Intraarticular viscosupplementation following arthroscopic anterior cruciate ligament reconstruction: A systematic review

Sujit Kumar Tripathy; Paulson Varghese; Hrudeswar Behera; Raghavendra Balagod; P Bhaskar Rao; Alok Kumar Sahoo; Aparajita Panda

doi:10.1016/j.jcot.2022.101847

Intraarticular viscosupplementation following arthroscopic anterior cruciate ligament reconstruction: A systematic review

J Clin Orthop Trauma. 2022 Mar 26:28:101847. doi: 10.1016/j.jcot.2022.101847. eCollection 2022 May.

Authors

Sujit Kumar Tripathy¹, Paulson Varghese¹, Hrudeswar Behera¹, Raghavendra Balagod¹, P Bhaskar Rao², Alok Kumar Sahoo², Aparajita Panda²

Affiliations

¹ Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India.
² Dept. of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India.

Abstract

Background: Pain, swelling and joint stiffness are the major problems following arthroscopic ACL reconstruction (ACLR) surgery that restrict early return to sports and athletic activities. The patients often receive prolonged analgesic medications to control the inflammatory response and resume the pre-injury activities. This systematic review aims to evaluate the safety and efficacy of intraarticular (IA) hyaluronic acid (HA) injection following ACLR.

Material and methods: A literature search of electronic databases and a manual search of studies reporting clinical effectiveness of IA HA following ACLR was performed on 1^st November 2020. The quality of the methodology and risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool and Newcastle-Ottawa scale for randomized-controlled trial and prospective cohort studies, respectively.

Results: Of 324 studies retrieved, four studies (3 RCTs and one prospective cohort study) were found to be suitable for inclusion in this review. These studies had a low to moderate risk of bias. There were 182 patients in the HA group and 121 patients in the control group. The demographic characteristics of the patients were similar in all studies. The pooled analysis of studies evaluating pain at different follow up periods (2-week, 4-6 weeks, 8-12 weeks) after ACLR revealed no significant difference between the HA and control groups (p > 0.05). The knee swelling was significantly less in the HA group at two weeks (MD -7.85, 95% CI: [-15.03, -0.68], p = 0.03, I2 = 0%), but no such difference was noted after 4-6 weeks and 8-12 weeks. The functional outcome score was not significantly different between the groups (SMD 0.00, 95% CI: 0.38 to 0.38, p = 0.99, I² = 0%).

Conclusions: Although the individual study demonstrated a short-term positive response regarding pain control and swelling reduction, the pooled analysis did not find any clinical benefit of IA HA injection following ACLR surgery.

Level of evidence: II.

Keywords: ACL; Arthroscopy; Biologic therapy; Functional outcome; Hyaluronate; Knee; Postoperative pain; Viscosupplementation.

Publication types

Review