What is the evidence for injections (corticosteroid, viscosupplementation, PRP) for arthritis of the ankle?
AMSTAR Rating
Summary
Patient Population:
27 studies with 1085 patients with ankle OA, rheumatoid arthritis (RA) and hemophilic arthropathy.
7 studies were RCT’s.
Incomplete data on male to female ratio
Intervention:
Injection with corticosteroids (triamcinolone, betamethasone) (4 case studies), hyaluronic acid (viscosupplementation) (19 trials), platelet-rich plasma (PRP) (3 studies) and mesenchymal stem cells (1 study)
Comparison:
7 RCT’s controls (saline injection (3), botulinum toxin, traction device, exercise therapy and variable dosing)
Outcome:
Corticosteroid injection (4 case studies)
- Low quality evidence of short term (4 weeks) benefit for pain reduction
Hyaluronic Acid (19 studies)
- Pool data from 3 RCT’s with saline injection controls
- No statistical benefit for Ankle Osteoarthritis Scale (AOS) at 6 weeks, nor 3 months
- Statistical benefit in favour of HA at 6 months v. Saline injection
Platelet-rich Plasma (PRP) (3 studies)
- Low quality mixed evidence of efficacy (1 negative, 2 positive)
- Safety demonstrated in 2 trials
Mesenchymal Stem Cells (1 case series)
- Low quality evidence in single small (6 patients) 30 month trial of benefit
Guideline Recommendations
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Corticosteroid (LOW quality evidence)
Pain (4 weeks)
Hyaluronic acid (Viscosupplement) (LOW quality evidence)
Pain and function (6 weeks)
Pain and function (3 months)
Pain and function (6 months)
PRP (LOW quality evidence)
Pain
Mesenchymal stem cells (Single LOW quality study)
Pain and function
Participant Information
the sample size was 1085
their were 27 studies used.
