title: Viscosupplementation in the management of ankle osteoarthritis: a review.
abstract: BACKGROUND
  Osteoarthritis (OA) is a disease of synovial joints and is the most common cause of chronic pain. Viscosupplementation (VS) with hyaluronic acid (HA) is largely used for knee osteoarthritis therapy but the evidence for its usefulness in ankle osteoarthritis is limited. The objective of this review is to assess the efficacy of viscosupplementation treatment of ankle osteoarthritis in the current literature.
  
  
  METHODS
  The following databases were searched: Medline (period 2006-2008), Database of Abstract on Reviews and Effectiveness and Cochrane Database of Systematic Reviews. Reference lists of relevant articles were controlled for additional references. The search terms Review, Viscosupplementation (VS), Osteoarthritis (OA), Hyaluronic acid (HA), Hyaluronan, Sodium hyaluronate, Ankle OA, Ankle joint were used to identify all studies relating to the use of VS therapy for the ankle OA. Methodological quality of included studies was assessed by assigning level of evidence as previously defined by the Centre for Evidence Based Medicine (CEBM).
  
  
  RESULTS
  Seven articles concerning the efficacy of a total of 275 patients undergoing VS treatment for ankle OA were included. One European study, one Taiwanese study, one Italian study, one Turkish study and three American studies with level of evidence ranging from I to IV evaluated the following products: Hyalgan, Synvisc, Supartz, Adant.
  
  
  CONCLUSIONS
  Viscosupplementation is used widely in knee OA and is included in the professional guidelines for treatment of the disease in this joint. The potential for treating osteoarthritis of the ankle joint by viscosupplementation has been suggested in the literature, however, no dosing studies have been published to date, and dosing in the ankle joint remains an area for discussion. Viscosupplementation could potentially provide an useful alternative in treating such patients with painful ankle OA.
authors.affiliation: Rheumatology, S.Pietro FBF Hospital, via Cassia 600, 00189 Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Migliore
authors.forename: Francesca
authors.initials: F
authors.lastname: Giovannangeli
authors.forename: Emanuele
authors.initials: E
authors.lastname: Bizzi
authors.forename: Umberto
authors.initials: U
authors.lastname: Massafra
authors.forename: Andrea
authors.initials: A
authors.lastname: Alimonti
authors.forename: Bruno
authors.initials: B
authors.lastname: Laganà
authors.forename: Andrea
authors.initials: A
authors.lastname: Diamanti Picchianti
authors.forename: Valentina
authors.initials: V
authors.lastname: Germano
authors.forename: Mauro
authors.initials: M
authors.lastname: Granata
authors.forename: Prisco
authors.initials: P
authors.lastname: Piscitelli
mesh_terms: D000843:Ankle Joint; D001182:Arthroscopy; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000031:analogs & derivatives; D010003:Osteoarthritis / Q000601:surgery*; D016896:Treatment Outcome; D055676:Viscosupplementation; D055675:Viscosupplements / Q000008:administration & dosage*
chemical_list: D055675:Viscosupplements; C049816:hylan; D006820:Hyaluronic Acid