Intra-articular injection of CS is perhaps the most common conservative approach in the treatment of knee OA. The aim of the present narrative review is to summarize the different mechanisms of action of the various injectables for knee OA, presenting also their clinical results and potential areas of future development. 6 In addition, advances in research have not only brought about new products to be injected but also novel techniques of injection such as subchondroplasty and intra-meniscal application.
#Fluid in knee pain series#
Autologous biologic products, according to their capability of modulating the joint environment by releasing a series of growth factors and immune-modulatory molecules, could play a beneficial role in reducing the local inflammation and promoting cartilage and synovial anabolism. 5 Conversely, there exists a more limited amount of evidence in support of the use of PRP and MSCs, due to their more recent discovery and introduction as OA treatments. CS and HA are ranked first as the most frequently injected substances and their use is supported by a large amount of literature, although some controversial findings have emerged. Among the most frequently used products we include corticosteroids (CS), hyaluronic acid (HA), polynucleotides, oxygen-ozone therapy, platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs). 4 Injections have therefore gained increasing attention thanks to their more direct effect on the target tissues and reduced side effects due to intra-articular delivery. 2 Pharmacological approaches based for example on non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol have been shown to be effective in controlling pain in OA, 3 but due to their systemic administration, they have also been associated with gastrointestinal, cardiovascular and renal adverse events, especially in patients already presenting with comorbidities. 1 Symptomatic control can be achieved through different therapeutic strategies such as lifestyle modifications, exercise therapy, pharmacological therapies and injections of various substances. The aim of OA treatment is to control symptoms until the severity of the condition mandates surgical intervention an early therapy may be a vital step for delaying the progression to end-stage disease. Osteoarthritis (OA) is a degenerative disease with a tendency to worsen over time, characterized by articular cartilage degradation, subchondral damage, and bone remodelling, most commonly affecting weight-bearing joints such as the knee and hip.
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