Br J Sports Med 50:84-92 doi:10.1136/bjsports-2015-095683
  • Consensus statement

AMSSM scientific statement concerning viscosupplementation injections for knee osteoarthritis: importance for individual patient outcomes

Editor's Choice
  1. Craig I Coleman6
  1. 1Community and Preventive Medicine, Lead Physician Drexel Athletics, Philadelphia, Pennsylvania, USA
  2. 2Department of Orthopedics and Sports Medicine, St Jude Medical Center, Fullerton, California, USA
  3. 3Department of Orthopaedic Surgery, The Cleveland Clinic, Cleveland, Ohio, USA
  4. 4Maine Medical Center Sports Medicine, Portland, Maine, USA
  5. 5UCONN School of Pharmacy, Hartford Hospital Evidence-Based Practice Center, Portland, Maine, USA
  6. 6Hartford Hospital Evidence-Based Practice Center, Portland, Maine, USA
  1. Correspondence to Dr Thomas H Trojian, College of Medicine, Drexel University, Philadelphia, PA 19127, USA; thomas.trojian{at}
  • Accepted 19 October 2015


Osteoarthritis (OA) is a disabling disease that produces severe morbidity reducing physical activity. Our position statement on treatment of knee OA with viscosupplementation injection (hyaluronic acid, HA) versus steroid (intra-articular corticosteroids, IAS) and placebo (intra-articular placebo, IAP) is based on the evaluation of treatment effect by examining the number of participants within a treatment arm who met the Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) criteria, which is different and more relevant than methods used in other reviews which examined if the average change across the treatment groups were clinically different. We performed a systematic literature search for all relevant articles from 1960 to August 2014 in the MEDLINE, EMBASE and Cochrane CENTRAL. We performed a network meta-analysis (NMA) of the relevant literature to determine if there is a benefit from HA as compared with IAS and IAP. 11 papers met the inclusion criteria from the search strategy. On NMA, those participants receiving HA were 15% and 11% more likely to respond to treatment by OMERACT-OARSI criteria than those receiving IAS or IAP, respectively (p<0.05 for both). In the light of the aforementioned results of our NMA, the American Medical Society for Sport Medicine recommends the use of HA for the appropriate patients with knee OA.