title: AMSSM Scientific Statement Concerning Viscosupplementation Injections for Knee Osteoarthritis: Importance for Individual Patient Outcomes.
abstract: OBJECTIVE
  Osteoarthritis (OA) is a disabling disease that produces severe morbidity reducing physical activity. Our position statement on treatment of knee OA with viscosupplementation injection [hyaluronic acid (HA)] versus steroid [intra-articular corticosteroid (IAS)] and placebo [intra-articular placebo (IAP)] is based on the evaluation of treatment effect by examining the number of subjects within a treatment arm that met the Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) criteria, which is different and more relevant than methods used in other reviews which examined if the average change across the treatment groups was clinically different.
  
  
  METHODS
  We performed a systematic literature search for all relevant articles from 1960 to August 2014 in the MEDLINE, EMBASE, and Cochrane CENTRAL. We performed a network meta-analysis (NMA) of the relevant literature to determine if there is a benefit from HA as compared with IAS and IAP.
  
  
  RESULTS
  Eleven articles met the inclusion criteria from the search strategy. On NMA, those subjects receiving HA were 15% and 11% more likely to respond to treatment by the OMERACT-OARSI criteria than those receiving IAS or IAP, respectively (P < 0.05 for both).
  
  
  CONCLUSIONS
  In light of the aforementioned results of our NMA, the American Medical Society for Sport Medicine recommends the use of HA for the appropriate patients with knee OA.
authors.affiliation: *Division of Sports Medicine, Department of Family, Community and Preventive Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania; †Outpatient Musculoskeletal Rehabilitation, St Jude Medical Center, Fullerton, California; ‡Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio; §Maine Medical Center Sports Medicine, Portland, Maine; ¶Hartford Hospital Evidence-Based Practice Center, UCONN School of Pharmacy; and ‖Hartford Hospital Evidence-Based Practice Center, Hartford, Connecticut.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Trojian
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Concoff
authors.forename: Susan M
authors.initials: SM
authors.lastname: Joy
authors.forename: John R
authors.initials: JR
authors.lastname: Hatzenbuehler
authors.forename: Whitney J
authors.initials: WJ
authors.lastname: Saulsberry
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
mesh_terms: D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007270:Injections, Intra-Articular; D020370:Osteoarthritis, Knee / Q000188:drug therapy; D016896:Treatment Outcome; D055676:Viscosupplementation; D055675:Viscosupplements / Q000008:administration & dosage
chemical_list: D006820:Hyaluronic Acid; D055675:Viscosupplements