J Korean Foot Ankle Soc.  2022 Jun;26(2):71-77. 10.14193/jkfas.2022.26.2.71.

The Efficacy of Intra-Articular Hyaluronic Acid Injections in Ankle Osteoarthritis

• Park CH
• Park JJ
• Seok HG
• Woo IH

• KMID: 2530486
• DOI: http://doi.org/10.14193/jkfas.2022.26.2.71

Abstract

Purpose
This study sought to investigate the appropriate indications for intra-articular injection of hyaluronic acid in ankle osteoarthritis, its efficacy at each stage of osteoarthritis and to compare the efficacy related differences at each stage.
Materials and Methods
A retrospective study was conducted from January 2016 to September 2019 on 43 patients (50 cases) diagnosed with ankle arthritis and given intra-articular injection of hyaluronic acid. Patients were classified according to the modified Takakura ankle osteoarthritis stages. Stage 2 comprised 24 cases; stage 3A, 15 cases; stage 3B, 8 cases; and stage 4, 3 cases. The clinical evaluation was carried out using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Foot and Ankle Outcome Score (FAOS). The patients’ satisfaction with the injection was evaluated at 1 year after injection. A radiographic evaluation was performed to gauge the progression of osteoarthritis before and after the injection.
Results
The VAS, AOFAS score, and FAOS at 3 months and 1 year after injection showed statistically significant improvements compared to those before the injection. There was a significant difference in the VAS for each stage over time; however, this was not the case with the AOFAS score and the FAOS. A significant improvement of the VAS after injection was seen only in stage 3A when compared with the other stages. The overall satisfaction rate with the injection was 90%. There were no ankle osteoarthritic stage changes in the serial follow-up radiograph.
Conclusion
Intra-articular injection of hyaluronic acid resulted in a significant clinical improvement up to 1 year after the injection. Therefore, the intra-articular injection of hyaluronic acid could be a treatment option for ankle osteoarthritis.

Keyword

Ankle; Osteoarthritis; Hyaluronic acid; Injections

Figure

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  Figure. 1 Intra-articular injection was performed using the medial site of the tibialis tendon as the anterior medial portal of the ankle arthroscopy.

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  Figure. 2 Graph showing the sequential change of the visual analogue scale (VAS) after injection over time in each stage of ankle osteoarthritis (mean value and standard deviation at each time point shown; *p<0.05 in VAS between before injection and 3 months after injection, and †p<0.05 in VAS between before injection and 1 year after injection).

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  Figure. 3 Graph showing the sequential change of the American Orthopaedic Foot and Ankle Society (AOFAS) score after injection over time in each stage of ankle osteoarthritis (mean value and standard deviation at each time point shown; *p<0.05 in AOFAS score between before injection and 3 months after injection, and †p<0.05 in AOFAS score between before injection and 1 year after injection).

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  Figure. 4 Graph showing the sequential change of the Foot and Ankle Outcome Score (FAOS) after injection over time in each stage of ankle osteoarthritis (mean value and standard deviation at each time point shown; *p<0.05 in FAOS between before injection and 3 months after injection, and †p<0.05 in FAOS between before injection and 1 year after injection).

Reference

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