Hyaluronan Injections in Athletes

Intra-articular and intra-bursal anti-inflammatory injections have always traditionally been a corticosteroid. However, there is mounting evidence that steroids provide no long term benefit and are detrimental to tendons and cartilage due to their proteolytic effects. Steroid injections are also prohibited under WADA regulations for professional athletes, requiring exemption approval for use in the athlete.

Injectable hyaluronans were originally marketed as a ‘lubricant’ for arthritis, and their efficacy well-proven. However, in vitro studies have shown that the major properties of the hyaluronans are anti-inflammatory, stimulating endogenous synovial fluid production and a barrier effect to pain receptors. It also has a pro-collagenous effect rather than proteolytic.

We have been using hyaluronans for intra-articular and intra-bursal injuries in athletes for three years now. It is beneficial for acute intra-articular soft tissue injuries of the shoulder or knee, such as labral or meniscal injuries; as well as early degenerative joints. It has been helpful to keep athletes playing through the season until definitive treatment is undertaken in the off-season. It is essential that major injuries requiring urgent repair be excluded before taking this route.