CoChat
Sign Up
Cited by 717Osteoarthritis Treatment and MechanismsMusculoskeletal pain and rehabilitationProteoglycans and glycosaminoglycans research

The DOI matches its Crossref record; 7 of the 7 references it cites were found in a registry or an index.

Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review and Meta-analysis

Open access
Rutjes, Anne W.S., Jüni, Peter, da Costa, Bruno R., Trelle, Sven, Nüesch, Eveline, Reichenbach, Stephan·2012·Annals of Internal Medicine
DOI 10.7326/0003-4819-157-3-201208070-00473
Open this paper in CoChat — free account

Abstract

BACKGROUND: Viscosupplementation, the intra-articular injection of hyaluronic acid, is widely used for symptomatic knee osteoarthritis. PURPOSE: To assess the benefits and risks of viscosupplementation for adults with symptomatic knee osteoarthritis. DATA SOURCES: MEDLINE (1966 to January 2012), EMBASE (1980 to January 2012), the Cochrane Central Register of Controlled Trials (1970 to January 2012), and other sources. STUDY SELECTION: Randomized trials in any language that compared viscosupplementation with sham or nonintervention control in adults with knee osteoarthritis. DATA EXTRACTION: Primary outcomes were pain intensity and flare-ups. Secondary outcomes included function and serious adverse events. Reviewers used duplicate abstractions, assessed study quality, pooled data by using a random-effects model, examined funnel plots, and explored heterogeneity by using meta-regression. DATA SYNTHESIS: Eighty-nine trials involving 12 667 adults met inclusion criteria. Sixty-eight had a sham control, 40 had a follow-up duration greater than 3 months, and 22 used cross-linked forms of hyaluronic acid. Overall, 71 trials (9617 patients) showed that viscosupplementation moderately reduced pain (effect size, -0.37 [95% CI, -0.46 to -0.28]). There was important between-trial heterogeneity and an asymmetrical funnel plot: Trial size, blinded outcome assessment, and publication status were associated with effect size. Five unpublished trials (1149 patients) showed an effect size of -0.03 (CI, -0.14 to 0.09). Eighteen large trials with blinded outcome assessment (5094 patients) showed a clinically irrelevant effect size of -0.11 (CI, -0.18 to -0.04). Six trials (811 patients) showed that viscosupplementation increased, although not statistically significantly, the risk for flare-ups (relative risk, 1.51 [CI, 0.84 to 2.72]). Fourteen trials (3667 patients) showed that viscosupplementation increased the risk for serious adverse events (relative risk, 1.41 [CI, 1.02 to 1.97]). LIMITATIONS: Trial quality was generally low. Safety data were often not reported. CONCLUSION: In patients with knee osteoarthritis, viscosupplementation is associated with a small and clinically irrelevant benefit and an increased risk for serious adverse events. PRIMARY FUNDING SOURCE: Arco Foundation.

Overview

Integrity signals

Registry

Crossref · 10.7326/0003-4819-157-3-201208070-00473

Cites

7 of 7 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Flagged first, then by citations

Show all 7 references

Research works printed but not linked: 111

  1. 10.1093/oxfordjournals.aje.a117469 · DOI
  2. 10.1136/bmj.c7086 · DOI
  3. 10.1002/1529-0131(200006)43:6<1192::AID-ANR2>3.0.CO;2-L · DOI
  4. Balazs EA, 1993, J Rheumatol Suppl, 39, 3
  5. 10.1016/j.joca.2007.01.022 · DOI
  6. Rutjes AW, 2009, Cochrane Database Syst Rev, CD002823
  7. 10.1016/S1063-4584(05)80101-3 · DOI
  8. 10.1016/j.joca.2004.02.001 · DOI
  9. 10.1016/j.berh.2006.05.002 · DOI
  10. 10.7326/0003-4819-146-8-200704170-00009 · DOI
  11. 10.1002/art.23103 · DOI
  12. 10.1136/bmj.c4675 · DOI
  13. Angst F, 2002, J Rheumatol, 29, 131
  14. 10.1002/1529-0131(200108)45:4<384::AID-ART352>3.0.CO;2-0 · DOI
  15. 10.1053/joca.1999.0246 · DOI
  16. 10.1016/j.ejpain.2003.09.004 · DOI
  17. 10.1136/bmj.b2981 · DOI · Paper page
  18. 10.1177/1536867X0800800206 · DOI
  19. 10.1016/S0140-6736(05)67177-2 · DOI
  20. 10.1136/bmj.315.7109.629 · DOI · Paper page
  21. 10.1002/(SICI)1097-0258(19991030)18:20<2693::AID-SIM235>3.0.CO;2-V · DOI
  22. 10.1002/sim.1815 · DOI
  23. 1974, Pathol Biol (Paris), 22, 731
  24. 10.1016/0049-0172(81)90081-0 · DOI
  25. 10.3999/jscpt.14.545 · DOI
  26. Shichikawa K, 1983, Ryumachi, 23, 280
  27. Bragantini A, 1987, Clin Trials J, 24, 333
  28. Grecomoro G, 1987, Pharmatherapeutica, 5, 137
  29. 10.1185/03007998809114237 · DOI
  30. Ghirardini M, 1990, Reumatismo, 42, 132
  31. Russell IJ, 1992, Arthritis Rheum, 35, S132, 10.1002/art.1780350509 · DOI
  32. 10.1016/S1063-4584(05)80024-X · DOI
  33. Isdale AH, 1993, Br J Rheumatol, 32, 61
  34. Moreland LW, 1993, Arthritis Rheum, 36, 165, 10.1002/art.1780360304 · DOI
  35. 10.1016/S1063-4584(05)80281-X · DOI
  36. 10.1016/S1063-4584(05)80329-2 · DOI
  37. Cohen MA, 1994, Arthritis Rheum, 37, R31, 10.1002/art.1780371124 · DOI
  38. 10.1016/S1063-4584(05)80063-9 · DOI
  39. 10.1136/ard.53.8.529 · DOI
  40. 10.1016/S0011-393X(05)80166-3 · DOI
  41. 10.1016/S1063-4584(05)80013-5 · DOI
  42. Carrabba M, 1995, Eur J Rheumatol Inflamm, 15, 25
  43. Corrado EM, 1995, Eur J Rheumatol Inflamm, 15, 47
  44. Formiguera Sala S, 1995, Eur J Rheumatol Inflamm, 15, 33
  45. 10.1136/ard.55.7.424 · DOI
  46. Graf von der Schulenburg JM, 1997, Rheumatol Eur, 26, 191
  47. 10.1016/S1063-4584(97)80010-6 · DOI
  48. 10.1055/s-2008-1039399 · DOI
  49. Wu JJ, 1997, Zhonghua Yi Xue Za Zhi (Taipei), 59, 99
  50. Altman RD, 1998, J Rheumatol, 25, 2203
  51. 10.1016/S0149-2918(98)80052-0 · DOI
  52. 10.1093/rheumatology/38.7.602 · DOI
  53. 10.1016/S0003-9993(00)90041-8 · DOI
  54. Renklitepe N, 2000, Ann Rheum Dis, 59, 142
  55. Ardiç F, 2001, Ann Rheum Dis, 60, 232, 10.1136/annrheumdis-2001.450 · DOI
  56. Bunyaratavej N, 2001, J Med Assoc Thai, 84, S576
  57. Caracuel MA, 2001, Ann Rheum Dis, 60, 236, 10.1136/annrheumdis-2001.466 · DOI
  58. Dickson DJ, 2001, J Clin Research, 4, 41
  59. Groppa LG, 2001, Ann Rheum Dis, 60, 230
  60. Tamir E, 2001, Clin Exp Rheumatol, 19, 265
  61. Bütün B, 2002, Romatizma, 17, 31
  62. 10.1093/rheumatology/41.11.1240 · DOI
  63. 10.1053/joca.2002.0815 · DOI
  64. 10.1001/archinte.162.3.292 · DOI
  65. 10.1053/joca.2002.0798 · DOI
  66. Saravanan V, 2002, Rheumatology, 41, 121, 10.1093/rheumatology/41.2.121 · DOI
  67. 10.1007/s10067-002-0691-0 · DOI
  68. Jubb RW, 2003, Int J Clin Pract, 57, 467, 10.1111/j.1742-1241.2003.tb10535.x · DOI
  69. 10.1016/S1297-319X(03)00043-5 · DOI
  70. 10.1163/156856903770196863 · DOI
  71. Tsai CL, 2003, Osteoarthritis Cartilage, 11, 119
  72. 10.1016/j.joca.2004.04.010 · DOI
  73. Day R, 2004, J Rheumatol, 31, 775
  74. 10.1136/ard.2003.019703 · DOI
  75. Wu HB, 2004, Zhongguo Linchuang Kangfu, 8, 5491
  76. 10.1007/s10067-004-1043-z · DOI
  77. 10.1002/art.21590 · DOI
  78. Neustadt D, 2005, J Rheumatol, 32, 1928
  79. 10.1007/s00296-003-0428-7 · DOI
  80. 10.1007/s00296-005-0611-0 · DOI
  81. Petrella RJ, 2006, J Rheumatol, 33, 951
  82. 10.3944/AOTT.2008.228 · DOI
  83. 10.2174/1876539400801010001 · DOI
  84. 10.3944/AOTT.2008.221 · DOI
  85. 10.1080/03009740701813103 · DOI
  86. 10.1007/s10067-007-0834-4 · DOI
  87. 10.1016/j.semarthrit.2009.04.001 · DOI
  88. 10.1016/j.joca.2008.06.014 · DOI
  89. 10.1016/S1063-4584(09)60348-4 · DOI
  90. 10.3233/BMR-2009-0207 · DOI
  91. Petrella RJ, 2009, Ann Rheum Dis, 68, 479
  92. 10.1136/ard.2008.094623 · DOI
  93. 10.1136/ard.2009.118042 · DOI
  94. Kosuwon W, 2010, Ann Rheum Dis, 69, 267
  95. Kul-Panza E, 2010, Minerva Med, 101, 63
  96. 10.1016/S1063-4584(10)60353-6 · DOI
  97. 10.1186/1471-2474-12-221 · DOI
  98. 10.1136/ard.2011.152017 · DOI
  99. 10.1097/00003086-200104000-00021 · DOI
  100. 10.1136/ard.16.4.494 · DOI
  101. 10.1093/ije/dyn265 · DOI
  102. 10.1136/bmj.c6328 · DOI
  103. 10.1016/j.jclinepi.2010.06.008 · DOI
  104. 10.1002/art.24894 · DOI
  105. Modawal A, 2005, J Fam Pract, 54, 758
  106. 10.2106/00004623-200403000-00012 · DOI
  107. Bellamy N, 2006, Cochrane Database Syst Rev, CD005321
  108. 10.1503/cmaj.1041203 · DOI
  109. 10.1001/jama.290.23.3115 · DOI
  110. Medina JM, 2006, J Fam Pract, 55, 669
  111. 10.1016/j.joca.2010.09.014 · DOI

Cited by

Sorted by citations

See all 717

Metadata

Authors
Rutjes, A. W. S., Jüni, P., da Costa, B. R., Trelle, S., Nüesch, E., & Reichenbach, S.
Affiliations
University of Bern (CH)
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2012-08-07
Volume
157
Issue
3
Pages
180-191
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-157-3-201208070-00473
OpenAlex
W2052535861
Cited by
717
References
7
Citations by year
2026: 14 · 2025: 31 · 2024: 21 · 2023: 26 · 2022: 26 · 2021: 54 · 2020: 67 · 2019: 43 · 2018: 48 · 2017: 40 · 2016: 57 · 2015: 195 · 2014: 48 · 2013: 36 · 2012: 10
FWCI
13.84
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Proteoglycans and glycosaminoglycans research
Keywords
viscosupplementation, knee osteoarthritis, hyaluronic acid, intra-articular injection, analgesia, flare-ups, serious adverse events, cross-linked hyaluronic acid, trial quality, publication bias, knee function, unpublished trials, meta-regression, heterogeneity, publication status, trial size, blinding
MeSH terms
Humans, Hyaluronic Acid, Pain, Randomized Controlled Trials as Topic, Osteoarthritis, Knee, Viscosupplements, Viscosupplementation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review