Table 1 Characteristics of the included studies
Authors | Inclusion criteria | Study design | N° Of patients (M/F) | Age (sd) [range] | Practiced sport | Injected product | Injective protocol Volume N. Injection Interval | Scores | Follow-up | Main findings |
|---|---|---|---|---|---|---|---|---|---|---|
Zietz et al. 2008 [58] | Outerbridge grade III or IV Previous knee arthroscopy with residual pain/no desired return to sport | Prospective case series | 15 (10/5) | 49.5 (/) [34–59] | 4 professional jai alai, 11 recreational basketball, golf, skiing, jogging | Hylan G-F 20 (Genzyme, Cambridge, MA) 6000 kDA | / 3 injections 1-week interval | IKDC WOMAC Activity level | 3–6 m | Improved activity levels and sports participation at 3 m follow-up. No difference in IKDC and WOMAC |
Gobbi et al 2012 [23] | Age 30–60 y Kellgren-Lawrence 1–3 Severe pain > 3 m Stable knees, normal knee alignment, normal patellofemoral tracking | Prospective case series | 50 (31/19) | 47.7 (/) [32–60] | Football (14%), skiing (14%), motocross (12%), basketball/volleyball (12%), jogging (10%), and others (tennis, bicycling, walking, trekking, etc.) but not at a professional level | PRP Autologous Fresh Code: XX-XX-00 | 4 mL 2 injections 1-month interval | VAS IKDC Tegner KOOS | 6–12 m | Encouraging preliminary clinical results was found in active patients with knee OA |
Papalia et al. 2016 [41] | Degenerative cartilage lesions Symptomatic unilateral knee pain Unresponsive to conservative therapies No previous surgery No major axial deformities | RCT | 47 (47/0) | 37.2 (/) [34–39] | Professional football players at the end of their career | SINOVIAL HL (IBSA, Lodi) 1100–1400 kDA and 80–100 kDA | 64 mg/2 mL 3 injections / | IKDC KOOS VAS | 3, 6, 12 m | Both treatments showed to be effective in relieving patients’ symptoms. HA showed higher effectiveness compared to PRP, although its superiority was limited by time |
PRP Autologous Fresh Code: XX-XX-00 | 5.5 mL 3 injections / | |||||||||
Tamburrino et al. 2016 [51] | Femoropatellar/femorotibial chondropaty ICRS Grade ≤ 3a | Prospective case series | 30 (30/0) | 30.7 (/) [17–39] | Professional football players | HYADD4-G (Fidia Farmaceutici) 500–730 kDA | 24 mg/3 mL 2 injections 1-week interval | VAS KOOS | 1, 3, 6 m | HA is an effective therapeutic option for patients with knee degenerative or traumatic chondropathy |
Wu et al. 2017 [56] | Kellgren-Lawrence 1–2 | Prospective case series | 18 (18/0) | / (/) [25–38] | Football | ArtiAid (Maxigen Biotech inc. Taiwam) 600–1200 kDA | 2.5 mL 3 injections 1-week interval | IKDC WOMAC | 1–4 w | Significantly improved IKDC and WOMAC scores |
Migliore et al. 2019 [38] | Age ≥ 18 y Kellgren-Lawrence 1–2 | Retrospective case series | 17 (16/1) | 39.8 (± 11.8) [/] | Football players (3 professional, 14 non-professional) | SINOVIAL HL (IBSA, Lodi) 800–1200 kDA | 16 mg/2 mL 2 injections 2-week interval | Lequesne index score VAS | 1, 2 d 2, 4 w 3, 6 m | Stable improvement of symptoms, rapid restart of sports activity |
Altamura et al. 2020 [1] | Age ≤ 50 y Unilateral knee pain for at least 4 m Kellgren-Lawrence 0–3 Any level of sport | Prospective case series | 47 (44/3) | 41.1 (± 7.1) [/] | NR | PRP Autologous Cryopreserved Code: XX-X1-11 | 5 mL 3 injections 1-week interval | IKDC subjective EQ-VAS Tegner | 2, 6, 12, 24 m | Pain and function improvement up to 24 months. However, only half of the patients can achieve the same sport level as before |
Bernetti et al. 2020 [9] | Age 30–70 y Kellgren-Lawrence 2–3 Amateur athletes | Prospective case series | 30 (22/8) | 60.4 (/) [/] | 15 runners, 4 football, 5 tennis, 6 couple dance | HYADD4-G (Fidia Farmaceutici) 500–730 kDA | 24 mg/3 mL 2 injections 2-week interval | VAS KOOS WOMAC | 1, 3, 6 m | Intra-articular HA injections represent a safe method in athlete management with low-moderate knee OA |
Bernetti et al. 2021 [8] | Age 18–65 y Kellgren-Lawrence 1–3 Professional or regular sport player No pain medications 48 h before visit | Prospective case series | 31 (8/23) | 49 (/) [/] | NR | HYADD4-G (Fidia Farmaceutici) 500–730 kDA | 32 mg/4 ml 1 injection / | KOOS WOMAC VAS | 1, 3, 6, 12 m | A single HA intra-articular injection seems to provide a rapid, lasting, and safe response in regular sports players affected by knee OA |
Perticarini et al. 2021 [43] | Age ≥ 18 y Knee chondropathy at MRI No inflammatory signs of the joint No ligament/meniscal pathologies No surgery | Prospective case series | 12 (12/0) | NR | Professional football players | HYADD4-G (Fidia Farmaceutici) 500–730 kDA | 32 mg/4 mL 2 injections 19/20-week interval | 0–4 VAS IKDC Lysholm | 40 w | A single HA injection, repeated after 19–20 weeks, may be a viable option to improve symptoms and function in professional players |