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The HA concentration in the joint decreases inexorably during the progression of knee osteoarthritis (OA) and so, for nearly five decades, HA has been trialled and used in the treatment of knee OA. There are strong data from clinical trials, meta-analyses and umbrella reviews to support the use of intra-articular hyaluronic acid (IAHA) in the treatment of patients with knee OA, though not in patients with acute, active OA experiencing a flare. The majority of the literature suggests that IAHA has a positive safety profile despite a few meta-analyses suggesting an increased risk of serious adverse effects. Further qualitative analysis integrating patient preferences for multi-modal and\/or non-surgical management is required in order to further explore these findings. IAHA has been combined with a number of additional agents, including mannitol, sorbitol, chondroitin sulphate, tranexamic acid, polynucleotides and hybrid IAHA formulations. These show variable performance beyond the baseline effect of their constituents. It is crucial to consider the patient\u2019s preference when considering treatments for knee OA. Specific to IAHA, patients seek minimally invasive, lower-risk, and non-steroidal options with at least moderate efficacy and advantageous safety profiles.<\/jats:p>","DOI":"10.1007\/s40520-026-03366-8","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T12:55:20Z","timestamp":1775048120000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Expert consensus on hyaluronic acid injections for knee osteoarthritis: a patient-centered approach"],"prefix":"10.1007","volume":"38","author":[{"given":"Nicholas","family":"Fuggle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Rannou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Maheu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Migliore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasser","family":"Al-Daghri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majed","family":"Alokail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Ammann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Berenbaum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angie","family":"Botto-van Bemden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"Brandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nansa","family":"Burlet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Chapurlat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus","family":"Cooper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Dennison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas C","family":"Harvey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gun-il","family":"Im","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Kurth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radmila","family":"Matijevic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Messina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi Monfort","family":"Faure","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9gis P.","family":"Radermecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Schmidmaier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Silverman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Wegrzyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leith","family":"Zakraoui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9","family":"Rizzoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Yves","family":"Reginster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Bruy\u00e8re","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6261-1286","authenticated-orcid":false,"given":"Ali","family":"Mobasheri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"3366_CR1","doi-asserted-by":"crossref","unstructured":"Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H (2020) Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. 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FR has received speaker fees and honoraria from Gr\u00fcnenthal, IPSEN, Laboratoires Expanscience, IBSA-Gen\u00e9vrier, Servier, Pierre Fabre, Mylan, Ceformed. FB reports personal fees from 4P Pharma, 4Moving Biotech, Grunenthal, GSK, Heel, Nordic Bioscience, Novartis, Servier, TRB Chemedica, Viatris. MLB declares Honoraria from Amgen, Ascendis, Bruno Farmaceutici, Calcilytix, Kyowa Kirin, grants and\/or speaker fees from Alexion, Amgen, Amolyt, Bruno Farmaceutici, CoGeDi, Echolight, Gedeon Richter, Kyowa Kirin, Monte Rosa Therapeutics, UCB and consultancy for Aboca, Alexion, Amolyt, Bruno Farmaceutici, Calcilytix, Echolight, Enterabio, Kyowa Kirin, Personal Genomics, Septern. OB has received consulting or lecture fees from Amgen, Aptissen, Biophytis, IBSA, Mylan, Novartis, Nutricia, Orifarm, Sanofi, UCB and Viatris. EMD reports honoraria from UCB, Viatris and Pfizer. ME reports consultancy for Gr\u00fcnenthal Sweden AB and Key2Compliance. NCH reports personal fees, consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, UCB, Kyowa Kirin, Servier, Shire, Consilient Healthcare, Theramex and Internis Pharma. RR has received fees for advisory board or lectures from Abiogen, Effryx and Theramex. JYR reports consulting fees, Advisory Boards and\/or speakers bureau for IBSA-Genevier, Mylan and TRB. AM has received speaker fees and honoraria from Sanofi, Sanofi CHC \/ Opella, Viatris, GSK, HALEON, Aptissen, Contura, Laboratoires Expanscience, ACI, Sunac Therapeutics, Ampio Pharmaceuticals, Synartro, Bruder Consulting and Venture Group, McKinsey and Company, Chiron, Chondropeptix, Gr\u00fcnenthal, Hypera Pharma, ICM, Kangstem, Kolon Life Science, Kolon TissueGene, Nestl\u00e9 Health Science, Pluri, Enlivex, Apos Health, Pacira Biosciences, BioSplice, Genascence, California Institute for Regenerative Medicine, SynOA Therapeutics, Sporlastic GmbH, Rottapharm Biotechnology, and IBSA. 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