427 Form

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Pharmacy Medical Policy Injections for Osteoarthritis Table of Contents Authorization Information
Description
Appendix
Policy History
Coding Information
References Endnotes

Policy Number: 427 BCBSA Reference Number: 2.01.31 (For Plans internal use only) Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity

Note: All requests for outpatient retail pharmacy for indications listed and not listed on the medical policy guidelines may be submitted to BCBSMA Pharmacy Operations by completing the Prior Authorization Form on the last page of this document. Physicians may also call BCBSMA Pharmacy Operations department at (800)366-7778 to request a prior authorization/formulary exception verbally. Patients must have pharmacy benefits under their subscriber certificates.

Prior Authorization Information ☒ Prior Authorization ☐ Step Therapy ☐ Quality Care Dosing

Pharmacy Operations: Tel: 1-800-366-7778 Fax: 1-800-583-6289 Policy last updated 3/15/2026 Pharmacy (Rx) or Medical (MED) benefit coverage ☒ Rx ☐ MED To request for coverage: Physicians may call, fax, or mail the attached form (Formulary Exception/Prior Authorization form) to the address below.
Blue Cross Blue Shield of Massachusetts Pharmacy Operations Department 25 Technology Place Hingham, MA 02043

Individual Consideration: Policy for requests that do not meet clinical criteria of this policy, see section labeled Individual Consideration
Policy applies to Commercial Members:
• Managed Care (HMO/POS) • PPO/EPO
• Indemnity
Policy does NOT apply to: • Medicare Advantage

See APPENDIX for additional information on Formulary Status, Member Cost Share Considerations, Criteria Documentation, Sampling, Individual Consideration, Forms, and Specialty (if applicable).

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Please refer to the chart below for the formulary and step status of the medications affected by this policy. Drug Formulary Status
(BCBSMA Commercial Plan) Special Considerations Intra-articular Hyaluronan Injections Non-Formulary, Non-Covered Durolane (sodium hyaluronate)

NFNC, SPBO Euflexxa (sodium hyaluronate) Gel-One (cross-linked hyaluronate) Durolane (sodium hyaluronate) Euflexxa (sodium hyaluronate) Gel-One (cross-linked hyaluronate) Durolane (sodium hyaluronate) Euflexxa (sodium hyaluronate) Gel-One (cross-linked hyaluronate) Gel_Syn (sodium hyaluronate) Genvisc (sodium hyaluronate) Hyalgan (sodium hyaluronate) Hymovis (High Molecular Wt. Viscoelastic Hyaluronan) Hymovis One (hyaluronate intra-articular) Monovisc (High Molecular Wt. Viscoelastic Hyaluronan) Orthovisc (High Molecular Wt. Viscoelastic Hyaluronan) Supartz (sodium hyaluronate) Synojoynt (hyaluronan) Synvisc (hylan G-F 20) Synvisc-One (hylan G-F 20) Triluron (hyaluronan) Visco-3 (sodium hyaluronate) PA – Prior Authorization; NFNC – Non-formulary, Non-Covered; QCD (Quality Care Dosing – Refer to Policy 621b) Medical -- This medication is excluded from the pharmacy benefit. It may be covered by the medical benefit. SPBO: This medication is covered ONLY under the pharmacy benefit. (Refer to Policy 071)

This non covered drug policy is based upon the review of the Blue Cross Blue Shield Association’s Policy 2.01.31 Intra-Articular Hyaluronan Injections for Osteoarthritis which states: “Intra-articular hyaluronan injections of the knee are considered not medically necessary. Intra-articular hyaluronan injections are considered investigational for all other joints.” All FDA approved uses and off-label uses are not covered due to insufficient scientific data to show that health outcomes will be improved.

3 Description

Knee osteoarthritis (OA) is common, costly, and a cause of substantial disability. Among U.S. adults, the most common causes of disability are arthritis and rheumatic disorders. Currently, no curative therapy is available for OA, and thus the overall goals of management are to reduce pain, disability, and the need for surgery.
Intra-articular injection of hyaluronan has been proposed as a means of restoring the normal viscoelasticity of the synovial fluid in patients with OA and improving pain and function. This treatment may also be called viscosupplementation. Hyaluronan is a naturally occurring macromolecule that is a major component of synovial fluid and is thought to contribute to its viscoelastic properties. Chemical crosslinking of Hyaluronan increases its molecular weight; cross-linked hyaluronans are referred to as hylans. In OA, the overall length of HA chains present in cartilage and the HA concentration in the synovial fluid are decreased. Summary Intra-articular (IA) injection of hyaluronan into osteoarthritic joints is proposed to improve pain and function. It is thought to replace endogenous hyaluronan, restore the viscoelastic properties of the synovial fluid. Most studies to date have assessed hyaluronan injections for knee osteoarthritis, and this is the U.S. Food and Drug Administration−approved indication. Other joints (eg, hip, shoulder) are being investigated for IA hyaluronan treatment of osteoarthritis. The evidence for IA hyaluronan injections in individuals who have osteoarthritis of the knee includes randomized controlled trials (RCTs) and systematic reviews of RCTs. Relevant outcomes are symptoms, functional outcomes, and treatment-related morbidity. Many RCTs have been published over the last 2 decades. While outcomes of these RCTs are mixed, the RCT evidence base is characterized by studies that show small treatment effects of IA hyaluronan treatment. In many cases, these trials are at risk of bias, and it cannot be determined with certainty whether there is a true treatment effect or whether the reported differences are due to bias. Meta-analyses of RCTs have also resulted in mixed findings. Some meta-analyses estimating the magnitude of treatment benefit have concluded that there is no clinically significant benefit; however, others have concluded that there is a clinically significant benefit. These meta-analyses have also highlighted the limitations of this evidence base, most notably publication bias. Overall, given the lack of a definitive treatment benefit despite a large quantity of literature, and given the biases present in the available evidence, it is unlikely there is a treatment benefit that is clinically meaningful. The evidence is sufficient to determine qualitatively that the technology is unlikely to improve the net health outcome.
The evidence for IA hyaluronan injections in individuals who have osteoarthritis of joints other than the knee includes RCTs and systematic reviews of RCTs. Relevant outcomes are symptoms, functional outcomes, and treatment-related morbidity. Meta-analyses of RCTs either have not found statistically significant benefits of the technology on health outcomes or have found benefits that were statistically, but likely not clinically, significant (eg, 0.27-point improvement on a 10-point visual analog scale). The evidence is insufficient to determine the effects of the technology on health outcomes.

CPT Codes / HCPCs Codes / ICD Codes Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable.

The following codes are included below for informational purposes only; this is not an all-inclusive list.

The following HCPCS codes are considered investigational for Commercial Members: Managed Care (HMO and POS), PPO and Indemnity:

4 HCPCS Codes HCPCS codes: Code Description J7318 Hyaluronan or derivative, Durolane, for intra-articular injection, 1 mg J7320 Hyaluronan or derivative, Genvisc 850, for intra-articular injection, 1 mg J7321 Hyaluronan or derivative, Hyalgan or Supartz, for intra-articular J7322 Hyaluronan or derivative, Hymovis, for intra-articular injection, 1 mg J7323 Hyaluronan or derivative, Euflexxa, for intra-articular injection, per dose J7324 Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose J7325 Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg J7326 Hyaluronan or derivative, Gel-One, for intra-articular injection, per dose J7327 Hyaluronan or derivative, Monovisc, for intra-articular injection, per dose J7328 Hyaluronan or derivative, GELSYN-3, for intra-articular injection, 0.1 mg J7329 Hyaluronan or derivative, Trivisc, for intra-articular injection, 1 mg J7331 Hyaluronan or derivative, Synojoynt, for intra-articular injection, 1 mg J7332 Hyaluronan or derivative, Triluron, for intra-articular injection, 1 mg J7333 Hyaluronan or derivative, VISCO-3, for intra-articular injection, per dose

Appendix Formulary Status For non-covered medications, in addition to the prior authorization criteria, the member must also have had a previous treatment failure with, or contraindication to, at least two covered formulary alternatives when available. See section on individual consideration for more information if you require an exception to any of these criteria requirements for an atypical patient. Member cost share consideration A higher non-preferred cost share may be applied if an exception request is approved for coverage of a non-preferred or a non-formulary/non-covered drug. Criteria Documentation Provider must submit supporting documentation (e.g., chart notes, lab results or other clinical information) to show that the member has met all approval criteria. Forms To request prior authorization using the Massachusetts Standard Form for Medication Prior Authorization Requests (eForm), click the link below: https://www.bluecrossma.org/medical- policies/sites/g/files/csphws2091/files/acquiadam- assets/023%20E%20Form%20medication%20prior%20auth%20instruction%20prn.pdf OR Print and fax, Massachusetts Standard Form for Medication Prior Authorization Requests #434 Individual Consideration (for Atypical Patients) Our medical policies are written for most people with a given condition. Each policy is based on peer reviewed clinical evidence. We also take into consideration the needs of atypical patient populations and diagnoses.
If the coverage criteria outlined is unlikely to be clinically effective for the prescribed purpose, the health care provider may request an exception to cover the requested medication based on an individual’s unique clinical circumstances. This is also referred to as “individual consideration” or an “exception request.”
Some reasons why you may need us to make an exception include: therapeutic contraindications; history of adverse effects; expected to be ineffective or likely to cause harm (physical, mental, or adverse reaction).

5 To facilitate a thorough and prompt review of an exception request, we encourage the provider to include additional supporting clinical documentation with their request. This may include: • Clinical notes or supporting clinical statements; • The name and strength of formulary alternatives tried and failed (if alternatives were tried) and specifics regarding the treatment failure, if applicable; • Clinical literature from reputable peer reviewed journals; • References from nationally recognized and approved drug compendia such as American Hospital Formulary Service® Drug Information (AHFS-DI), Lexi-Drug, Clinical Pharmacology, Micromedex or Drugdex®; and • References from consensus documents and/or nationally sanctioned guidelines

Providers may call, fax or mail relevant clinical information, including clinical references for individual patient consideration, to:

Blue Cross Blue Shield of Massachusetts Pharmacy Operations Department 25 Technology Place Hingham, MA 02043 Phone: 1-800-366-7778 Fax: 1-800-583-6289 Samples Requests based exclusively on the use of samples will not meet coverage criteria for exception. Additional clinical information demonstrating medical necessity of the desired medication must be submitted by the requesting prescriber for review. Specialty Blue Cross Blue Shield of Massachusetts (BCBSMA*) members (other than Medex®; Blue MedicareRx, Medicare Advantage plans that include prescription drug coverage) obtaining the medication from the Pharmacy benefit instead of the Medical benefit will be required to fill their prescriptions for medications listed as specialty at one of the providers in our retail specialty pharmacy network, see link below: Link to Specialty Pharmacy List
Policy History Date Action 3/15/2026 Added Hymovis One to the policy and updated references. 11/2025 Annual review. Updated formatting and references.
7/2023 Reformatted Policy. 5/2021 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 6/2020 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 2/2020 Updated list of HCPCS codes. 10/2019 Add Triluron & Synojoynt to the policy with Med UM 5/2019 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 2/2019 Updated to include Trivisc. 1/2019 Clarified coding information. 5/2018 Updated to Include Durolane.

6 2/2018 Updated to Include Visco-3. 9/2017 Updated to clarified criteria. 6/2017 Updated address for Pharmacy Operations. 6/2016 Updated to include Hymovis®. 5/2016 Annual policy review. New references added. 1/2016 Updated Background (description) & Summary also include Gel-Syn® & GenVisc®. 10/2015 Updated to include updated language for Medications only available in the Pharmacy benefit. 7/2014 Updated policy after annual policy review.
1/2014 Updated coverage criteria to require use of Orthovisc, Synvisc or Synvisc-One prior to other products.
6/2012 Converted from a medical policy to a pharmacy medical policy. All prior authorization requests should be submitted to the Clinical Pharmacy Department. 4/2012 Updated with specialty pharmacy contact information. 11/2011-4/2012 Medical policy ICD 10 remediation: Formatting, editing and coding updates.
No changes to policy statements.
6/2011 Reviewed MPG – Orthopedics, Rehabilitation and Rheumatology, no changes in coverage were made.
3/2010 Updated to include prior authorization requirement for retail pharmacy requests. 7/2009 Updated to include Synvisc-One course information as discussed at MPG.
Reviewed MPG - Orthopedics, Rehabilitation Medicine, and Rheumatology, no changes in coverage were made. 9/2008 Policy updated to remove single treatment language for individual consideration. 7/2008 Reviewed 7/08 MPG- orthopedics, no changes in coverage were made. 5/2008 Updated to cover multiple courses of intra-articular hyaluronan injections of Hyalgan®, Euflexxa™ 3, Orthovisc®, Supartz® or Synvisc® when all of the stated criteria are met; policy updated with literature review; reference numbers 15–18 added; policy statements revised; multiple courses may be medically necessary.
7/2007 Reviewed MPG - Orthopedic/Rheumatology, no changes in coverage were made. 4/2007 Annual policy review. New references added.: additional references added and 2006 related summary of new references. 7/2006 Reviewed MPG - Orthopedic/Rheumatology, no changes in coverage were made. 6/2006 Updated to include Euflexxa and Orthovisc into coverage criteria. 9/2005 Annual policy review. New references added. 7/2005 Reviewed MPG-Orthopedic, no changes in coverage were made.
7/2004 Reviewed MPG Orthopedic, no changes in coverage were made.
7/2003 Reviewed MPG Orthopedic, no changes in coverage were made.
7/2002 Policy reviewed 7/02, (paper review), by representatives of the Massachusetts Orthopedic Association. No changes were recommended. 7/2001 Update to include coverage guidelines for Supartz. 7/2000 Reviewed 7/00, no changes in coverage were made.
10/1998 Updated to clarify that only one treatment course is allowed per knee; one course of treatment for Hyalgan is a series of five injections and one course of treatment for Synvisc is a series of three injections.
7/1998 New policy, issued 7/1998.

References

1. Agency for Healthcare Research and Quality. Evidence-based Practice Center Systematic Review Protocol: Treatment of Osteoarthritis of the Knee: An Update. 2016 July; https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/osteoarthritis-knee-update_research- protocol.pdf. Accessed March 11, 2025.
2. American Academy of Orthopaedic Surgeons. Management of glenohumeral joint osteoarthritis: evidence-based clinical practice guideline. 2020; https://www.aaos.org/globalassets/quality-and- practice-resources/glenohumeral/gjo-cpg.pdf. Accessed March 10, 2025.

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3. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Hip Evidence- Based Clinical Practice Guideline. 2023; https://www.aaos.org/globalassets/quality-and-practice- resources/osteoarthritis-of-the-hip/oah-cpg.pdf. Accessed March 11, 2025.
4. American Academy of Orthopaedic Surgeons. Management of osteoarthritis of the knee (non- arthroplasty): Evidence-based clinical practice guidelines. 3rd Edition. 2021; https://aaos.org/globalassets/quality-and-practice-resources/osteoarthritis-of-the- knee/oak3cpg.pdf. Accessed March 9, 2025.
5. American Academy of Orthopaedic Surgeons. The treatment of glenohumeral joint osteoarthritis: guideline and evidence report. 2009; https://www.aaos.org/globalassets/quality-and-practice- resources/glenohumeral/glenohumal-joint-osteoarthritis-clinical-practice-guideline-4-24-19.pdf. Accessed March 8, 2025.
6. American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee: Evidence- based guidelines. 2nd Edition. 2013; https://www.aaos.org/globalassets/quality-and-practice- resources/osteoarthritis-of-the-knee/osteoarthritis-of-the-knee-2nd-editiion-clinical-practice- guideline.pdf. Accessed March 7, 2025.
7. Ammar TY, Pereira TA, Mistura SL, et al. Viscosupplementation for treating knee osteoarthrosis: review of the literature. Rev Bras Ortop. 2015; 50(5): 489-94. PMID 26535192
8. Askari A, Gholami T, NaghiZadeh MM, et al. Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomized control trail. Springerplus. 2016; 5: 442. PMID 27104130
9. Bannuru RR, Natov NS, Dasi UR, et al. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis. Osteoarthritis Cartilage. Jun 2011; 19(6): 611-
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12. PMID 31278997
13. Bannuru RR, Schmid CH, Kent DM, et al. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. Jan 06 2015; 162(1): 46-54. PMID 25560713
14. Blaine T, Moskowitz R, Udell J, et al. Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am. May 2008; 90(5): 970-9. PMID 18451387
15. Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Intra-Articular Hyaluronan Injections for Treatment of Osteoarthritis of the Knee. TEC Assessments 1998;Volume 13:Tab 17.
16. Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Intra-articular hyaluronic acid for osteoarthritis of the knee. TEC Assessments. 2014;Volume 29:Tab 6.
17. Colen S, Geervliet P, Haverkamp D, et al. Intra-articular infiltration therapy for patients with glenohumeral osteoarthritis: A systematic review of the literature. Int J Shoulder Surg. Oct 2014; 8(4): 114-21. PMID 25538430
18. Colen S, van den Bekerom MP, Mulier M, et al. Hyaluronic acid in the treatment of knee osteoarthritis: a systematic review and meta-analysis with emphasis on the efficacy of different products. BioDrugs. Aug 01 2012; 26(4): 257-68. PMID 22734561
19. Familiari F, Ammendolia A, Rupp MC, et al. Efficacy of intra-articular injections of hyaluronic acid in patients with glenohumeral joint osteoarthritis: A systematic review and meta-analysis. J Orthop Res. Nov 2023; 41(11): 2345-2358. PMID 37314198
20. Farr J, Gomoll AH, Yanke AB, et al. A Randomized Controlled Single-Blind Study Demonstrating Superiority of Amniotic Suspension Allograft Injection Over Hyaluronic Acid and Saline Control for Modification of Knee Osteoarthritis Symptoms. J Knee Surg. Nov 2019; 32(11): 1143-1154. PMID 31533151
21. Gazendam A, Ekhtiari S, Bozzo A, et al. Intra-articular saline injection is as effective as corticosteroids, platelet-rich plasma and hyaluronic acid for hip osteoarthritis pain: a systematic review and network meta-analysis of randomised controlled trials. Br J Sports Med. Mar 2021; 55(5): 256-261. PMID 32829298
22. Hermans J, Bierma-Zeinstra SMA, Bos PK, et al. The effectiveness of high molecular weight hyaluronic acid for knee osteoarthritis in patients in the working age: a randomised controlled trial. BMC Musculoskelet Disord. May 07 2019; 20(1): 196. PMID 31064359
23. Hymovis One [package insert]. Florham Park, NJ: Fidia Pharma USA.; March 2025.

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22. Jevsevar D, Donnelly P, Brown GA, et al. Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence. J Bone Joint Surg Am. Dec 16 2015; 97(24): 2047-60. PMID 26677239
23. Johansen M, Bahrt H, Altman RD, et al. Exploring reasons for the observed inconsistent trial reports on intra-articular injections with hyaluronic acid in the treatment of osteoarthritis: Meta- regression analyses of randomized trials. Semin Arthritis Rheum. Aug 2016; 46(1): 34-48. PMID 27139169
24. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. Feb 2020; 72(2): 220-233. PMID 31908163
25. Kroon FP, Rubio R, Schoones JW, et al. Intra-Articular Therapies in the Treatment of Hand Osteoarthritis: A Systematic Literature Review. Drugs Aging. Feb 2016; 33(2): 119-33. PMID 26650235
26. Kroon FPB, Carmona L, Schoones JW, et al. Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis. RMD Open. 2018; 4(2): e000734. PMID 30402266
27. Kwon YW, Eisenberg G, Zuckerman JD. Sodium hyaluronate for the treatment of chronic shoulder pain associated with glenohumeral osteoarthritis: a multicenter, randomized, double- blind, placebo-controlled trial. J Shoulder Elbow Surg. May 2013; 22(5): 584-94. PMID 23333168
28. Liao YY, Lin T, Zhu HX, et al. Intra-Articular Viscosupplementation for Patients with Hip Osteoarthritis: A Meta-Analysis and Systematic Review. Med Sci Monit. Aug 27 2019; 25: 6436-
29. PMID 31454342
30. Lieberman JR, Engstrom SM, Solovyova O, et al. Is intra-articular hyaluronic acid effective in treating osteoarthritis of the hip joint?. J Arthroplasty. Mar 2015; 30(3): 507-11. PMID 25542833
31. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. Mar 2014; 22(3): 363-88. PMID 24462672
32. Migliore A, Giovannangeli F, Bizzi E, et al. Viscosupplementation in the management of ankle osteoarthritis: a review. Arch Orthop Trauma Surg. Jan 2011; 131(1): 139-47. PMID 20697901
33. Migliorini F, Maffulli N, Schäfer L, et al. Less Pain with Intra-Articular Hyaluronic Acid Injections for Knee Osteoarthritis Compared to Placebo: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Pharmaceuticals (Basel). Nov 20 2024; 17(11). PMID 39598466
34. Miller LE, Block JE. 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. Clin Med Insights Arthritis Musculoskelet Disord. 2013; 6: 57-63. PMID 24027421
35. Miller LE, Fredericson M, Altman RD. Hyaluronic Acid Injections or Oral Nonsteroidal Anti- inflammatory Drugs for Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Trials. Orthop J Sports Med. Jan 2020; 8(1): 2325967119897909. PMID 32047830
36. Munteanu SE, Zammit GV, Menz HB, et al. Effectiveness of intra-articular hyaluronan (Synvisc, hylan G-F 20) for the treatment of first metatarsophalangeal joint osteoarthritis: a randomised placebo-controlled trial. Ann Rheum Dis. Oct 2011; 70(10): 1838-41. PMID 21791454
37. National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management [NG226]. 2022; https://www.nice.org.uk/guidance/ng226. Accessed March 11,
39. Newberry SJ, Fitzgerald JD, Maglione MA, et al. Systematic Review for Effectiveness of Hyaluronic Acid in the Treatment of Severe Degenerative Joint Disease (DJD) of the Knee. Rockville, MD: Agency for Healthcare Research and Quality; 2015.
40. O'Hanlon CE, Newberry SJ, Booth M, et al. Hyaluronic acid injection therapy for osteoarthritis of the knee: concordant efficacy and conflicting serious adverse events in two systematic reviews. Syst Rev. Nov 04 2016; 5(1): 186. PMID 27814744
41. Paget LDA, Mokkenstorm MJ, Tol JL, et al. What Is the Efficacy of Intra-articular Injections in the Treatment of Ankle Osteoarthritis? A Systematic Review. Clin Orthop Relat Res. Sep 01 2023; 481(9): 1813-1824. PMID 37039814
42. Pereira TV, Jüni P, Saadat P, et al. Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis. BMJ. Jul 06 2022; 378: e069722. PMID 36333100

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41. Petterson SC, Plancher KD. Single intra-articular injection of lightly cross-linked hyaluronic acid reduces knee pain in symptomatic knee osteoarthritis: a multicenter, double-blind, randomized, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. Jun 2019; 27(6): 1992-2002. PMID 30159738
42. Phillips M, Vannabouathong C, Devji T, et al. Differentiating factors of intra-articular injectables have a meaningful impact on knee osteoarthritis outcomes: a network meta-analysis. Knee Surg Sports Traumatol Arthrosc. Sep 2020; 28(9): 3031-3039. PMID 31897550
43. Ran J, Yang X, Ren Z, et al. Comparison of intra-articular hyaluronic acid and methylprednisolone for pain management in knee osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg. May 2018; 53: 103-110. PMID 29574247
44. Richette P, Chevalier X, Ea HK, et al. Hyaluronan for knee osteoarthritis: an updated meta- analysis of trials with low risk of bias. RMD Open. 2015; 1(1): e000071. PMID 26509069
45. Riley N, Vella-Baldacchino M, Thurley N, et al. Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis. BMJ Open. Sep 11 2019; 9(9): e027507. PMID 31511280
46. Rutjes AW, Jüni P, da Costa BR, et al. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. Aug 07 2012; 157(3): 180-91. PMID 22868835
47. Samson DJ, Grant MD, Ratko TA, et al. Treatment of primary and secondary osteoarthritis of the knee (Evidence Reports/Technology Assessments No. 157). Rockville, MD: Agency for Healthcare Research and Quality; 2007.
48. Silverstein E, Leger R, Shea KP. The use of intra-articular hylan G-F 20 in the treatment of symptomatic osteoarthritis of the shoulder: a preliminary study. Am J Sports Med. Jun 2007; 35(6): 979-85. PMID 17395958
49. Strand V, McIntyre LF, Beach WR, et al. Safety and efficacy of US-approved viscosupplements for knee osteoarthritis: a systematic review and meta-analysis of randomized, saline-controlled trials. J Pain Res. 2015; 8: 217-28. PMID 26005358
50. Tammachote N, Kanitnate S, Yakumpor T, et al. Intra-Articular, Single-Shot Hylan G-F 20 Hyaluronic Acid Injection Compared with Corticosteroid in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial. J Bone Joint Surg Am. Jun 01 2016; 98(11): 885-92. PMID 27252432
51. Trellu S, Dadoun S, Berenbaum F, et al. Intra-articular injections in thumb osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Joint Bone Spine. Oct 2015; 82(5): 315-9. PMID 25776442
52. Trojian TH, Concoff AL, Joy SM, et al. AMSSM scientific statement concerning viscosupplementation injections for knee osteoarthritis: importance for individual patient outcomes. Br J Sports Med. Jan 2016; 50(2): 84-92. PMID 26729890
53. Vannabouathong C, Del Fabbro G, Sales B, et al. Intra-articular Injections in the Treatment of Symptoms from Ankle Arthritis: A Systematic Review. Foot Ankle Int. Oct 2018; 39(10): 1141-
54. PMID 29909689
55. Wang F, He X. Intra-articular hyaluronic acid and corticosteroids in the treatment of knee osteoarthritis: A meta-analysis. Exp Ther Med. Feb 2015; 9(2): 493-500. PMID 25574222
56. Witteveen AG, Hofstad CJ, Kerkhoffs GM. Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle. Cochrane Database Syst Rev. Oct 17 2015; 2015(10): CD010643. PMID 26475434
57. Wu B, Li YM, Liu YC. Efficacy of intra-articular hyaluronic acid injections in hip osteoarthritis: a meta-analysis of randomized controlled trials. Oncotarget. Oct 17 2017; 8(49): 86865-86876. PMID 29156841
58. Zhang B, Thayaparan A, Horner N, et al. Outcomes of hyaluronic acid injections for glenohumeral osteoarthritis: a systematic review and meta-analysis. J Shoulder Elbow Surg. Mar 2019; 28(3): 596-606. PMID 30502030
59. Zhao Z, Ma JX, Ma XL. Different Intra-articular Injections as Therapy for Hip Osteoarthritis: A Systematic Review and Network Meta-analysis. Arthroscopy. May 2020; 36(5): 1452-1464.e2. PMID 31919027