Meta-analysis of hyaluronic acid in the treatment of rotator cuff injury

doi:10.12307/2021.075

Abstract

Abstract: OBJECTIVE: Although studies have reported the efficacy of hyaluronic acid in promoting tendon-bone healing, many sports medicine physicians are still controversial and skeptical about the clinical efficacy of hyaluronic acid in the treatment of rotator cuff injuries due to limitations in methods, follow-up, and study design. The efficacy and safety of hyaluronic acid in the treatment of rotator cuff injury compared with conventional treatment or saline control were evaluated by meta-analysis.
METHODS: The Cochrane Library, EMBASE, PubMed, Wanfang, CNKI and VIP databases were used to search and collect randomized controlled clinical trials of hyaluronic acid versus conventional treatment or blank control treatment for rotator cuff injuries. Two reviewers independently evaluated the quality of the included studies through the Cochrane Evaluation Manual and the Jadad score, extracted and cross-checked the data, and meta-analyzed the collected data using RevMan 5.3 software. The main outcome indicators analyzed were continuous variables, such as visual analogue scale score, Constant score, and University of California at Los Angeles score; dichotomous variables, such as satisfaction.
RESULTS: (1) A total of eight randomized controlled clinical trials were selected for meta-analysis, including three of general quality, five of medium quality and high quality. A total of 541 patients were selected, including 255 patients treated with subacromial injection of hyaluronic acid for supplementary treatment and 286 patients treated with conventional or blank control. (2) Meta-analysis results showed that visual analogue scale pain scores of the hyaluronic acid group were better than those of the control group at 1, 2, 3 and 4 weeks after treatment (MD=-1.34, 95%CI:-1.73 to-0.95, P < 0.05; MD=-1.80, 95%CI:-2.28 to-1.32, P < 0.05; MD=-0.70, 95%CI:-1.12 to-0.29, P < 0.05; MD=-2.55, 95%CI:-5.00 to -0.09, P < 0.05). There was no significant difference in visual analogue scale pain score between the hyaluronic acid group and the control group at 12 and 24 weeks after treatment (MD=-2.09, 95%CI:-4.52-0.35, P > 0.05; MD=-0.04, 95%CI:-0.36-0.29, P > 0.05). Constant scores of the hyaluronic acid group at 2 and 12 weeks after treatment were better than those of the control group (MD=3.23, 95%CI:2.34-4.11, P < 0.05; MD=20.28, 95%CI:0.54-40.03, P < 0.05). The University of California at Los Angeles scores of the hyaluronic acid group at 24 weeks after treatment were all better than that in the control group (MD=0.69, 95%CI:0.20-1.18, P < 0.05). There was no significant difference in patient satisfaction in the last follow-up after treatment between the hyaluronic acid group and the control group (OR=1.82, 95%CI:0.93-3.55, P > 0.05).
CONCLUSION: The treatment of rotator cuff injury with hyaluronic acid could reduce pain, increase activity function and improve daily life quality, and the pain relief effect was particularly obvious in the short term. It is effective and safe to treat rotator cuff injury with hyaluronic acid. However, more large-scale, multi-center, high-quality randomized controlled trials are needed to verify this.

Key words: soft tissue, hyaluronic acid, rotator cuff injury, tendon and bone, healing, pain, quality of life, meta-analysis

CLC Number:

Zhao Guoyuan, Hu Weijian, Guo Siyin, Wei Hewei, Wan Lei, Zheng Weipeng, Liu Zhijun, Liao Zhihao, Chen Sheng. Meta-analysis of hyaluronic acid in the treatment of rotator cuff injury[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(28): 4573-4579.

Figures/Tables 14

References

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