Efficacy of hyaluronic acid in rotator cuff pathology compared to other available treatment modalities: A Systematic Review and meta-analysis
Bibliographic record
Abstract
Purpose Rotator cuff tendinopathy is associated with decreased function and restricted range of motion (ROM) of the shoulder. Hyaluronic acid(HA) injections have been used for the management and pain relief. The objective of this study is to compare the efficacy of HA with steroids, Placebo(normal saline), physical therapy, Lignocaine, PRP, and ESWT. Methods PRISMA guidelines were followed for the literature search. The literature search was done on PubMed, Embase and Cochrane, using multiple search terms or derivatives until 20 th March 2023. 18 RCTs meeting the eligibility criteria were included. Quality assessment was done using the Newcastle Ottawa score and GRADE criteria and risk assessment using risk of bias 2 tool. Quantitative analysis was done on VAS and constant murphy score whereas Qualitative analysis was done on ROM, DASH, UCLA and ASES. The follow-up period was up to 12 months. Results Eighteen studies (1773 rotator cuffs) were pooled in the Systematic Review and Meta-analysis. GRADE assessment had high quality for VAS and Constant score. The Newcastle Ottawa Score ranged from 4 to 6. Significant improvement (p < 0.05) in VAS and constant murphy score was seen on comparing HA with Physical therapy and PRP on short-term follow-up(1 & 3 months) with insignificant results on comparing HA with placebo(normal saline) and steroids. Significant improvement in DASH scores on comparing HA with physiotherapy. No significant change was seen in ROM, UCLA and ASES scores on comparing HA with steroid injections. Conclusion Intra-articular HA injection in RC tendinopathy is associated with improved VAS score and functional outcome score. HA as well as steroids both are found to be effective with no significant difference. But the risk of complications is more with steroids as suggested by the literature. More specific RCT between the two might be needed to provide a clear picture in terms of both efficacy and complications. Level of evidence Therapeutic Level I. Study design Systematic Review and Meta-analysis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.020 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.023 | 0.035 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".