Efficacy of 3 Weekly Injections of Hyaluronate in Patients With Ankle Osteoarthritis

Inclusion Criteria: * were 18 years of age or older, reported unilateral ankle pain for at least 6 months and had either reported no significant benefit from conservative treatment (rest, physical therapy, orthoses or pain medications etc.) or were unable to tolerate side effects of medications * ankle radiographs taken within 6 months were equivalent to grade 2 or 3 according to the Kellgren-Lawrence grading system (grade 2, definite osteophytes and possible narrowing of joint space; grade 3, moderate multiple osteophytes, definite narrowing of joint space, some sclerosis and possible deformity of bone contour)22 * had a current total AOS score (described below) of \> 3 and \< 9 (possible range, 0-10) * were normally active, not bedridden or confined to a wheelchair, and were able to walk 30 meters without the aid of a walker, crutches or cane * were willing to discontinue all nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesic medication (except for rescue medication) for the duration of the study * did not receive physical therapy or trial of shoe modifications or orthotics during the study period Exclusion Criteria: * pregnant and lactating women * bilateral ankle OA requiring treatment of both ankles * chronic ankle instability * lower leg trauma other than within the ankle * previous orthopedic surgery on the spine, hip or knee * presence of active joint infections of foot or ankle * previous surgery or arthroscopy on the ankle within 12 months * intraarticular steroid or HA injection in the treated ankle within the past 6 months * treatment with anticoagulants or immunosuppressives * history of rheumatoid arthritis, gout, or any other inflammatory arthropathy * history of avian protein allergy * presence of other comorbidity (neoplasm, diabetes mellitus, paresis, recent trauma, etc) or poor health status that would interfere with the clinical assessments during the study