Effects of Early Viscosupplementation After Arthroscopic Partial Meniscectomy

G, Di Matteo B, Francesco T, Cavicchioli A, Di Martino A, Lo Presti M, Iacono
F, Kon E, & Marcacci M. Am J Sports
. 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. 

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

by: Nicole Cattano
by: Jeffrey Driban


Do Hyaluronic Acid Injection Reduce Biomarkers of Collagen Degradation?

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