Hyaluronic acid was isolated in 1934 from the vitreous humor of the bovine eye, and is a non-sulfurated glycosaminoglycan (a polysaccharide of disaccharide repeats formed by Glucuronic Acid and N-Acetyl Glucosamine), which forms a fundamental part of the extracellular matrix of connective tissue (including skin, tendons and cartilage); hyaluronic acid is a very important component of the synovial fluid of the joints. Among Top Doctors’ team of medical professionals we find Dr. David López Capapé, Traumatologist and Expert in Knee Arthroscopy, Ankle Arthroscopy and Sports Traumatology, among other specialties.
Injectable hyaluronic acid: benefits of this type of treatment in traumatology.
Although hyaluronic acid may be better known for its application in aesthetic medicine treatments, hyaluronic acid injections are highly effective in rehabilitation and/or traumatology processes. Hyaluronic acid injections can be performed in a doctor’s office.
The synovial joint fluid is a non-newtonian viscous fluid, which comes from an ultrafiltrate of plasma and is rich in hyaluronic acid and lubricin. It reduces joint friction, especially during impact exercises such as jumping or running, and is involved in the absorption and transport of nutrients and other waste products, acting as a molecular filter.
In a normal knee the volume of synovial fluid is approximately 3ml to 4ml, with a hyaluronic acid content of 3-4%, over a molecular weight of about 6,000 kDa. The treatment with infiltrations of this product is very useful in trauma and rehabilitation treatments. In cases of joint mobility problems, joint infiltrations with hyaluronic acid are recommended.
In cases of osteoarthritic joints, there are alterations in the production and quality of synovial fluid, and a decrease in the concentration of hyaluronic acid, in the interactions between molecules and a lower molecular weight of hyaluronic acid has also been observed. The purpose of hyaluronic acid infiltrate treatment in patients with osteoarthritis is to restore the rheological properties of the synovial fluid in the joint and to stimulate the endogenous production of hyaluronic acid in the joint. The beneficial effects of a treatment with this product are mainly biophysical, but also biochemical and biological.
Treatment with intra-articular hyaluronic acid has been shown in numerous studies to be effective and safe; most of the cases that have been studied are osteoarthritis of the knee, but it is also used in hip, shoulder, ankle and other joints to a lesser extent.
How is a treatment with hyaluronic acid infiltrations performed?
Hyaluronic acid infiltration treatments must be prescribed by medical specialists, as other categories of healthcare personnel, such as a pharmacist, are not the type of practitioner who can prescribe them.
Intra-articular infiltration of hyaluronic acid or its derivatives is called viscosupplementation; the injections are performed by the physician after using an antiseptic and with little or no local anesthesia. Each joint has its own approach for a correct and simple infiltration, the volume of this varies from 1ml, in small joints such as the trapeziometacarpal joint of the hand, to 6ml in a single dose in the knee. The tendency is to perform single injections.
After a complete treatment, the improvement of symptoms may last between 6 months and 1 year; in a pathology such as osteoarthritis, it is normal to repeat the injections when they lose their effect. The best results with hyaluronic acid injections are obtained in moderate osteoarthritis.
The viscosupplementation treatment has been shown to delay the indication of needing a knee prosthesis, especially in patients with osteoarthritis in that same joint.