Ultrasound-guided intra-articular administration of hyaluronic acid (Monovisc/Cingal)
Ultrasound-Guided Intra-Articular Injection with Hyaluronic Acid (Monovisc or Cingal) is a minimally invasive procedure used to treat joint pain and stiffness caused by osteoarthritis or other inflammatory conditions.
The injection is administered directly into the joint cavity under real-time ultrasound guidance, ensuring maximum precision and even distribution of the substance. The procedure is safe, fast, and effective, providing stable and long-lasting results.
Hyaluronic acid is a natural substance physiologically present in the synovial fluid of joints, where it acts as a lubricant and shock absorber. Through viscosupplementation — the intra-articular injection of hyaluronic acid — the viscoelasticity of the synovial fluid is restored, friction between articular surfaces is reduced, pain and local inflammation decrease, and joint mobility improves significantly.
The therapeutic effect is maintained long-term, up to approximately 6 months after administration, depending on the preparation type and the patient’s clinical characteristics.
Types / Options of Intra-Articular Treatment
| Preparation | Composition and Mechanism | Main Benefits |
|---|---|---|
| Monovisc | Ultra-pure, non-avian hyaluronic acid with high molecular weight (~2.5–3 million Da), obtained by bacterial fermentation. | • Restores the viscoelasticity of synovial fluid, lubricates the joint, and reduces pain • Improves joint mobility for up to 6 months after a single injection • High molecular weight ensures prolonged persistence and superior cartilage protection • Non-avian origin eliminates the risk of allergic reactions. |
| Cingal | Combination of cross-linked hyaluronic acid (high molecular weight, ~2.4–3 million Da) and corticosteroid (triamcinolone hexacetonide). Cross-linking increases the stability and duration of action of the preparation. | • Rapid anti-inflammatory and analgesic effect due to the corticosteroid • Therapeutic effects maintained up to 6 months due to cross-linked hyaluronic acid • Provides long-lasting lubrication and cartilage protection • Non-avian origin minimizes the risk of allergic reactions. |
The choice of treatment type (Monovisc or Cingal) is made by the physician depending on the patient’s clinical condition and therapeutic goals:
Monovisc – for viscosupplementation and long-term improvement;
Cingal – for rapid anti-inflammatory effect + long-lasting benefits.
Role of the Procedure
- Ensures precise delivery of the active substance directly into the joint.
- Reduces pain and joint stiffness.
- Improves joint mobility and function.
- Minimizes the risk of vascular or nerve injury through ultrasound guidance.
- Provides an effective alternative to systemic therapy or early surgical interventions.
Indications
- Osteoarthritis of the knee, hip, or shoulder – for pain relief and increased mobility.
- Rheumatoid arthritis – as an adjuvant local therapy.
- Post-traumatic injuries – to restore function and reduce inflammation.
- Reactive synovitis – for local symptom control.
- In cases of insufficient response or intolerance to systemic anti-inflammatory therapy.
Preparation
- No special preparation is required (unless otherwise recommended by the physician).
- A light breakfast is allowed on the day of the procedure.
- The patient must inform the doctor about current treatments, especially anticoagulants and non-steroidal anti-inflammatory drugs (NSAIDs).
- A hygienic shower is recommended on the day of the procedure.
- No creams or ointments should be applied to the area where the injection will be performed.
Procedure
The procedure is performed under sterile conditions, with ultrasound guidance, and does not require hospitalization.
Using ultrasound imaging, the physician visualizes the joint and precisely inserts the needle and preparation into the joint cavity, ensuring maximum accuracy and safety of administration.
The average duration of the procedure is 15–30 minutes, and after the injection, the patient can resume normal activities on the same day.
Results and Benefits
- Rapid reduction of pain and inflammation
- Improved mobility and joint function
- Long-lasting effects up to 6 months
- Safe procedure with immediate recovery
- May delay the need for joint replacement surgery.
Ultrasound-guided intra-articular injection with hyaluronic acid (Monovisc or Cingal) is a modern, precise, and effective method for alleviating joint pain and stiffness.
By lubricating and protecting the cartilage, this procedure helps relieve symptoms, improve quality of life, and slow the progression of osteoarthritis.
Sources:
https://monovisc.ca/en/monovisc
https://www.cingal.com/why-cingal/next-generation-osteoarthritis-treatment/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10668939/
https://pmc.ncbi.nlm.nih.gov/articles/PMC6506808/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7931012/
Preparation:
No special training is required. A light diet is recommended on the day of the procedure. The patient must inform the doctor about chronic treatments (anticoagulants, anti-inflammatories, etc. ). Proper hygiene is recommended before the procedure.
