Sports Medicine Research: In the Lab & In the Field: Debating Early Viscosupplementation (Sports Med Res)
Wednesday, January 4, 2017

Debating Early Viscosupplementation

No Effects of Early Viscosupplementation After Arthroscopic Partial Meniscectomy

Filardo G, Di Matteo B, Francesco T, Cavicchioli A, Di Martino A, Lo Presti M, Iacono F, Kon E, & Marcacci M. Am J Sports Med. 2016; 44:3119-3125. doi: 10.1177/0363546516660070

Take Home Message: Viscosupplementation at the time of partial meniscectomy failed to provide better outcomes than surgery alone. 

Some clinicians believe that viscosupplementation injections may be best for patients with early-stage osteoarthritis – before many structural changes occur.  An ideal time to intervene may be after a knee injury when the injection could alter biochemical conditions after an injury or surgery, which may result in a better recovery.  Therefore, the authors of this randomized clinical trial investigated the effects of viscosupplementation on pain and function in patients after a partial meniscectomy for a degenerative meniscus tear.  Ninety participants with a partial meniscectomy (18 to 55 years of age) who did not have any cartilage defects were randomized to receive surgery alone or surgery WITH one viscosupplementation injection immediately post-surgery.  The participants were unaware which group they were in.  Researchers assessed pain and function of the participants at 5 time points (baseline, 15 days, 30 days, 60 days, and 180 days post-surgery) with patient-reported outcomes for physical activity and knee-related symptoms and clinical measure (i.e., knee circumference and range of motion measurements).  The authors found no differences between groups for any of the outcome variables. 

These findings are interesting because it shows that early viscosupplementation failed to improve short-term recovery.  Viscosupplementation is thought to have an anti-inflammatory effect within the joint.  Unfortunately, the authors did not test the anti-inflammatory effects with blood or synovial fluid samples. It would be beneficial to know if the treatments had the desired biochemical effects. It would be interesting to know if participants in both groups consumed over-the-counter anti-inflammatory medication or other supplements and if this had any effect on the outcomes of the study.  Another reason for the lack of effect is that viscosupplementation is often done in a series of injections, rather than a single injection.  Hence, it remains unknown if repeated injections after surgery would be beneficial.  This is one of the first studies to investigate the effects of early viscosupplementation on short-term recovery. It would be interesting to continue to follow these participants to see if there are any long-term differences in osteoarthritis onset or progression.  It appears that early viscosupplementation via one injection failed to aid in recovery. Clinicians should advise patients of the possible risks and benefits of these injections when helping them to decide their next course of clinical action. 

Questions for Discussion:  Have you had any patients who have had success with viscosupplementation?  What are your thoughts on possible early supplementation or interventions for osteoarthritis?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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Filardo, G., Di Matteo, B., Tentoni, F., Cavicchioli, A., Di Martino, A., Lo Presti, M., Iacono, F., Kon, E., & Marcacci, M. (2016). No Effects of Early Viscosupplementation After Arthroscopic Partial Meniscectomy: A Randomized Controlled Trial The American Journal of Sports Medicine, 44 (12), 3119-3125 DOI: 10.1177/0363546516660070

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