
The systematic review included 182 studies exploring the mechanisms of action (MoAs) of intra-articular hyaluronic acid (IAHA) for knee osteoarthritis (OA). Of these, 107 reported chondroprotective action, 59 anti-inflammatory activity, 18 analgesic properties, 30 proteoglycan or glycosaminoglycan synthesis, 8 subchondral bone effects, 2 mechanical effects, and 1 other effect of IAHA. IAHA demonstrated increased collagen types II, IX, and XI and reduced matrix metalloproteinases, alleviating knee pain and improving knee function.
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