Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Jul-Aug;27(4):230-236.
doi: 10.1590/1413-785220192704218616.

BRAZILIAN CONSENSUS STATEMENT ON VISCOSUPPLEMENTATION OF THE KNEE (COBRAVI)

Gustavo Constantino de Campos  1 , Eduardo Branco de Sousa  2 , Paulo César Hamdan  3 , Cyro Scala de Almeida  4 , Antonio Martins Tieppo  4 , Marcia Uchôa de Rezende  5 , Adrieni Antunes do Amaral Alchaar  6 , Carlos Bruno Pinheiro  7 , Eduardo de Melo Carvalho Rocha  4 , Fabiano Gonçalves Cunha  8 , Ivan Pacheco  9 , Mário Sérgio Rossi Vieira  4 , Sílvio Figueira Antonio  10 , Zartur José Barcelos Menegassi  3
Affiliations
Review

BRAZILIAN CONSENSUS STATEMENT ON VISCOSUPPLEMENTATION OF THE KNEE (COBRAVI)

Gustavo Constantino de Campos et al. Acta Ortop Bras. 2019 Jul-Aug.

Abstract
in English, Portuguese

Objective: The aim of this consensus statement on viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability.

Methods: A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement.

Results: The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and viscosupplementation is cost-effective.

Conclusion: This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.

Objetivo: O Consenso Brasileiro de Viscossuplementação visa gerar uma fonte referencial e consensual, a partir de levantamentos bibliográficos relevantes, do conhecimento teórico e da experiência clínica de especialistas de áreas afins para tratamento de viscossuplementação na osteoartrite do joelho, mitigando pontos críticos desse procedimento, como via de aplicação, indicação, eficácia e tolerabilidade.

Métodos: Um painel multidisciplinar foi formado com dois médicos do esporte, seis ortopedistas, quatro fisiatras e dois reumatologistas, com base nas experiências clínica e acadêmica no uso da viscossuplementação. Foram elaboradas, discutidas e votadas 16 afirmativas. Cada membro do painel deu um valor entre zero e 10, em uma escala tipo Likert, especificando seu nível de concordância com a afirmação.

Resultados: O painel chegou a um consenso sobre diversos aspectos da viscossuplementação, com destaque para as seguintes afirmativas: a melhor indicação é para artrose de joelhos leve a moderada; o uso prévio ou concomitante de hexacetonido de triancinolona intra-articular pode otimizar o efeito do ácido hialurônico; a viscossuplementação não deve ser realizada como procedimento isolado no tratamento da OA, mas em conjunto com outras medidas reabilitadoras e farmacológicas; promove efeito analgésico; anti-inflamatório; condroprotetor; e é custo-efetiva.

Conclusão: Este consenso traz informações claras e servirá, como guia tanto para médicos quanto para as fontes pagadoras. Nível de evidência V, Consenso de especialistas.

Keywords: Knee; Osteoarthritis; Viscosupplementation.

PubMed Disclaimer

Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

References

    1. Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum. 2008;58(1):15–25. - PubMed
    1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26–35. - PMC - PubMed
    1. Global Burden of Disease Study 2013 Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. - PMC - PubMed
    1. Rezende MU, Campos GC. Viscosuplementation. Rev Bras Ortop. 2012;47(2):160–164. - PubMed
    1. Meyer K, Palmer JW. The polysaccharide of the vitreous humor. J Biol Chem. 1934;107(3):629–634.

LinkOut - more resources