Managing knee osteoarthritis (OA) pain is a significant challenge in clinical practice, impacting patient mobility and quality of life. When foundational therapies fall short, intra-articular viscosupplementation with hyaluronic acid (HA) is a well-established treatment option. Among the available HA products, Monovisc® (by Anika Therapeutics) stands out due to its single-injection administration protocol and non-avian derived source. This guide provides practitioners with a clinical overview of Monovisc®, detailing its composition, mechanism, clinical applications, efficacy, and safety considerations.

This information is intended for trained medical professionals experienced in intra-articular injection techniques. Adherence to product Instructions is mandatory. This content is not a substitute for specific formal training.

Understanding Monovisc®: Composition and Single-Injection Design

Monovisc® is a 1% Sodium Hyaluronate solution (10 mg/mL) containing 44mg of highly purified, partially cross-linked Sodium Hyaluronate in a 4mL syringe. A notable characteristic is its non-avian source, being produced via bacterial fermentation. This eliminates the theoretical risk of allergic reactions related to avian proteins that can be present in some other HA products.

The formulation, particularly the partial cross-linking and the 4mL volume, is specifically designed to deliver a sufficient dose of HA in a single injection to achieve a clinically meaningful duration of effect, providing convenience for both practitioners and patients compared to multi-injection regimens.

Mechanism of Action: How Monovisc® Works

The primary mechanism of Monovisc® is viscosupplementation. In an osteoarthritic knee, the natural HA in the synovial fluid is often degraded and depleted, leading to reduced viscosity and elasticity. Injecting Monovisc aims to:

• Supplement Synovial Fluid: Increase the concentration of HA within the joint.
• Restore Viscoelastic Properties: Help return the synovial fluid to a more gel-like state, enhancing its ability to act as a lubricant and shock absorber.
• Reduce Friction and Cushion: By restoring these properties, Monovisc helps reduce friction between the articulating surfaces of the knee and provides cushioning during movement and weight-bearing.

While the primary benefits are thought to be mechanical (lubrication and shock absorption), research also explores potential biological effects of HA, such as modulating inflammation and potentially supporting the health of the joint cartilage, contributing to overall pain relief and improved function.

Clinical Applications and Patient Selection

Monovisc® is specifically indicated for the treatment of pain associated with osteoarthritis (OA) of the knee. It is not typically used or indicated for other joints.

• Target Patient Profile: It is suitable for patients with symptomatic mild to moderate knee OA who experience pain and stiffness and have not achieved adequate relief from conservative non-pharmacologic therapy and simple analgesics (e.g., acetaminophen).
• Contraindications: Practitioners must carefully review and adhere to the product IFU for contraindications. These typically include known hypersensitivity to hyaluronan preparations. The presence of active knee joint infections or skin diseases/infections in the area of the injection site are absolute contraindications due to the severe risk of septic arthritis. Caution may be advised in patients with bleeding disorders.

Administration Technique and Protocol (Single Injection)

A key advantage of Monovisc® is its simplified administration protocol:

• Single Injection: The recommended protocol is a single 4mL intra-articular injection administered directly into the intra-articular space of the knee joint.
• Aseptic Technique: Strict aseptic technique is absolutely mandatory for every intra-articular injection to prevent the devastating complication of septic arthritis. This involves thorough skin preparation, using sterile gloves, sterile single-use needles/syringes, and maintaining a sterile field.
• Injection Procedure: Utilize a standard intra-articular knee injection technique (e.g., superolateral, anteromedial) to ensure accurate placement within the joint space. If significant joint effusion is present, it should generally be removed via arthrocentesis using a separate syringe and needle before injecting Monovisc®. Always refer to the specific Monovisc® IFU provided with the product for detailed injection guidelines and recommended needle size.

Clinical Efficacy and Expected Outcomes

Monovisc® has been evaluated in clinical trials for its efficacy in treating knee OA pain. Studies have demonstrated that a single 4mL injection of Monovisc® provides significant pain reduction and improvement in joint function in appropriately selected patients compared to control groups (like saline injections). The duration of pain relief is typically cited as lasting up to 6 months following the single injection, although individual patient response and the longevity of benefit are variable. Patients may begin to experience relief within a few weeks after the injection.

It is important to manage patient expectations; Monovisc® provides symptomatic relief and may improve joint function and mobility, but it does not halt or reverse the underlying osteoarthritic process.

Safety Profile and Potential Side Effects

Monovisc® is generally considered safe and well-tolerated based on clinical trials and use. Adverse events are typically local and temporary:

• Common Adverse Events: The most frequently reported side effects are transient injection site reactions such as pain, swelling, joint effusion, stiffness, and redness at the injection site. These are usually mild to moderate and resolve within a few days. Arthralgia (joint pain) in the injected knee or other limbs may also occur.
• Serious Risks (CRITICAL):
  • Septic Arthritis: Infection within the joint space. Though rare, it is the most severe potential complication of any intra-articular injection and requires immediate medical management. Strict aseptic technique is the most crucial preventative measure.
  • Hypersensitivity/Allergic Reactions: Although rare, can occur with any injectable product. The non-avian source of Monovisc® reduces the risk of reactions related to avian proteins.
  • Severe inflammatory reactions (Pseudo-sepsis): A rare, non-infectious reaction that can mimic septic arthritis.

Practitioners must be prepared to recognize and manage potential side effects and complications promptly. Always consult the full product Instructions For Use relevant to your region for comprehensive safety information.

Post-Injection Care

Advise patients on standard post-injection care to maximize benefits and minimize discomfort:

• Immediate Aftercare: Recommend relative rest of the joint for 24-48 hours following the injection. Avoid strenuous activity or heavy weight-bearing.
• Managing Reactions: Local reactions (pain, swelling) can often be managed with ice application and simple over-the-counter analgesics if needed.

Sourcing Authentic Monovisc®

Ensuring the authenticity, sterility, and quality of Monovisc® is paramount for patient safety and treatment efficacy. Always purchase genuine Monovisc® from well-established suppliers. Be vigilant against counterfeit or improperly stored medical injectables, as they pose significant risks.

Conclusion

Monovisc® provides a convenient single-injection HA solution for knee OA, delivering symptomatic relief for up to 6 months. Success depends on proper patient selection, aseptic technique, and accurate injection. Its single-dose protocol enhances patient convenience while reducing clinic visits.

Doris Dickson

About the Author: Doris Dickson is a specialist writer for Health Supplies Plus, focusing on the aesthetic medicine industry. She diligently researches cosmetic treatments and products to provide clear, concise information relevant to licensed medical professionals. Her work supports Health Supplies Plus’s commitment to being a reliable informational resource and trusted supplier for the aesthetic community.

 

Disclaimer: The content provided in this article is intended for informational purposes only and is directed towards licensed medical professionals. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment, nor does it constitute an endorsement of any specific product or technique. Practitioners must rely on their own professional judgment, clinical experience, and knowledge of patient needs, and should always consult the full product prescribing information and relevant clinical guidelines before use. Health Supplies Plus does not provide medical advice.