Evidence map›Paper›PMID 30046992›Full record

ReviewKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2019

Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis.

Christopher Smith, Rahil Patel, Christopher Vannabouathong, Brendan Sales, Alexander Rabinovich, Robert McCormack, Etienne L Belzile, Mohit Bhandari

Registry-linked trialAbstract readReview
PubMed Publisher
In one paragraph

Review in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05408065 (A Randomized Single-blinded Clinical Trial of the Efficacy of Intra-articular Infiltration of Cingal), which is not on this map. Cited by 37 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed, 5 pooled it
4.9field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05408065 narecruitingnot on this mapstarted 2022, after this paper: background citation

A Randomized Single-blinded Clinical Trial of the Efficacy of Intra-articular Infiltration of Cingal (Sodium Hyaluronate/Triamcinolone) Versus Cortisone (Triamcinolone) in Patients With Osteoarthritis of the Shoulder.

TypeinterventionalSponsorCentre hospitalier de l'Université de Montréal (CHUM)Ran2022 to 2026Enrolled84ConditionsInfiltration, Shoulder OsteoarthritisArmsTriamcinolone Hexacetonide and hyaluronic acid, Triamcinolone Hexacetonide
3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 5 syntheses or guidelines pooled it, 63 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Trial
  7. Review
  8. Review
  9. Article
  10. Expert consensus on glucocorticoids injection for knee osteoarthritis.Journal of orthopaedic surgery and research · 2026
    Article
  11. Hemochromatosis osteoarthritis.Frontiers in endocrinology · 2026
    Review
  12. Review
  13. Article
  14. Article
  15. Article
  16. 9. Chronic knee pain.Pain practice : the official journal of World Institute of Pain · 2025
    Review
  17. Review
  18. The Effects ofLife (Basel, Switzerland) · 2024
    Article
  19. Article
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Christopher SmithOrthoEvidence, 3228 South Service Rd, Burlington, ON, Canada. chris.smith@myorthoevidence.com.
Rahil PatelMcMaster University, 1280 Main St W, Hamilton, ON, Canada.
Christopher VannabouathongOrthoEvidence, 3228 South Service Rd, Burlington, ON, Canada.
Brendan SalesOrthoEvidence, 3228 South Service Rd, Burlington, ON, Canada.
Alexander RabinovichMcMaster University, 1280 Main St W, Hamilton, ON, Canada.
Robert McCormackUniversity of British Columbia, 2329 West Mall, Vancouver, BC, Canada.
Etienne L BelzileUniversity Laval, 1050 Avenue de la Medecine, Quebec City, QC, Canada.
Mohit BhandariMcMaster University, 1280 Main St W, Hamilton, ON, Canada.
McMaster University · CAUniversité Laval · CAUniversity of British Columbia · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeIntra-articular injections of corticosteroid (CS) and hyaluronic acid (HA) have individually demonstrated efficacy for knee osteoarthritis (OA); however, both treatments are limited by the trajectory of symptom relief. The combination of CS and HA in the management of knee OA may provide improved symptomatic relief for patients who are candidates for intra-articular therapies.

methodsElectronic databases Medline, EMBASE and Cochrane Library were used to identify relevant publications. Randomized controlled trials (RCT) that evaluated intra-articular injections of combined CS and HA in comparison to HA alone were included. Outcomes eligible for meta-analysis were WOMAC pain, WOMAC total, OMERACT-OARSI responder rate, and treatment-related adverse events. Standardized mean differences (SMD) were calculated for continuous outcomes using an inverse variance method and a random-effects model. Odds ratios (OR) were calculated for dichotomous outcomes using the Mantel-Haenszel method and a random-effects model. Heterogeneity was assessed using the I

resultsEight trials (n = 751 patients) were included. Reduction in WOMAC pain scores at 2-4 weeks favoured the combined CS and HA group compared to HA alone [SMD 0.60, 95% CI (0.23, 0.97); p = 0.002, I

conclusionCombined intra-articular injections of CS and HA led to reductions in pain at 2-4, 24-26 and 52 weeks compared to HA injections alone. LEVEL OF EVIDENCE: Level II-meta-analysis.

Indexed as

Adjuvants, ImmunologicArthralgiaDrug Therapy, CombinationGlucocorticoidsHumansHyaluronic AcidInjections, Intra-ArticularKnee JointOsteoarthritis, KneePain MeasurementAdjuvants, ImmunologicGlucocorticoidsHyaluronic AcidCombination therapyCorticosteroidHyaluronic acidKnee osteoarthritis

Identifiers

PMID30046992
OpenAlexW2883609079

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.