Mechanisms of Action of Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis: A Targeted Review of the Literature

作者：Seth L. Sherman, Andrew Gudeman, John D. Kelly, Robert J. Dimeff, Jack Farr · 发表于：The American Journal of Sports Medicine · 年份：2025 · DOI：10.1177/03635465241302820 · 被引用次数：18 · 研究领域：Osteoarthritis Treatment and Mechanisms、Proteoglycans and glycosaminoglycans research、Total Knee Arthroplasty Outcomes

BACKGROUND: The knee is the most commonly afflicted joint in osteoarthritis (OA). Injection of intra-articular of hyaluronic acid (IAHA) is a frequently used therapy for the management of knee OA with varying product characteristics. PURPOSE: To describe and characterize the mechanism of action (MoA) of IAHA products concerning nociception, chondroprotection, and anti-inflammatory properties via a targeted literature review. STUDY DESIGN: Systematic review; Level of evidence, 2. METHODS: , adapted for conducting a targeted literature review. Relevant studies were identified by searching the Embase database using predefined search strategies via the Ovid platform. The results of the review were reported according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). RESULTS: A total of 182 studies were included in this targeted literature review. Of these, 107 reported chondroprotective action, 59 anti-inflammatory activity, 18 analgesic properties, 30 proteoglycan or glycosaminoglycan synthesis, 8 subchondral bone effects, 2 mechanical effects, and 1 other effects of IAHA. These MoAs were studied through diverse types of studies: in vitro biochemistry, animal physiological studies, or human physiological and clinical studies. The chondroprotective effect was the most studied MoA and showed an increase in anabolic biomarkers, such as collagen types II, IX, and XI, and a reduction in catabolic biomarkers, such as matrix metalloproteinase...