Intra-articular hyaluronic acid injections and oral collagen supplementation for knee OA: A case report of an elite female soccer player
Keywords:Knee osteoarthritis, Intra-articular therapy, Hyaluronic acid, Oral collagen supplementation, Female soccer player
Soccer players are susceptible to repeated trauma that could lead to a precocious development of knee osteoarthritis (OA). Intra-articular hyaluronic acid (IA-HA) injections have been proposed as a valid treatment for knee OA. Objectives: To describe the effects of IA-HA injections and oral collagen supplementation in a female soccer goalkeeper playing in Italian Women’s Serie A with secondary OA in her knee. Design: Case report. Setting: The athlete underwent three IA-HA injections (1 per week for 3 weeks in a row) together with oral collagen supplementation for one month. Treatment outcomes were evaluated using five scoring scales. Results: One week after the first IA-HA injection all the scores improved. One week after the second injection, compared with the first week, two scores improved, two remained the same, and one worsened. One week after the third injection, compared with the second week, all the scores worsened. At one month, compared with the third week, one score remained the same and all the others worsened. From baseline to one month, three scores improved, one remained the same, and one worsened. Conclusions: In our study, IA-HA injections and oral collagen supplementation showed short-term effects on pain and functional impairment for knee OA.
Agel, J., & LaPrade, R. F. (2009). Assessment of differences between the modified Cincinnati and International Knee Documentation Committee patient outcome scores: A prospective study. The American Journal of Sports Medicine, 37(11), 2151-2157. https://doi.org/10.1177/0363546509337698
Aghamohammadi, D., Dolatkhah, N., Bakhtiari, F., Eslamian, F., & Hashemian, M. (2020). Nutraceutical supplements in management of pain and disability in osteoarthritis: A systematic review and meta-analysis of randomized clinical trials. Scientific Reports, 10(1), 20892. https://doi.org/10.1038/s41598-020-78075-x
Aicale, R., Tarantino, D., & Maffulli, N. (2018). Overuse injuries in sport: A comprehensive overview. Journal of Orthopaedic Surgery and Research, 13(1), 309. https://doi.org/10.1186/s13018-018-1017-5
Altman, R. D., Bedi, A., Karlsson, J., Sancheti, P., & Schemitsch, E. (2016). Product Differences in Intra-articular Hyaluronic Acids for Osteoarthritis of the Knee. The American Journal of Sports Medicine, 44(8), 2158-2165. https://doi.org/10.1177/0363546515609599
Altman, R., Hackel, J., Niazi, F., Shaw, P., & Nicholls, M. (2018). Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Seminars in Arthritis and Rheumatism, 48(2), 168-175. https://doi.org/10.1016/j.semarthrit.2018.01.009
Aune, K. T., Andrews, J. R., Dugas, J. R., & Cain, E. L. (2014). Return to Play After Partial Lateral Meniscectomy in National Football League Athletes. The American Journal of Sports Medicine, 42(8), 1865-1872. https://doi.org/10.1177/0363546514535069
Ayhan, E., Kesmezacar, H., & Akgun, I. (2014). Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World Journal of Orthopedics, 5(3), 351-361. https://doi.org/10.5312/wjo.v5.i3.351
Bahrami, M. H., Raeissadat, S. A., Cheraghi, M., Rahimi-Dehgolan, S., & Ebrahimpour, A. (2020). Efficacy of single high-molecular-weight versus triple low-molecular-weight hyaluronic acid intra-articular injection among knee osteoarthritis patients. BMC Musculoskeletal Disorders, 21. https://doi.org/10.1186/s12891-020-03577-8
Baltzer, A. W. A., Moser, C., Jansen, S. A., & Krauspe, R. (2009). Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis. Osteoarthritis and Cartilage, 17(2), 152-160. https://doi.org/10.1016/j.joca.2008.06.014
Bannuru, R. R., Schmid, C. H., Kent, D. M., Vaysbrot, E. E., Wong, J. B., & McAlindon, T. E. (2015). Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: A systematic review and network meta-analysis. Annals of Internal Medicine, 162(1), 46-54. https://doi.org/10.7326/M14-1231
Bannuru, R. R., Vaysbrot, E. E., Sullivan, M. C., & McAlindon, T. E. (2014). Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis: A systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 43(5), 593-599. https://doi.org/10.1016/j.semarthrit.2013.10.002
Cheng, O. T., Souzdalnitski, D., Vrooman, B., & Cheng, J. (2012). Evidence-based knee injections for the management of arthritis. Pain Medicine (Malden, Mass.), 13(6), 740-753. https://doi.org/10.1111/j.1526-4637.2012.01394.x
Collins, N. J., Misra, D., Felson, D. T., Crossley, K. M., & Roos, E. M. (2011). Measures of Knee Function. Arthritis Care & Research, 63(0 11), S208-S228. https://doi.org/10.1002/acr.20632
Concoff, A., Sancheti, P., Niazi, F., Shaw, P., & Rosen, J. (2017). The efficacy of multiple versus single hyaluronic acid injections: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 18(1), 542. https://doi.org/10.1186/s12891-017-1897-2
Creamer, P., Sharif, M., George, E., Meadows, K., Cushnaghan, J., Shinmei, M., & Dieppe, P. (1994). Intra-articular hyaluronic acid in osteoarthritis of the knee: An investigation into mechanisms of action. Osteoarthritis and Cartilage, 2(2), 133-140. https://doi.org/10.1016/s1063-4584(05)80063-9
Crichton, N. (2001). Visual analogue scale (VAS). Journal of Clinical Nursing, 10. https://doi.org/10.1007/978-3-211-89836-9_1450
da Costa, B. R., Hari, R., & Jüni, P. (2016). Intra-articular Corticosteroids for Osteoarthritis of the Knee. JAMA, 316(24), 2671-2672. https://doi.org/10.1001/jama.2016.17565
Drawer, S., & Fuller, C. W. (2001). Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. British Journal of Sports Medicine, 35(6), 402-408. https://doi.org/10.1136/bjsm.35.6.402
Dvorak, J. (2011). Osteoarthritis in football: FIFA/F-MARC approach. British Journal of Sports Medicine, 45(8), 673-676. https://doi.org/10.1136/bjsm.2011.083584
Elleuch, M. H., Guermazi, M., Mezghanni, M., Ghroubi, S., Fki, H., Mefteh, S., Baklouti, S., & Sellami, S. (2008). Knee osteoarthritis in 50 former top-level soccer players: A comparative study. Annales De Readaptation Et De Medecine Physique: Revue Scientifique De La Societe Francaise De Reeducation Fonctionnelle De Readaptation Et De Medecine Physique, 51(3), 174-178. https://doi.org/10.1016/j.annrmp.2008.01.003
Gouttebarge, V., Inklaar, H., & Frings-Dresen, M. H. (2014). Risk and consequences of osteoarthritis after a professional football career: A systematic review of the recent literature. The Journal of Sports Medicine and Physical Fitness, 54(4), 494-504.
Guadagna, S., Barattini, D. F., Pricop, M., & Rosu, S. (2018). Oral hyaluronan for the treatment of knee osteoarthritis: A systematic review. Progress in Nutrition, 20(4), 537-544. https://doi.org/10.23751/pn.v20i4.7581
He, W.-W., Kuang, M.-J., Zhao, J., Sun, L., Lu, B., Wang, Y., Ma, J.-X., & Ma, X.-L. (2017). Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis. International Journal of Surgery (London, England), 39, 95-103. https://doi.org/10.1016/j.ijsu.2017.01.087
Honvo, G., Lengelé, L., Charles, A., Reginster, J.-Y., & Bruyère, O. (2020). Role of Collagen Derivatives in Osteoarthritis and Cartilage Repair: A Systematic Scoping Review With Evidence Mapping. Rheumatology and Therapy, 7(4), 703-740. https://doi.org/10.1007/s40744-020-00240-5
Hummer, C. D., Angst, F., Ngai, W., Whittington, C., Yoon, S. S., Duarte, L., Manitt, C., & Schemitsch, E. (2020). High molecular weight Intraarticular hyaluronic acid for the treatment of knee osteoarthritis: A network meta-analysis. BMC Musculoskeletal Disorders, 21(1), 702. https://doi.org/10.1186/s12891-020-03729-w
Irrgang, J. J., Anderson, A. F., Boland, A. L., Harner, C. D., Kurosaka, M., Neyret, P., Richmond, J. C., & Shelborne, K. D. (2001). Development and validation of the international knee documentation committee subjective knee form. The American Journal of Sports Medicine, 29(5), 600-613. https://doi.org/10.1177/03635465010290051301
Krajnc, Z., Vogrin, M., Recnik, G., Crnjac, A., Drobnic, M., & Antolic, V. (2010). Increased risk of knee injuries and osteoarthritis in the non-dominant leg of former professional football players. Wiener Klinische Wochenschrift, 122 Suppl 2, 40-43. https://doi.org/10.1007/s00508-010-1341-1
Lane, N. E., Michel, B., Bjorkengren, A., Oehlert, J., Shi, H., Bloch, D. A., & Fries, J. F. (1993). The risk of osteoarthritis with running and aging: A 5-year longitudinal study. The Journal of Rheumatology, 20(3), 461-468.
Liu, X., Machado, G. C., Eyles, J. P., Ravi, V., & Hunter, D. J. (2018). Dietary supplements for treating osteoarthritis: A systematic review and meta-analysis. British Journal of Sports Medicine, 52(3), 167-175. https://doi.org/10.1136/bjsports-2016-097333
Maheu, E., Bannuru, R. R., Herrero-Beaumont, G., Allali, F., Bard, H., & Migliore, A. (2019). Why we should definitely include intra-articular hyaluronic acid as a therapeutic option in the management of knee osteoarthritis: Results of an extensive critical literature review. Seminars in Arthritis and Rheumatism, 48(4), 563-572. https://doi.org/10.1016/j.semarthrit.2018.06.002
Marks, R. (2020). Collagen Supplements and Osteoarthritis Pain: How Persuasive is the Evidence? 11, 28-39.
Marshall, K. W. (2003). Intra-articular hyaluronan therapy. Foot and Ankle Clinics, 8(2), 221-232. https://doi.org/10.1016/S1083-7515(03)00046-9
McAlindon, T. E., Bannuru, R. R., Sullivan, M. C., Arden, N. K., Berenbaum, F., Bierma-Zeinstra, S. M., Hawker, G. A., Henrotin, Y., Hunter, D. J., Kawaguchi, H., Kwoh, K., Lohmander, S., Rannou, F., Roos, E. M., & Underwood, M. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage, 22(3), 363-388. https://doi.org/10.1016/j.joca.2014.01.003
Migliore, A., Giannini, S., Bizzi, E., Massafra, U., Cassol, M., Abilius, M. J. M., & Boni, G. (2018). Use of viscosupplementation for the recovery of active football players complaining of knee pain. Open Access Journal of Sports Medicine, 10, 11-15. https://doi.org/10.2147/OAJSM.S164693
Miller, L. E., & Block, J. E. (2013). US-Approved Intra-Articular Hyaluronic Acid Injections are Safe and Effective in Patients with Knee Osteoarthritis: Systematic Review and Meta-Analysis of Randomized, Saline-Controlled Trials. Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders, 6, 57-63. https://doi.org/10.4137/CMAMD.S12743
Mitsou, A., Vallianatos, P., Piskopakis, N., & Maheras, S. (1990). Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. The Journal of Bone and Joint Surgery. British Volume, 72(3), 398-404. https://doi.org/10.1302/0301-620X.72B3.2341436
Moreland, L. W. (2003). Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: Mechanisms of action. Arthritis Research & Therapy, 5(2), 54-67. https://doi.org/10.1186/ar623
Nouri, F., Raeissadat, S. A., Eliaspour, D., Rayegani, S. M., Rahimi, M. S., & Movahedi, B. (2019). Efficacy of High-Power Laser in Alleviating Pain and Improving Function of Patients With Patellofemoral Pain Syndrome: A Single-Blind Randomized Controlled Trial. Journal of Lasers in Medical Sciences, 10(1), 37-43. https://doi.org/10.15171/jlms.2019.06
Noyes, F. R., Barber, S. D., & Mooar, L. A. (1989). A rationale for assessing sports activity levels and limitations in knee disorders. Clinical Orthopaedics and Related Research, 246, 238-249. https://doi.org/10.1097/00003086-198909000-00034
Papalia, R., Zampogna, B., Russo, F., Vasta, S., Tirindelli, M. C., Nobile, C., Di Martino, A. C., Vadalà, G., & Denaro, V. (2016). Comparing hybrid hyaluronic acid with PRP in end career athletes with degenerative cartilage lesions of the knee. Journal of Biological Regulators and Homeostatic Agents, 30(4 Suppl 1), 17-23.
Raeissadat, S. A., Rayegani, S. M., Sedighipour, L., Bossaghzade, Z., Abdollahzadeh, M. H., Nikray, R., & Mollayi, F. (2018). The efficacy of electromyographic biofeedback on pain, function, and maximal thickness of vastus medialis oblique muscle in patients with knee osteoarthritis: A randomized clinical trial. Journal of Pain Research, 11, 2781-2789. https://doi.org/10.2147/JPR.S169613
Raeissadat, S. A., Tabibian, E., Rayegani, S. M., Rahimi-Dehgolan, S., & Babaei-Ghazani, A. (2018). An investigation into the efficacy of intra-articular ozone (O2-O3) injection in patients with knee osteoarthritis: A systematic review and meta-analysis. Journal of Pain Research, 11, 2537-2550. https://doi.org/10.2147/JPR.S175441
Reid, M. C. (2013). Viscosupplementation for osteoarthritis: A primer for primary care physicians. Advances in Therapy, 30(11), 967-986. https://doi.org/10.1007/s12325-013-0068-6
Roos, E. M., Roos, H. P., Lohmander, L. S., Ekdahl, C., & Beynnon, B. D. (1998). Knee Injury and Osteoarthritis Outcome Score (KOOS)-Development of a self-administered outcome measure. The Journal of Orthopaedic and Sports Physical Therapy, 28(2), 88-96. https://doi.org/10.2519/jospt.19188.8.131.52
Roque, V., Agre, M., Barroso, J., & Brito, I. (2013). Managing knee ostheoarthritis: Efficacy of hyaluronic acid injections. Acta Reumatologica Portuguesa, 38(3), 154-161.
Sánchez, M., Fiz, N., Azofra, J., Usabiaga, J., Aduriz Recalde, E., Garcia Gutierrez, A., Albillos, J., Gárate, R., Aguirre, J. J., Padilla, S., Orive, G., & Anitua, E. (2012). A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 28(8), 1070-1078. https://doi.org/10.1016/j.arthro.2012.05.011
Sirico F, Ricca F, DI Meglio F, Nurzynska D, Castaldo C, Spera R, Montagnani S. Local corticosteroid versus autologous blood injections in lateral epicondylitis: meta-analysis of randomized controlled trials. Eur J Phys Rehabil Med. 2017 Jun;53(3):483-491. https://doi.org/10.23736/S1973-9087.16.04252-0
Takeda, H., Nakagawa, T., Nakamura, K., & Engebretsen, L. (2011). Prevention and management of knee osteoarthritis and knee cartilage injury in sports. British Journal of Sports Medicine, 45(4), 304-309. https://doi.org/10.1136/bjsm.2010.082321
Tarantino, D., & Brancaccio, P. (2019, December 30). Sports Injury Prevention: A Concise Review. Pharmacologyonline, 1-11.
Tasciotaoglu, F., & Oner, C. (2003). Efficacy of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis. Clinical Rheumatology, 22(2), 112-117. https://doi.org/10.1007/s10067-002-0690-1
Tegner, Y., & Lysholm, J. (1985). Rating systems in the evaluation of knee ligament injuries. Clinical Orthopaedics and Related Research, 198, 43-49. https://doi.org/10.1097/00003086-198509000-00007
Vazquez, P., Tovilla-Zarate, C.A., Hernández-Díaz, Y., González-Castro, T., Juárez‐Rojop, I., Narváez, L., Bermudez‐Ocaña, D., Barjau‐Madrígal, H., Legorreta‐Ramírez, G. (2019). Short-Term Therapeutic Effects of Ozone in the Management of Pain in Knee Osteoarthritis: A Meta-Analysis. PM&R. 11. https://doi.org/10.1002/pmrj.12088
Wu, C.-S., Cheng, H.-Y., Hsu, P.-F., Kao, Y.-H., & Kuo, S. M. (2017). Evaluation of the Therapeutic Effects of Hyaluronic Acid Injections on Football Players' Articular Cartilage Using an Immunochromatographic Urine Strip. Journal of Medical and Biological Engineering, 37(2), 268-275. https://doi.org/10.1007/s40846-017-0221-9
How to Cite
Copyright (c) 2021 Journal of Human Sport and Exercise
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Each author warrants that his or her submission to the Work is original and that he or she has full power to enter into this agreement. Neither this Work nor a similar work has been published elsewhere in any language nor shall be submitted for publication elsewhere while under consideration by JHSE. Each author also accepts that the JHSE will not be held legally responsible for any claims of compensation.
Authors wishing to include figures or text passages that have already been published elsewhere are required to obtain permission from the copyright holder(s) and to include evidence that such permission has been granted when submitting their papers. Any material received without such evidence will be assumed to originate from the authors.
Please include at the end of the acknowledgements a declaration that the experiments comply with the current laws of the country in which they were performed. The editors reserve the right to reject manuscripts that do not comply with the abovementioned requirements. The author(s) will be held responsible for false statements or failure to fulfill the above-mentioned requirements.
This title is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license (CC BY-NC-ND 4.0).
You are free to share, copy and redistribute the material in any medium or format. The licensor cannot revoke these freedoms as long as you follow the license terms under the following terms:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
NonCommercial — You may not use the material for commercial purposes.
NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation.
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
Transfer of Copyright
In consideration of JHSE’s publication of the Work, the authors hereby transfer, assign, and otherwise convey all copyright ownership worldwide, in all languages, and in all forms of media now or hereafter known, including electronic media such as CD-ROM, Internet, and Intranet, to JHSE. If JHSE should decide for any reason not to publish an author’s submission to the Work, JHSE shall give prompt notice of its decision to the corresponding author, this agreement shall terminate, and neither the author nor JHSE shall be under any further liability or obligation.
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article, except as disclosed on a separate attachment. All funding sources supporting the Work and all institutional or corporate affiliations of the authors are acknowledged in a footnote in the Work.
Each author certifies that his or her institution has approved the protocol for any investigation involving humans or animals and that all experimentation was conducted in conformity with ethical and humane principles of research.
Biomedical journals typically require authors and reviewers to declare if they have any competing interests with regard to their research.
JHSE require authors to agree to Copyright Notice as part of the submission process.