Knee Osteoarthritis Pain Management: Hyaluronic Acid vs Mesotherapy Treatment

In orthopedics and rheumatology, there is a constant search for effective treatments for knee osteoarthritis. Injectable hyaluronic acid (HA) has received much attention and is proven to be an effective solution. Nevertheless, in recent studies, the impact of mesotherapy on patients suffering from mild to moderate knee osteoarthritis was also researched. What do those findings include? Are mesotherapy injections effective, and in which cases? 

We will explore both traditional HA treatments and the latest insights about knee osteoarthritis management with mesotherapy and give answers to the question: In what measure do mesotherapy cocktails help alleviate symptoms and slow the progression of this disease? Are mesotherapy injections safe and equally effective as HA and PRP, or do some options show bigger potential to provide relief to patients?

Key Takeaways

• Traditional hyaluronic acid injectables: Variety of indications and applications.
• How does mesotherapy help in treating knee osteoarthritis? 
• Clinical efficacy of HA injections; Positive effects on knee cartilage and bone.
• Comparative effectiveness in knee osteoarthritis pain management: HA injections vs. Mesotherapy and PRP.

Hyaluronic Acid (HA): A Versatile Substance for Natural Healing Processes

Hyaluronic acid possesses remarkable versatility. Due to its characteristics to act like a ‘cushion’ and lubricant in the joints and other tissues, this fluid has a broad range of applications and brings many benefits and positive results. 

Since hyaluronic acid is naturally present in our bodies (in the fluids in our eyes and joints), its use is considered non-harmful. Various formulations of hyaluronic acid have already found their applications in cosmetic procedures, while its potential extends to influencing the body’s response to injury, likely to reduce swelling. In dermatology and aesthetic medicine, HA has emerged as a cornerstone of many treatments, offering a holistic approach to addressing many skin concerns. From facial skin hydration, revitalizing tired skin, and combating wrinkles to repairing sun damage, HA has established itself as a formidable player in various fields. From reducing acne, stretch marks, and cellulite to increasing skin firmness, it has become a sought-after ingredient in the skincare industry worldwide.

Besides these cosmetic applications, research shows that hyaluronic acid also helps the development of joint cartilage and bone. This is because HA can promote the growth of new cells and tissues while also reducing inflammation. 

What is the Best Injection for Knee Osteoarthritis Pain Management?

For those seeking to avoid knee surgery, injections present a convenient alternative. Orthopedic HA injections are a popular choice because they typically entail less risk and shorter recovery periods compared to surgery, which makes them an appealing option for individuals looking to maintain their quality of life while managing their knee symptoms. 

Hyaluronic acid injections, for example, have been shown to minimize inflammation and friction while also slowing cartilage and bone degradation.

Other non-surgical treatment options include bracing, infusions, nutraceuticals, pain medications, physical therapy, and lifestyle modifications, which can also bring good results but require much more recovery time. Of course, each patient is an individual case, and a healthcare professional should assess which therapy and combination of recommended treatments are best for them. It is preferable to regularly receive feedback from the patient regarding symptoms and any improvements during treatment, indicating which therapy they have responded well to and which they have not.

Speaking of injecting substances as a pain relief for bone-on-bone knee pain, PRP, BMC, and HA injections are alternatives to surgery that can decrease pain and improve function. 

HA is proven to suppress the symptoms and modify the osteoarthritic disease process. Studies demonstrate that mesotherapy shows promise in providing pain relief and enhancing functional capabilities in musculoskeletal pain conditions. Its potential to facilitate early access to rehabilitation may contribute to an improved quality of life for patients.

Orthopedic HA injections showed certain positive effects on knee cartilage and bone such as:

• Assisting in the growth and preservation of cartilage
• Strengthening existing cartilage
• Enhancing the strength of existing bone
• Triggering the body’s production of its own hyaluronic acid

One of the listed benefits involves the stimulation of chondrocytes, which are specialized cells responsible for producing cartilage. Moreover, HA also stimulates the production of important proteins (proteoglycans) and carbohydrates (glycosaminoglycans). All of the abovementioned prevent the progression of osteoarthritis.

Typically, hyaluronic acid injected into the knee remains in the joint for only a few days. However, the results could last for months. The number of injections varies depending on the brand and in cases where multiple injections are needed, each shot is typically administered once per week over a span of 3 to 5 weeks.

So, what are the characteristics of hyaluronic acid that can mitigate conditions like knee osteoarthritis?

• Lubrication

The thickness of hyaluronic acid can make the knee joint better lubricated and absorb shock. This might help decrease friction in the knee.

• Anti-inflammatory properties 

According to research, there is a strong correlation between synovitis and the progression of osteoarthritis (OA) which highlights the significance of inflammation inhibition in OA management. Therefore, mesotherapy, with its anti-inflammatory and analgesic properties, plays a role in addressing these aspects of OA treatment. Studies indicate that hyaluronic acid injections could have anti-inflammatory effects, potentially leading to decreased pain, inflammation, and swelling in the knee.

• Blocking pain signals 

In some cases, hyaluronic acid molecules wrap around nerve endings, stopping pain signals from reaching the brain. They also attach to other cells in the knee that send pain signals. By doing this, hyaluronic acid might help reduce knee pain.

What does the procedure for injecting HA into the knee look like?

Experts advise a needle tilt of 30° to 45° to deliver the medication approximately 2 millimeters deep into the dermis. If there’s swelling with excess fluid in the knee, the doctor might inject a local painkiller before inserting a needle into the joint to draw out the excess fluid. Subsequently, using the same needle, the doctor typically administers the hyaluronic acid into the knee joint.

Mesotherapy Intervention for Managing Arthritis in Knees 

Mesotherapy involves injecting small amounts of various therapeutic substances directly into the mesoderm to target specific areas of pain and inflammation. This procedure presents a new option for osteoarthritis knee pain treatment. 

A recent study included 43 patients assigned randomly to either the mesotherapy group (MG, n=28) or the saline group (SG, n=28). They received 4 weekly injections of either mesotherapy or saline. Indicators such as pain, functional status, and quality of life were evaluated using VAS, WOMAC, and SF-36 subscales at the beginning, as well as 8 and 16 weeks into the study. Saline injections contained only sterile salt water (placebo) and were used as a control to compare against the effects of the active treatment, mesotherapy in this case. In both groups, each patient received injection treatments once a week for a total of 4 weeks using so-called point-to-point and nappage techniques.

The point-to-point technique means injecting the medicine straight into specific spots on the knee, about 4 mm deep, aiming directly into the skin. It involved administering the injections at four points on the front (anterior aspect) of the knee and two points on the back (posterior aspect) of the knee, targeting the areas identified as the most painful through palpation. On the other hand, the nappage technique includes injecting the medication diagonally into the skin at a 45-degree angle but at a shallower depth of 2 mm. In this study, the nappage technique was applied around the front of the knee in five rows encircling the patella. 

In the conducted trial, the injection cocktail comprised several key components: lidocaine, meloxicam, pentoxifylline, and cyanocobalamin. Lidocaine is used for immediate pain relief, numbing the injection site, pentoxifylline for vasodilation, meloxicam is an anti-inflammatory drug, and cyanocobalamin (Vitamin B12) contributes to nerve function and analgesic effects.

After an eight-week post-treatment period, both study groups exhibited enhancement in various parameters, including VAS pain scores, WOMAC scores, and physical component scores (PCS) of the SF-36, when compared to their respective baseline values (p<0.05). 

Comparison of Traditional Orthopedic Injections, PRP, and Mesotherapy

Traditionally, acetaminophen/paracetamol has been the primary analgesic recommended as first-line treatment for mild knee osteoarthritis (OA). At the same time, nonsteroidal anti-inflammatory drugs (NSAIDs) are preferred for moderate OA but also severe osteoarthritis knee pain relief. Nonetheless, NSAIDs carry risks such as gastrointestinal bleeding, combinational risk, and increased cardiovascular risk, limiting their use in patients with coexisting disorders. 

Mechanisms of Action: Best Pain Relief for Arthritic Knees

HA injections, mesotherapy, and PRP all have important contributions and trigger processes such as enhanced circulation, tissue repair, and the stimulation of collagen and elastin production in the skin. 

Mesotherapy, a treatment involving the injection of active compounds, including NSAIDs, directly into the skin, has demonstrated effectiveness in osteoarthritis in knee pain management. 

Knowing that inflammation plays a significant role in the progression of knee osteoarthritis, as evidenced by the close relationship between synovitis (inflammation of the synovial membrane) and the advancement of OA, consequently, inhibiting inflammation becomes crucial in OA treatment. Therefore, the potential anti-inflammatory and analgesic effects of NSAIDs make them a valuable component of mesotherapy. It can be concluded that mesotherapy’s localized administration and lower drug doses help minimize systemic interactions, resulting in significantly reduced side effects compared to traditional treatments. 

Other injection therapies commonly used in knee osteoarthritis include platelet-rich plasma (PRP) and prolotherapy injections. PRP demonstrates superior benefits over hyaluronic acid in conservative knee osteoarthritis treatment, including reduced long-term discomfort and improved knee joint function, with no additional risks.

HA acts like a lubricant and shock absorber in the joints, helping them function properly. Orthopedic injections, PRP and mesotherapy have all shown promising results in pain management for knee arthritis in some instances, but their effectiveness can vary from person to person. 

Similar to mesotherapy, PRP (Platelet-Rich Plasma) represents a distinctive rejuvenation system leveraging the body’s own resources. This type of treatment aims to utilize the body’s natural healing abilities found in blood to mend damaged cartilage, tendons, ligaments, muscles, and even bone. 

In summary, comparing orthopedic injections to PRP and mesotherapy needs to take individual patient characteristics, preferences, and clinical guidelines into account. Experts point out that further research with larger sample sizes and longer-term observations is needed in order to compare the effectiveness of various injection therapies in treating knee osteoarthritis.

Is Mesotherapy Approved for Knee Osteoarthritis Treatment by the FDA?

A study published in 2018 indicates that mesotherapy demonstrates effectiveness and safety in treating patients with osteoarthritis, suggesting its consideration as an alternative treatment for individuals with contraindications for nonsteroidal anti-inflammatory drug (NSAID) use. Even though mesotherapy has yet to be approved by the US Food and Drug Administration (FDA) for knee osteoarthritis pain management, many of the ingredients used in the treatment have FDA approval for treating other conditions. As long as the ingredients have FDA approval, they may be used for mesotherapy.

FDA-approved treatment options include using hyaluronic acid injections like HYALGAN® or DUROLANE®. The FDA states that such injections should be administered only when other treatments like physical therapy and pain-relieving medications have proven ineffective. Some clinicians may explore off-label usage of hyaluronic acid injections to treat ankle, shoulder, and thumb osteoarthritis.

Summary

In conclusion, mesotherapy emerges as a well-tolerated, safe, and effective alternative treatment for patients with knee osteoarthritis. Its application demonstrates notable pain reduction and enhanced functionality, highlighting its potential as a valuable therapeutic option in knee osteoarthritis management.

It is important to note that mesotherapy for managing arthritis in knees should be administered by a qualified doctor, and meso cocktails should be obtained only from reputable and licensed sources like Doctor Medica.

FAQ

What is the best injection for osteoarthritis of the knee?

Orthopedic HA injections are a popular choice because they typically entail less risk and shorter recovery periods than surgery. Doctor Medica offers a range of reliable orthopedic injectable brands, like SYNVISC®, HYALGAN®, and ORTHOVISC®.

Is mesotherapy better than HA injections for knee osteoarthritis?

Both HA injections and mesotherapy have demonstrated effectiveness in osteoarthritis in knee pain management. The treatment choice depends on patient’s indication and the desired outcomes.

What is the new treatment for knee osteoarthritis?

Mesotherapy is recently emerged knee osteoarthiris treatment option that could be used on patients that are non responsive to other treatments.

How do you treat severe osteoarthritis of the knee?

Viscosupplementation, physical therapy, pain medications and healthy weight management are among the standard osteoarthiris treatment options.

References:

• Maheu E, Rannou F, Reginster JY. Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016;45(4 Suppl):S28-33.
• Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015;16:321. Published 2015 Oct 26. doi:10.1186/s12891-015-0775-z
• Faetani L, Ghizzoni D, Ammendolia A, Costantino C. Safety and efficacy of mesotherapy in musculoskeletal disorders:A systematic review of randomized controlled trials with meta-analysis. J Rehabil Med. 2021;53(4):jrm00182. 
• Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop. 2014;5:351–61. 
• Moretti L, Maccagnano G, Coviello M, Cassano GD, Franchini A, Laneve A, Moretti B. Platelet Rich Plasma Injections for Knee Osteoarthritis Treatment: A Prospective Clinical Study. J Clin Med. 2022 May;11(9):2640. doi: 10.3390/jcm11092640.