Hyaluronic Acid in Improving Clinical Outcome of Knee Joint after Anterior Cruciate Ligament Reconstruction: A Systemic Review

Hyaluronic acid (HA) is a viscosupplementation which is currently used as treatment option for non-operative management of knee osteoarthritis (OA). HA could be a pain medication and joint regulator, which might play a beneficial role in restoring overall joint homeostasis and reduce pro-inflammatory stimuli after knee surgery, e.g. anterior cruciate ligament (ACL) reconstruction thus reducing pain and accelerating range of motion (ROM). Therefore, there is possibility of administering intraarticular HA to reduce post-operative inflammation, which can reduce pain and hasten recovery OBJECTIVES: To identify the clinical outcome of the knee joint after HA administration in post ACL reconstruction. METHODS: We conducted a literature search through medical databases to identify randomized controlled trials (RCTs) that focused on clinical outcome of knee joint after HA administration in post ACL reconstruction patients. Included articles were assessed. The key findings and conclusions from each article were obtained and analyzed. RESULTS: We found four included studies from 64 relevant citations. It contained three articles of level of evidence 1 and one article of level of evidence 2. The administration methods are intraarticular in three articles and per oral in one article. We obtained some parameters used to assess the improvement of clinical outcome of knee joint after HA administration. Some parameters, such as VAS, IKDC, SF-36 Health Survey PF and Tegner score showed no significant improvement after HA administration, yet KOOS and LKSS score showed improvement. In three articles, the effect of HA showed improvement in active ROM. Analgesic consumption also showed lower use in patients who was administered HA in two articles. CONCLUSION: The current study suggested that there was limited evidence of HA administration after ACL reconstruction in improving clinical outcome of the knee joint. Future high-quality studies are highly needed to confirm these findings.