The primary objective was to demonstrate the safety and effectiveness of Monovisc™ in the relief of joint pain in patients with idiopathic knee OA compared to saline injection. It was hypothesized that patient success, defined as ≥ 50% improvement from baseline and ≥ 20 mm absolute improvement from baseline in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) visual analog scale (VAS) pain score, would be greater in the Monovisc™ group compared to the Saline control group.
In this multicenter, double-blind, randomized, placebo-controlled trial, patients with idiopathic, symptomatic, knee OA were randomized to either 4 ml single injection of Monovisc™ or 4 ml injection of 0.9% saline. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess patient outcomes at 2, 4, 8, 12, 20, and 26 weeks post-injection. The primary effectiveness endpoint was a 50% improvement and ≥ 20 mm improvement from baseline in the WOMAC pain through 26 weeks. Secondary outcome measures included a ≥ 20 mm improvement from baseline on the WOMAC physical function, patient global assessment, evaluator global assessment, and knee range of motion.
369 patients (154 male, 215 female) were randomized to either Monovisc™ or saline. The Monovisc™ group had a significantly greater rate of patient success (e.g. ≥ 50% improvement and ≥ 20 mm absolute improvement from baseline in the WOMAC pain through Week 26) compared to saline (p = 0.043).
Monovisc™, a single-injection intra-articular HA device, is a safe and effective treatment for providing a clinically meaningful reduction in knee pain within 2 weeks. The results of this study support the use of a single injection of hyaluronic acid (Monovisc™) for patients with symptomatic knee OA in patients older than 45 years, as a safe and effective alternative for patients who may want an alternative treatment modality or may not be candidates for partial or total knee replacement.
Level of evidence
I, multicenter, double-blind, randomized, placebo-controlled trial.
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Western Ontario and McMaster Universities Osteoarthritis Index
Visual analog scale
Non-steroidal anti-inflammatory medications
United States dollar
American Academy of Orthopaedics
Institutional Review Board
Good clinical practice
International Conference on Harmonization
Body mass index
Medical Dictionary for Regulatory Activities
Generalized estimating equations
Minimum clinically important differences
Range of motion
American College of Rheumatology
Osteoarthritis Research Society International
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The authors would like to personally thank all the principal investigators and study coordinators for their help with subject recruitment and data collection. Special thanks go to Dr. Baraf, Dr. Covall, Dr. Kivitz, and Dr. Neustadt for their assistance in the completion of this manuscript and to Gary Stevens for his assistance with the data analysis.
This manuscript is based upon clinical trial results from a study sponsored by Anika Therapeutics.
Conflict of interest
Grants or other financial support were received from Anika Therapeutics.
Ethics committee approvals were obtained.
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Petterson, S.C., Plancher, K.D. 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 27, 1992–2002 (2019). https://doi.org/10.1007/s00167-018-5114-0
- Hyaluronic acid
- Knee osteoarthritis
- Intra-articular injection
- Knee joint pain