Department of Neuroscience and Imaging, Infrared Imaging Laboratory, Institute of Advanced Biomedical Technologies (ITAB), University G. d' Annunzio Chieti - Pescara, Via dei Vestini 31, 66013, Chieti Scalo (CH), Italy.
Clin Exp Rheumatol. 2012 Mar-Apr;30(2):277-81. Epub 2012 Apr 13.
Intra-articular injections of hyaluronic acid (HA) are useful in the treatment of osteoarthritis (OA), as shown by studies on knee, hip, and trapezio-metacarpal joints. The positive results can be explained by several factors: the restoration of elastic and viscous properties of intra-articular fluid, the anti-inflammatory and the anti-nociceptive activity, and the normalisation of hyaluronan synthesis and inhibition of hyaluronic acid degradation. However, evidence of efficacy of hyaluronic acid in ankle osteoarthritis is still lacking: several studies have been performed without a control group, or have shown similar results to those obtained with different therapeutic procedures. The aim of this paper is to analyse the reasons which can explain the discrepancy between the sound biological background and the inconclusive clinical results. First, it must be considered that the ankle joint, from a biomechanical point of view, is more complex than other joints, and that greater stress is sustained by the articular surfaces. Second, the limited benefit can be related to the use of hyaluronic acid mostly in cases of post-traumatic osteoarthritis, where the treatment must be addressed to solve the biomechanical problems, and then to restore the rheological properties of the ankle joint. A third important explanation of the failure may be the improper technique of administration, that has been performed in all studies, but one, without imaging guidance. Indeed, it is well known that hyaluronic acid, if not delivered directly into the intra-articular space, is unlikely to be effective.
关节内注射透明质酸（HA）对骨关节炎（OA）的治疗有效，这已在膝关节、髋关节和腕掌关节的研究中得到证实。积极的结果可以用几个因素来解释：恢复关节内液的弹性和粘性特性、抗炎和抗伤害作用，以及透明质酸合成的正常化和抑制透明质酸降解。然而，在踝关节骨关节炎中，透明质酸的疗效证据仍然缺乏：已经进行了几项没有对照组的研究，或者显示出与不同治疗方法相同的结果。本文旨在分析可以解释良好的生物学背景与不确定的临床结果之间差异的原因。首先，必须考虑到从生物力学的角度来看，踝关节比其他关节更复杂，关节表面承受更大的压力。其次，有限的益处可能与透明质酸的使用有关，主要是在创伤后骨关节炎的情况下，治疗必须解决生物力学问题，然后恢复踝关节的流变学特性。治疗失败的第三个重要解释可能是管理不当的技术，所有研究都进行了，但没有一个研究是在影像学指导下进行的。事实上，众所周知，如果透明质酸不能直接输送到关节内，就不太可能有效。
