Treatment of Ankle Osteoarthritis? A Systematic Review. In Clinical Orthopaedics & Related Research: Vol. Publish Ahead of Print. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/corr.0000000000002624