Viscosupplementation (Gel Injections)

What is Viscosupplementation?

Viscosupplementation refers to the injection of a substance called hyaluronic acid into the knee joint. Viscosupplementation is often referred to as “gel injections” or “rooster comb injections.

Hyaluronic acid is a natural substance present in the fluid of normal, healthy joints that assists in lubrication. It allows smooth movement of the cartilage covered articulating surfaces of the joint. Patients that have osteoarthritis have decreased quality and quantity of hyaluronic acid. With less hyaluronic acid, there is a loss of lubrication and protection of the joint which leads to more pain.

Indications of Viscosupplementation

Viscosupplementation is recommended for the management of knee osteoarthritis that has not responded to non-surgical treatment options such as pain medications, physical therapy and corticosteroid injections.

Viscosupplementation Procedure

Viscosupplementation can provide symptomatic relief and delay the need for surgery. It is injected directly into the knee joint to replenish the diminished joint fluid, thereby enhancing its lubricating properties. The injections are available as a single dose or as total of 3-5 separate weekly doses. Viscosupplementation is usually covered by insurance companies and allow for treatment every 6 months.

How does Viscosupplementation Work?

Viscosupplementation not only supplements the hyaluronic acid in the joint but also stimulates the production of new, healthy hyaluronic acid in the treated knee which provides gradual symptomatic relief. Most patients start to notice improvement 3 weeks after the first injection and this effect may last for several months. The more advanced the arthritis, the less likely the injections are to work.

The most recent research, however, has not found viscosupplementation to be effective at significantly reducing pain or improving function. Although some patients report pain relief with the procedure, some people are not helped by the injections.

Post-procedural Care Following Viscosupplementation

Ice packs and pain medication may be used, if required, to ease the discomfort. Any strenuous activity such as jogging or tennis should be completely avoided for 48 hours to a week after the injection and should be resumed only after consultation with your doctor.

Am I a Candidate for Viscosupplementation?

Most patients are candidates for viscosupplementation. Dr. Makda performs a physical examination, reviews your x-rays and medical history, and discusses your treatment options. To find out if you are a candidate, schedule an appointment with Dr. Makda at