From the Guidelines
Monovisc may be considered for pain management after an ACL tear, but it's not a primary treatment for the injury itself. Monovisc is a single-injection hyaluronic acid viscosupplement that can help reduce pain and improve joint function in patients with osteoarthritis. For an ACL tear, the standard treatment typically involves physical therapy, bracing, and possibly surgical reconstruction depending on the severity of the tear and the patient's activity level. If you're experiencing pain from associated osteoarthritis or cartilage damage following an ACL tear, Monovisc might be prescribed as a complementary treatment. The injection delivers hyaluronic acid directly to the knee joint, which acts as a lubricant and shock absorber, potentially reducing pain for up to 6 months. However, this should be discussed with your orthopedic surgeon or sports medicine physician, as they will need to evaluate whether you're an appropriate candidate based on your specific injury pattern, activity goals, and overall knee health. Viscosupplementation like Monovisc works best when used as part of a comprehensive treatment plan that addresses the underlying ACL injury, as supported by recent guidelines such as the 2023 Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction 1.
Some key points to consider in the management of ACL tears include:
- The use of autograft over allograft to improve patient outcomes and decrease ACL graft failure rate, particularly in young and/or active patients, as recommended by the American Academy of Orthopaedic Surgeons clinical practice guideline summary: management of anterior cruciate ligament injuries 1.
- The importance of a comprehensive rehabilitation program that includes physical therapy, strength training, and neuromuscular training, as outlined in the 2023 Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction 1.
- The potential benefits and risks of different treatment options, including surgical reconstruction, physical therapy, and viscosupplementation, as discussed in the evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus 1.
Ultimately, the decision to use Monovisc or any other treatment for an ACL tear should be made in consultation with an orthopedic surgeon or sports medicine physician, taking into account the individual patient's needs and circumstances, and based on the most recent and highest-quality evidence available, such as the 2023 Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction 1.
From the Research
Monovisc After ACL Tear
- Monovisc, a type of hyaluronic acid (HA), has been studied as a potential treatment for ACL tears to reduce inflammatory stress and improve articular function 2.
- A randomized controlled trial found that a single injection of HA after ACL reconstruction improved active range of motion and reduced transpatellar circumference, but did not lead to significant improvement in clinical scores 2.
- Another study found that arthroscopic anterior cruciate ligament reconstruction combined with sodium hyaluronate improved knee function and reduced inflammatory markers in ACL injury patients with or without knee osteoarthritis 3.
- The optimal treatment for ACL tears depends on patient-specific factors, including age, occupation, and desired activity level, and may involve nonoperative management, ACL reconstruction, or a combination of both 4, 5.
- HA therapy has been shown to result in improved functional and muscle peak torque outcomes in ACL rehabilitation, with the best results occurring when HA is administered 8 weeks after surgery 6.
Treatment Options
- Nonoperative management, consisting of physical therapy, bracing, and activity modification, may be suitable for less active patients with sedentary jobs 5.
- ACL reconstruction is recommended for active patients who want to resume participation in jumping, cutting, or pivoting sports, or for patients who have physically demanding occupations 5.
- Arthroscopic anterior cruciate ligament reconstruction combined with sodium hyaluronate may be an effective treatment option for ACL injury patients with or without knee osteoarthritis 3.
Rehabilitation
- Rehabilitation programs for ACL tears should be tailored to the individual patient's needs and goals, and may involve a combination of physical therapy, bracing, and activity modification 4, 5.
- HA therapy may be a useful adjunct to rehabilitation programs, particularly when administered 8 weeks after surgery 6.