Monovisc Intra-articular Injection for Knee Osteoarthritis

Evidence Against Viscosupplementation

The 2019 American College of Rheumatology/Arthritis Foundation guidelines conditionally recommend against intra-articular hyaluronic acid injections in patients with knee osteoarthritis 1, 2
When limited to trials with low risk of bias, meta-analysis has shown that the effect size of hyaluronic acid injections compared to saline injections approaches zero 2

Land-based exercise (aerobic and/or resistance) is recommended for patients with knee osteoarthritis 4
Weight loss is recommended for overweight patients with knee osteoarthritis 4
Physical therapy is recommended for patients with knee osteoarthritis 1, 5
Knee bracing is recommended when appropriate for patients with knee osteoarthritis 4, 5
Acetaminophen (up to 3g daily in divided doses) is recommended for patients with knee osteoarthritis 4, 6
Oral NSAIDs are recommended for patients with knee osteoarthritis 4, 6
Topical NSAIDs are recommended, particularly for patients ≥75 years old with knee osteoarthritis 4, 7

Intra-articular corticosteroid injections are strongly recommended for knee OA, but typically provide only short-term relief 4, 6, 8

Intra-articular hyaluronic acid (including Monovisc) is not recommended due to limited evidence of benefit and potential harm 1, 2, 3

The American Academy of Orthopaedic Surgeons recommends arthroscopic surgery for patients with meniscal tears and knee osteoarthritis who have failed conservative treatments 5
The American College of Rheumatology recommends shared decision-making for patients with knee osteoarthritis who have had an inadequate response to nonpharmacologic therapies, topical and oral NSAIDs, and intraarticular steroids 2, 4, 8