Knee arthroscopy is one of the most commonly performed procedures. There is many different types of cartilage and meniscus damage, from mild tears to severe tears. mild task and often heal themselves along with corrective rehabilitation whereas significant tears will often need surgery. This is simply because the meniscus itself has a poor blood supply, therefore affecting its ability to repair, heal and regenerate. Removal of part of the meniscus will inevitably accelerate cartilage degradation over time due to recent moving parts of the meniscus that deals with compression and loading. However, in some cases stitching can be done to the meniscus instead of removal. This, still allowing for compressive loading.
Among knee arthroscopy, partial meniscectomy is one of the most performed surgeries. During arthroscopic surgery, it is known to negatively impact articular cartilage, as they can alter the ideal environment of the knee joint by changing the temperature, osmolarity, and pH of the synovial fluid. During this process, arthroscopic surgery can lead to a removal of healthy fluid from the joint, which can facilitate damage on articular cartilage. This damage combined with surgical trauma may negatively affect management during the post surgical period. Collagen, proteoglycans and proteins make up articular cartilage, all relating to the tissue’s compressive and tensile strength.
Synovial joint fluid is a biological lubricant and a biochemical pool through which nutrients and cytokines pass through. Proteoglycan 4, hyaluronan, and surface-active phospholipids play a crucial role in lubricating the articular cartilage, important for preservation, healing and repair. The natural replacement of synovial fluid after arthroscopic surgery can be delayed by at least one week. Administering hyaluronic acid (HA) or viscosupplementation to the joint immediately after surgery has been shown to positively affect the altered joint environment, resulting in reduced postoperative pain and accelerated functional improvements such as mobility of the joint, along with improved weight bearing. Many studies have reported positive effects in in mild to moderate cases of osteoarthritis and postoperative pain relief and functional improvement.
The recent study below study looked to analyze the efficacy of hyaluronic acid joint injection on pain and functional recovery after arthroscopic partial meniscus surgery. They found that the most important finding was that postoperative use of hyaluronic acid after surgery significantly reduced pain 2 weeks after surgery and resulted in better mobility at 2 and 6 weeks after surgery.
The justification for this treatment is based on the biological and mechanical properties of hyaluronic acid, functioning as a joint lubricant, restoring healthy lost joint fluid, providing a mechanical shock absorber, and ultimately slowing the progression of further degenerative changes leading to the possibility of joint osteoarthritis. Hyaluronic acid is also known to decrease proinflammatory activity. Based on these factors, hyaluronic acid has been shown to be beneficial in a variety of therapeutic situations, at the same time as having very minimal side-effects.
In previous clinical studies Chen et al and Mathies et al both identified that the knee muscle strength index and pain scores were significantly better when using hyaluronic acid post knee arthroscopy, alone side reducing surgery. Huang et al. reported that injection after anterior cruciate ligament reconstruction resulted in more functional muscle improvements. In addition, Anand et al shown that using the injection treatment after arthroscopic surgery identified improved pain scores 3-6 weeks post-surgery.
After partial meniscus surgery, pain is a major limiting factor for patients before returning to full activities. There are many reasons that may contribute to poor outcomes after surgery that are challenging to solve, such as obesity or large amount of meniscal removal. However, it is speculated that hyaluronic acid injections may have beneficial effects in pain reduction and functional recovery during the early postoperative period (the first 2weeks), which in turn may lead to earlier rehabilitation. In conclusion, the recent randomised clinical trial showed that hyaluronic acid injection treatment after arthroscopic partial knee meniscus surgery can significantly reduce pain at 2 weeks post-surgery and improve functional range of motion at 2 weeks post-surgery. Based on this viscosupplementation may provide some benefits in terms of pain and functional recovery after arthroscopic surgery, leading to better recovery, reduced retail rates and complications, and have beneficial implications on reducing the speed of further cartilage degeneration.
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