Visco-supplementation or “Rooster Comb” Injections for Knee Pain
If you are feeling chicken about having knee surgery, you may want to consider “chicken shots” into your knee joints! The technical term for this procedure is “Visco-Supplementation”, and refers to injection of a substance called Hyaluronic Acid into the knee joint. Hyaluronic acid (HA) acts like oil to lubricate your knee, and when injected either with a single injection or with the series of injections, can help to provide long-term pain relief for patients suffering with chronic arthritis–related knee pain. Historically, patients have referred to these injections as ‘chicken shots’ because in the past, HA was derived from the combs on the back of roosters’ heads. Thankfully, we have come a long way since the early days of HA therapy and most of the HA used these days is synthetic. So, all you barnyard roosters out there can relax!
It is a temporary replacement for the insufficient synovial fluid in your knee and simply serves as a thin cushion and a shock absorber between the ends of two long bones (Femur and Tibia) of the knee joint.
Who can get these Rooster Comb injections?
HA injection is indicated in patients with knee osteoarthritis who fail to obtain sufficient relief with conservative treatments, including exercise, physical therapy, oral pain medications, Knee braces, TENS unit and hot /cold packs. We typically see HA injection as being helpful for some patients who have failed corticosteroid–based injections and do not want to yet consider surgery. For some people, HA injections can provide many months of relief and may be helpful even when corticosteroid injections have not been.
How are the injections performed?
Although not mandatory, we feel that it is in the patient’s best interest to have HA injections done with some sort of “image guidance”. By using either ultrasound or fluoroscopy, we can verify in real time that the medication is, in fact, being injected into the affected joint and not simply into the soft tissue surrounding the joint. Sometimes people will report lack of efficacy with prior HA injections or severe pain with prior HA injections. Although not always the case, this can sometimes be due to the HA having been injected “outside of the joint”, where it has absolutely no chance of helping. Image guidance will not guarantee a positive outcome but it will minimize the chance that a patient will experience a “false negative” outcome. (Lack of relief due to faulty technique)
How often do you need these injections?
HA injection is usually performed as a series of injections 1 week apart for a total of 3 to 5 injections depending on the particular product being used. One or both knees can be injected simultaneously. Commercial names for various Visco-Supplementation products include: Euflexxa, Hyalgan, Synvisc, and Supartz. “Gel One” and “Synvisc One” are approved for single injection only, and may be more convenient for some patients. When HA injections have been helpful, patients typically experience relief in within 2-3 weeks. For some patients relief may last for 6 months or for longer.
The most common side effects around the injected joint include: temporary pain at the injection site, mild bruising, redness and warmth, mild stiffness and swelling, itching or achy feeling. Most people tolerated the procedure very well and have little to no complaints after the injections. Some people even reports feeling better immediately after the injection is performed.
Is it covered by insurance?
Most commercial insurance companies and Medicare will usually cover HA injections for knee pain. Depending on your insurance plan, there may be a portion of the cost that you are responsible for.
If Rooster Comb injections don’t work for me, does that mean I need surgery?
No, it does not necessarily mean that. Compared to even a few years ago, we now have many more options available for patients who are not ready for surgery. These options include:
• Prolotherapy —injection of a concentrated sugar solution into and around the joint.
• PRP (Platelet Rich Plasma) injection — injection of a concentrated solution of a patient’s own platelets into and around the joint.
• BMC (Bone Marrow Concentrate) injection — injection of a patient’s own MSC’s or “stem cells” into and around the joint
• Genicular Complex RFA — cauterizing of the nerves surrounding the knee joint to deaden the pain from an osteoarthritic joint.
We typically feel that there are many steps the patient should pursue before considering joint replacement surgery. “Rooster Comb Injections” is one of the many important steps that you may want to consider along your path to feeling better!