L’acide hyaluronique avant l’arthrose : à propos de 339 sportifs

Introduction

Physical activities, through traumas and intensity of practice expose the athletes to cartilage pain caused earlier compared to a population of sedentary people. Lesions at the origin of the pain may be traumatic or microtrauma however without meeting the radio-clinical osteoarthritis criteria defined by the American College of Rheumatology. Hyaluronic acid (HA) is commonly used in the treatment of knee osteoarthritis. It became legitimate to think that the mechanism of action of the product can lead to a pain relief of patients when used in other joints and pre-arthritic stage. As such, we use it in these indications for over 10 years. The objective of this study is to evaluate its effectiveness in the knee, hip and ankle and to identify prognostic factors.

Method

Retrospective study analysing the effectiveness of the viscosupplementation through a questionnaire assessing pain, athletic/professional level, pain relief on a daily basis and satisfaction. All of the lesions have been classified Kellgren 0 and staging of the ICRS for the knee. Definition of the criteria for response on the sedation of pain, and the maintenance of the sport/professional level. We also searched factors prognostications for the knee, only joint with sufficient sample size expected (biometric data: sex, age, body mass index, sports and professional profile, used presentation and prior injected corticosteroid solution).

Results

Three hundred and thirty-nine protocols have been realized to 332 cartilaginous traumatic or microtraumatic degenerative lesions (279 knees with single cartilaginous injury, 61 patients with associated treated meniscal tear, 29 hips, 31 ankles) and seven painful after-effects of osteochondritis. The average age of patients was 39.30 (± 14.38), 76% male; 83.2% had a sports profile with strong joint solicitation. Overall effectiveness was 49.85% (single chondral injury: 46.26%, chondral injury plus meniscal tear both treated: 60.66%, 44.82% for hip and 57.14% for the ankle). Four patients on seven treated for painful sequela of osteochondritis have been relieved. The rate of adverse events was 4.13%, represented by puncture pain or swelling reaction. In the knee, the stage lesion did not impact on efficiency (P = 0.17), neither the presence of an associated meniscal tear non-treated (P = 0.15); the pursuit of a support activity is correlated with a loss of efficiency (P = 0.039).

Discussion

This study is interesting as far as no study in vivo exists regarding the use of HA in support of isolated microtraumatic or traumatic chondral lesions except in the course of surgery of the meniscus with visualization of an arthroscopic cartilage injury. Efficiency appears interesting, almost equal to that found in the available studies on arthritis in these joints, although, because of the heterogeneity of the protocols and the results obtained, the estimation of a reliable response rate seems delicate.

Conclusion

The use of HA for the treatment of the pain of single traumatic or microtraumatic cartilage injury appears safe, with an interesting efficiency to be confirmed by studies of high level of evidence.