# Viscosupplementation in the Therapy for Osteoarthritic Knee
## 2 Hyaluronic Acid
\begin{table}
\begin{tabular}{c c c c} \hline \hline
**Publication Year [Ref.]** & **Study Design** & **Pro/Cons** & **Result** \\ \hline
2006 [35] & Systemic review & pro & 5 to 13 weeks post injection period which showed improvement for pain and function. Comparable efficacy was noted against NSAIDs and longer-term benefits were noted in comparisons against IA CS \\ \hline
2010 [36] & Systemic review & pro & HA is more effective than the placebo group without major side effects. It is similar to CS in terms of effect. \\ \hline
2011 [37] & Meta-analysis & pro & IA HA is efficacious by 4 weeks, reaches its peak effectiveness at 8 weeks and exerts a residual detectable at 24 weeks. \\ \hline
2015 [38] & Meta-analysis & pro &
\begin{tabular}{c} Acetaminophen, diclofenac, ibuprofen, naproxen, celecoxib, IA CS, IA HA, oral \& IA placebo. \\ Comparing 2 or more; most efficacious treatment is IA HA, the least efficacious treatment is acetaminophen \\ \end{tabular} \\ \hline
2015 [39] & Systemic review & pro &
\begin{tabular}{c} ESCEO 2014 \\ Short-term weekly HA injections are effective for up to 6 months. \\ \end{tabular} \\ \hline
2015 [40] & Meta-analysis & pro &
\begin{tabular}{c} IA HA vs. NSAIDs, IA CSs, IA PRP, or IA placebo; \\ The current highest level of evidence suggests that IA HA is a viable option for knee OA. \\ \end{tabular} \\ \hline
2015 [41] & Meta-analysis & pro & IA HA vs. IA placebo; \\ \hline
2017 [42] & Systemic review & pro &
\begin{tabular}{c} IA HA is safe and efficacious through 26 weeks in patients with symptomatic knee OA. \\ \end{tabular} \\ \hline
2018 [43] & Meta-analysis & pro &
\begin{tabular}{c} IA-HA vs. IA CS \\ Both HA and CS injections were effective therapies for patients with knee OA. \\ \end{tabular} \\ \hline
2019 [44] & Meta-analysis & pro &
\begin{tabular}{c} IA HA provides a moderate symptomatic benefit to knee OA patients and without major safety concerns \\ \end{tabular} \\ \hline
2019 [45] & Systemic review & pro &
\begin{tabular}{c} OARSI guideline (2019) \\ In the absence of comorbidity, the recommendation level is 2, and in the presence of cardiovascular and gastrointestinal comorbidity, the recommendation level is 1B. \\ \end{tabular} \\ \hline
2019 [46] & Meta-analysis & pro &
\begin{tabular}{c} Efficacy of IA HA: early-moderate OA vs. end-stage OA \\ Regardless of OA stage, IA HA provided significant pain relief compared to the saline group, but the level of pain relief was lower in end-stage OA patients. \\ \end{tabular} \\ \hline
2019 [47] & Systemic review & pro &
\begin{tabular}{c} ESCEO 2019 \\ Weak recommendation to the use of IAHA in patients who have contraindications to NSAIDs, or if the patient is still symptomatic despite the use of NSAIDs. \\ \end{tabular} \\ \hline
2020 [48] & Meta-analysis & pro &
\begin{tabular}{c} Six months of treatment IA and the combination of IA HA and triamcinolone \\ improve pain and/or physical function in patients suffering from knee OA. \\ \end{tabular} \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Review articles evaluating the efficacy of intra-articular hyaluronic acid (IA HA) in knee osteoarthritis.