Comparison of Hyaluronic acid and other treatment modalities for rotator cuff tendinopathy

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Created On: 19/07/2023

A systematic review and meta-analysis aimed to examine the effectiveness of Hyaluronic acid with steroids, placebo (normal saline), Extracorporeal shock wave therapy (ESWT), Platelet-Rich Plasma (PRP), Lignocaine, and physical therapy.

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Key take away

In people with rotator cuff tendinopathy, improved pain and functional outcome scores were related to the use of intra-articular Hyaluronic acid injection.

Background

Method

According to PRISMA guidelines, the literature search was carried out. Multiple search terms or their derivatives were used to conduct the search on Cochrane, Embase, and PubMed. There were 18 RCTs that fulfilled the qualifying requirements. The Newcastle Ottawa score, GRADE criteria, and the risk of bias 2 tool were used to evaluate the quality.

While the University of California at Los Angeles (UCLA), range of motion (ROM), disability of the arm, shoulder and hand (DASH), and American Shoulder and Elbow Surgeons Shoulder Score (ASES) were used for qualitative investigation, visual analog scale (VAS) and constant murphy scores were used for quantitative analysis. The follow-up phase lasted up to a year.

Result

Data from 18 studies (1773 rotator cuffs) was pooled. The GRADE evaluation showed excellent VAS and Constant score quality. The range of Newcastle Ottawa score was between 4 and 6. On short-term follow-ups (1 and 3 months), there was a substantial improvement in VAS and constant Murphy score when contrasting Hyaluronic acid with physical therapy and PRP, but not when comparing Hyaluronic acid with steroids or placebo (normal saline).

DASH scores were remarkably enhanced when Hyaluronic acid was compared to physiotherapy. When comparing Hyaluronic acid with steroid injections, no appreciable alteration was found in the ROM, UCLA, and ASES scores.

Conclusion

Improved VAS and functional outcome scores were related to intra-articular Hyaluronic acid injection for rotator cuff tendinopathy. Both Hyaluronic acid and steroids were reported to be efficient with no discernible difference. But, using steroids may elevate complications risk. A more in-depth randomized controlled trial comparing the two may be required to obtain a clear picture of both complications and effectiveness.