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Clin Exp Rheumatol. 2008 Mar-Apr;26(2):288-94.

Intra-articular hyaluronic acid compared to exercise therapy in osteoarthritis of the ankle. A prospective randomized trial with long-term follow-up.

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Department of Orthopedic Surgery, Dokuz Eylul University Hospital, Balcova, Izmir, Turkey.



The goal of this study has been to determine whether hyaluronic acid (HA) or exercise therapy can improve functional parameters in patients with osteoarthritis (OA) of the ankle.


In a prospective clinical trial, 43 ankles (30 patients) with radiographic Kellgren Lawrence grade III OA were randomized to receive three intra-articular HA injections, with one-week interval of or exercise therapy for six weeks. Patients were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and followed-up after 12 months.


Total AOFAS Ankle-Hindfoot score of OA patients has improved in both groups, varying from 61.6+/-16.8 to 90.1+/-9.7 with HA treatment and from 72.1+/-16.6 to 87.5+/-17.5 using exercise therapy at the end of the trial (p<0.01). There were no statistically significant differences between the groups.


This prospective randomized trial confirmed that, both HA injections and exercise therapy provide functional improvement. However, larger trials with longer follow-up are necessary for more definite conclusions.

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