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. 2025 Mar 29:19476035241286578.
doi: 10.1177/19476035241286578. Online ahead of print.

EUROVISCO Good Medical Practice Recommendations for the Use of Viscosupplementation with Hyaluronic Acid in the Management of Knee Osteoarthritis

Jordi Monfort  1 , Yves Henrotin  2   3 , Xavier Chevalier  4 , Alberto Migliore  5 , Dominique Baron  6 , Jörg Jerosch  7 , Pascal Richette  8 , Hervé Bard  9 , Mats Brittberg  10 , Demirhan Diraçoglù  11 , Raghu Raman  12 , Thierry Conrozier  13
Affiliations

EUROVISCO Good Medical Practice Recommendations for the Use of Viscosupplementation with Hyaluronic Acid in the Management of Knee Osteoarthritis

Jordi Monfort et al. Cartilage. .

Abstract

Objective: Viscosupplementation (VS) by intra-articular injections of hyaluronic acid (HA) is a commonly used treatment of knee osteoarthritis. However, there are no clear recommendations for its use in clinical situations not usually addressed in therapeutic guidelines.

Design: Members of the European Viscosupplementation Consensus Group (EUROVISCO), made up of rheumatologists, orthopedic surgeons, and rehabilitation physicians from seven European countries, were asked to make a therapeutic decision on 30 clinical scenarios based on their clinical experience and data from the literature, using the Delphi method. For each scenario, the strength of agreement and the level of consensus were calculated by the chairman of the group.

Results: The expert panel reached consensus on 18 of the 30 clinical scenarios proposed. According to the experts, the factors that most influence the decision to use VS with HA to treat knee osteoarthritis are the nature and severity of symptoms, the presence of comorbidity, the absence of therapeutic alternatives, and the patient's refusal to undergo knee arthroplasty. Obesity and an advanced radiological degree of osteoarthritis have been identified as the two main factors for poor response to VS with HA and should be considered before any decision is made to viscosupplement.

Conclusion: This set of recommendations, based on common clinical scenarios, is intended to help practitioners make decisions about HA VS in patients with osteoarthritis of the knee.

Keywords: EUROVISCO; clinical scenario; hyaluronic acid; knee; osteoarthritis; recommendations; viscosupplementation.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Yves Henrotin: Received honorarium from Menarini, Flexion therapeutics, IBSA, Bioiberica, Expansciences, Royal Canin, MagPharm, Pfizer, Fidia, LABRHA, and Tilman SA, Grunenthal, Artialis, Kiomed pharma, and Genequine for consultant services. Pascal Richette: Received fees from BioIbérica, Fidia, IBSA, Expanscience, Genévrier, Sanofi, Rottapharm, Servier, Flexion Therapics, and Ménarini. Hervé Bard: Received speaker and expert fees from Sanofi, Pfizer, Labrha, Expanscience, and TRB Chemedica. Thierry Conrozier: Received honorarium from Sanofi, MEDAC, Fidia, and Labrha for expert or consultant services. Xavier Chevalier: Received fees as a Genevrier Board member, Sanofi-Aventis expert, member of the IBSA Foundation, speaker in IBSA and Labrha meetings, and Moebius and Flexion therapist consultant. Alberto Migliore: Received consulting fees from Abbvie, BMS, MSD, Fidia, Sanofi, IBSA, Pfizer, and Labrha, for national and international studies and courses. Jordy Monfort: Received consulting fees from Sanofi and Bioiberica. Dominique Baron: Received speaker fees from LCA and Expansciences. Demirhan Diraçoglu: Received speaker fees from LABRHA. Mats Brittberg is a Member Advisory board of: Episurf Medical AB, Xintela AB, Magellan Stem Cells PTY LTD, Cline Scientific AB, Askel Healthcare LTD, Vanarix SA. Participation Speaker’s bureau for Arthrex and for Anika Therapeutics. Member editorial board Osteoarthritis & Cartilage, Editor-in-Chief CARTILAGE.

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