Keywords
osteoarthritis
injection therapy
intra-articular injections
How to Cite
Abstract
Summary. Treatment of post-traumatic osteoarthritis (OA) of the ankle joint remains an issue of modern orthopedics. Conservative therapy may lose its effect over time or cause considerable side effects. Intra-articular injections are successfully used in the treatment of ОA in other major joints, so it has been hypothesized that they also may be effective in patients with ankle OA.
Objective: to analyze the literature devoted to injection methods of treatment of post-traumatic ankle OA.
Material and Methods. The search for publications which evaluated the effectiveness of intra-articular therapy in reducing pain and improving function in the treatment of ankle OA was conducted on PubMed databases, from 2007 to 2022. Intra-articular therapy included corticosteroids (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), mesenchymal stem cells (MSC), botulinum toxin A (BoNT-A), prolotherapy, and bone marrow aspirate.
Results. 146 publications related to intra-articular therapy in the treatment of ankle OA were found. 40 publications were selected for analysis, of which there were 11 randomized controlled studies and 4 meta-analyses; other publications were of III and IV levels of evidence. The number of literature sources related to the effectiveness of intra-articular therapy was as follows: HA – 24, CS – 3, BoNT-A – 1, PRP – 5, MSc – 1, prolotherapy – 2, and bone marrow aspirate – 1.
Conclusions. Intra-articular therapy may be effective in the treatment of post-traumatic OA of the ankle joint. However, modern literature data in this area are mostly of poor quality and consist of small sample studies. Since there are currently no studies comparing these techniques, it is difficult to determine whether one type of injection therapy should be preferred over another. This determines the need for further research, especially regarding the criteria for evaluating the effectiveness and long-term safety of these treatments.
References
Godoy-Santos AL, Fonseca LF, de Cesar Netto C, et al. Ankle Osteoarthritis. Rev Bras Ortop (Sao Paulo). 2020:29;56(6):689-696. doi: 10.1055/s-0040-1709733.
Murray CL, Marshall M, Rathod T, et al. Population prevalence and distribution of ankle pain and symptomatic radiographic ankle osteoarthritis in community-dwelling older adults. PLoS One. 2018; 13(4): e0193662. doi: 10.1371/journal.pone.0193662.
Fukawa T, Yamaguchi S, Akatsu Y, et al. Safety and efficacy of intra-articular injection of platelet-rich plasma in patients with ankle osteoarthritis. Foot Ankle Int. 2017;38(6):596-604. doi: 10.1177/1071100717700377.
Valderrabano V, Horisberger M, Russell I, et al. Etiology of ankle osteoarthritis. Clin Orthop Relat Res 2009; 467 (07) 1800-1806. doi: 10.1007/s11999-008-0543-6.
Brown TD, Johnston RC, Saltzman CL, et al. 2006. Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma 20:739–744. doi: 10.1097/01.bot.0000246468.80635.ef.
Horisberger M, Valderrabano V, Hintermann B. Posttraumatic ankle osteoarthritis after ankle-related fractures. J Orthop Trauma 2009; 23 (01) 60-67. doi: 10.1097/ BOT.0b013e31818915d9.
Herzog MM, Kerr ZY, Marshall SW, et al. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training 2019;54(6):603–610 doi: 10.4085/1062-6050447-17.
Paget LDA, Reurink G, de Vos R-J, et al. Effect of Platelet-Rich Plasma Injections vs Placebo on Ankle Symptoms and Function in Patients With Ankle Osteoarthritis: A Randomized Clinical Trial JAMA. PRIMA Study Group. 2021;26;326(16):1595-1605. doi: 10.1001/jama.2021.16602.
Carbone A., Rodeo S. Review of current understanding of post-traumatic osteoarthritis resulting from sports injuries. J Orthop Res 2017;35(3):397-405. doi: 10.1002/jor.23341.
Gribble PA, Bleakley CM, Caulfield BM, et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1496–1505. doi: 10.1136/bjsports-2016-096189.
Papalia R, Albo E, Russo F, et al. The use of hyaluronic acid in the treatment of ankle osteoarthritis: a review of the evidence J Biol Regul Homeost Agents 2017:27;31(4 Suppl 2):91-102. PMID: 29202567.
Tejero S., Prada-Chamorro E, González-Martín D, et al. Conservative Treatment of Ankle Osteoarthritis. J. Clin. Med. 2021:10;4561. doi: 10.3390/jcm10194561.
Bossert M, Boublil D, Parisaux JM, et al. Imaging guidance improves the results of viscosupplementation with HANOXM-XL in patients with ankle osteoarthritis: results of a clinical survey in 50 patients treated in daily practice. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:195-199. doi: 10.4137/CMAMD.S40401.
Migliore A, Giovannangeli F, Bizzi E, et al. Viscosupplementation in the management of ankle osteoarthritis: a review. Arch Orthop Trauma Surg. 2011;131(1):139-147. doi: 10.1007/s00402-010-1165-5.
Jantzen C, Ebskov LB, Andersen KH. The effect of a single hyaluronic acid injection in ankle arthritis: a prospective cohort study J Foot Ankle Surg. 2020;59(5):961-963. doi: 10.1053/j.jfas.2020.03.015.
Murphy EP, Curtin M, McGoldrick NP, et al. Prospective evaluation of intra-articular sodium hyaluronate injection in the Ankle J Foot Ankle Surg. 2017;56(2):327-331. doi: 10.1053/j.jfas.2016.09.017.
Lucas J, Hernandez Y, Darcel V, et al. Viscosupplementation of the ankle: a prospective study with an average follow-up of 45.5 months Orthop Traumatol Surg Res. 2013;99(5):593-9. doi: 10.1016/j.otsr.2013.02.008.
Witteveen AG, Sierevelt IN, Blankevoort L, et al. Intraarticular sodium hyaluronate injections in the osteoarthritic ankle joint: effects, safety and dose dependency. J Foot Ankle Surg. 2010;16(4):159-163. doi: 10.1016/j.fas.2009.10.003.
Sun SF, Hsu CW, Lin HS, et al. Efficacy of intraarticular botulinum toxin A and intraarticular hyaluronate plus rehabilitation exercise in patients with unilateral ankle osteoarthritis: a randomized controlled trial. J Foot Ankle Res. 2014;7(1):9. doi: 10.1186/1757-1146-7-9.
Karatosun V, Unver B, Ozden A, et al. Intra-articular hyaluronic acid compared to exercise therapy in osteoarthritis of the ankle. A prospective randomized trial with long-term follow-up. Clin Exp Rheumatol. 2008;26(2):288-294. PMID: 18565251.
Vannabouathong C, Del Fabbro G, Sales B. et al. Intraarticular Injections in the Treatment of Symptoms from Ankle Arthritis: A Systematic Review. Foot Ankle Int 2018; 39 (10) 1141-1150 doi: 10.1177/1071100718779375.
Boffa A, Previtali D, Frattura GDL, et al. Evidence on ankle injections for osteochondral lesions and osteoarthritis: a systematic review and meta-analysis. Int Orthop 2021;45(2):509-523. doi: 10.1007/s00264-020-04689-5.
Faleiro TB, Schulz Rda S, Jambeiro JE, et al. Viscosupplementation in ankle osteoarthritis: a systematic review. Acta Ortop Bras 2016;24:52–54. doi: 10.1590/1413785220162401139470.
Khlopas H, Khlopas A, Samuel LT, et al. Current Concepts in Osteoarthritis of the Ankle: Review. Surg Technol Int. 2019:25;35. PMID: 31237341.
Carpenter B, Motley T. The role of viscosupplementation in the ankle using Hylan G-F 20. J Foot Ankle Surg. 2008;47(5):377-384. doi: 10.1053/j.jfas.2008.06.013.
Monticone M, Frizziero A, Rovere G, et al. Hyaluronic acid intra-articular injection and exercise therapy: effects on pain and disability in subjects affected by lower limb joints osteoarthritis. A systematic review by the Italian Society of Physical and Rehabilitation Medicine (SIMFER) Eur J Phys Rehabil Med. 2016;52(3):389-99. PMID: 26365146.
Witteveen AG, Kok A, Sierevelt IN, et al. The optimal injection technique for the osteoarthritic ankle: a randomized, cross-over trial Foot Ankle Surg. 2013 Dec;19(4):283-8. doi: 10.1016/j.fas.2013.07.003.
Faleiro TB, Schulz RS, Jambeiro JES, et al. Viscosupplementation in ankle osteoarthritis: a systematic review. Acta Ortop Bras. 2016 Jan-Feb; 24(1): 52–54. doi: 10.1590/1413-785220162401139470.
Witteveen AG, Hofstad CJ, Kerkhoffs GM. Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle. Cochrane Database Syst Rev 2015;(10):CD010643. doi: 10.1002/14651858.CD010643.pub2.
van Dijk CN, Reilingh ML, Zengerink M, et al. Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc 2010;18:570-80. doi: 10.1007/s00167-0101064-x.
Younger ASE, Penner M, Wing K, et al. Nonanimal hyaluronic acid for the treatment of ankle osteoarthritis: a prospective, single-arm cohort study. The Journal of Foot and Ankle Surgery. 2019;58;3:514-518. doi: 10.1053/j. jfas.2018.10.003.
Henning PR, Grear BJ. Platelet-rich plasma in the foot and ankle. Curr Rev Musculoskelet Med. 2018;11(4):616–623. doi: 10.1007/s12178-018-9522-z.
Mei-Dan O, Carmont MR, Laver L, et al. Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med. 2012 Mar;40(3):534-41. doi: 10.1177/0363546511431238.
Sun S, Hsu C, Lin G, et al. Efficacy and Safety of a Single Intra-articular Injection of Platelet-rich Plasma on Pain and Physical Function in Patients With Ankle Osteoarthritis-A Prospective Study J Foot Ankle Surg. Jul-Aug 2021;60(4):676682. doi: 10.1053/j.jfas.2020.12.003.
Repetto I, Biti B, Cerruti P, et al. Conservative treatment of ankle osteoarthritis: can platelet-rich plasma effectively postpone surgery? J Foot Ankle Surg. 2017;56(2):362-365. doi: 10.1053/j.jfas.2016.11.015.
Angthong C, Khadsongkram A, Angthong W. Outcomes and quality of life after platelet-rich plasma therapy in patients with recalcitrant hindfoot and ankle diseases: a preliminary report of 12 patients. J Foot Ankle Surg. 2013;52(4):475-480. doi: 10.1053/j.jfas.2013.04.005.
Fox MG, Wright PR, Alford B, et al. Lateral mortise approach for therapeutic ankle injection: an alternative to the anteromedial approach. AJR Am J Roentgenol. 2013;200(5):10961100. doi: 10.2214/AJR.12.9227.
Ward ST, Williams PL, Purkayastha S. Intra-articular Corticosteroid Injections in the Foot and Ankle: A Prospective 1-year Follow-up Investigation. J. Foot Ankle Surg. 2008, 47, 138–144. doi: 10.1053/j.jfas.2007.12.007.
Sun S, Hsu C, Lin H, et al. Efficacy of intraarticular botulinum toxin A and intraarticular hyaluronate plus rehabilitation exercise in patients with unilateral ankle osteoarthritis: a randomized controlled trial. J Foot Ankle Res. 2014;6;7(1):9. doi: 10.1186/1757-1146-7-9.
Emadedin M, Ghorbani LM, Fazeli R, et al. Long-term follow-up of intra-articular injection of autologous mesenchymal stem cells in patients with knee, ankle, or hip osteoarthritis. Arch Iran Med. 2015;18(6):336-344. PMID: 26058927.
Chahla J, Cinque ME, Shon JM. Bone marrow aspirate concentrate for the treatment of osteochondral lesions of the talus: a systematic review of outcomes. J Exp Orthop. 2016;3(1):33. doi: 10.1186/s40634-016-0069-x.
Akpancar S, Gül D. Comparison of Platelet Rich Plasma and Prolotherapy in the Management of Osteochondral Lesions of the Talus: A Retrospective Cohort Study. Med Sci Monit. 2019;30;25:5640-5647. doi: 10.12659/MSM.914111.
Legré-Boyera V. Viscosupplementation: Techniques, indications, results Orthopaedics & Traumatology: Surgery & Research 101;2015:S101–S108. doi: 10.1016/j.otsr.2014.07.027.
Han SH, Park DY, Kim TH. Prognostic factors after intra-articular hyaluronic acid injection in ankle osteoarthritis. Yonsei Med J 2014;55:1080–1086. doi: 10.3349/ymj.2014.55.4.1080.
Mei-Dan O, Carmont M, Laver L, et al. Intra-articular injections of hyaluronic acid in osteoarthritis of the subtalar joint: a pilot study. J Foot Ankle Surg 2013;52:172–176. doi: 10.1053/j.jfas.2012.12.008.
Sun SF, Hsu CW, Sun HP, et al. The effect of three weekly intraarticular injections of hyaluronate on pain, function, and balance in patients with unilateral ankle arthritis. J Bone Joint Surg Am 2011;93:1720–1726. doi: 10.2106/ JBJS.J.00315.
Abate M, Schiavone C, Salini V. Hyaluronic acid in ankle osteoarthritis: why evidence of efficacy is still lacking? Clin Exp Rheumatol. 2012;30(2):277-81. PMID: 22338615.
Chevalier TL, Chockalingam N. Foot orthoses: a review focusing on kinematics. J Am Podiatr Med Assoc 2011; 101 (04) 341-348. doi: 10.7547/1010341.
Tezcan ME, Goker B, Lidtke R, et al. Long-term effects of lateral wedge orthotics on hip and ankle joint space widths. Gait Posture 2017; 51: 36-40. doi: 10.1016/j.gaitpost.2016.09.017.
Guney A, Akar M, Karaman I, et al. Clinical outcomes of platelet rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus. Knee surgery, sports traumatology, arthroscopy. 2015:23(8):2384–2389. doi: 10.1007/s00167-013-2784-5.
Akpancar S, Seven MM, Tuzun HY et al. Current concepts of prolotherapy in orthopedic surgery. Arch Trauma Res. 2017; 6(2): e40447.
This work is licensed under a Creative Commons Attribution 4.0 International License.