{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:58:36Z","timestamp":1790791116249,"version":"4.1.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Patellofemoral pain (PFP) is a frequent cause of activity-related knee pain and functional limitation in athletic populations. Elevated body mass index (BMI) may contribute to patellofemoral joint loading, but evidence on hyaluronic acid\u2013sorbitol injection outcomes in athletes with elevated BMI remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To describe longitudinal changes in knee function and symptoms over 6 months after intra-articular hyaluronic acid\u2013sorbitol injection in athletes with PFP, and to explore whether baseline BMI was associated with post-injection improvement.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This prospective, single-arm, non-randomized interventional study included 60 athletes aged 30\u201355 years who received a single 4 mL intra-articular hyaluronic acid\u2013sorbitol injection. IKDC and KOOS scores were assessed at baseline, 15 days, 3 months, and 6 months. Longitudinal changes were evaluated using linear mixed models, with generalized estimating equations as a sensitivity analysis; exploratory regression and subgroup analyses assessed the association between BMI and improvement.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Mean IKDC and KOOS scores increased from baseline to 6 months, with estimated changes of +18.58 points for IKDC (95% CI 16.81\u201320.36) and +19.28 points for KOOS (95% CI 17.52\u201321.04; both p\u2009<\u20090.001). At 6 months, 75.0% of participants reached the predefined IKDC threshold for clinically meaningful improvement and 83.3% reached the KOOS threshold. Participants with BMI\u2009\u2265\u200925 kg\/m\n 2<\/jats:sup>\n also showed within-group improvement. BMI was not independently associated with improvement rate after adjustment for baseline score; however, the small elevated-BMI subgroup (\n n<\/jats:italic>\n \u2009=\u200922) limited these exploratory comparisons, and a clinically relevant difference could not be excluded. Minor local adverse events occurred in 4 of 60 participants and resolved with cryotherapy.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Athletes with PFP, including those with elevated BMI, showed consistent improvement in knee function and symptoms over 6 months following hyaluronic acid\u2013sorbitol injection. These findings support intra-articular hyaluronic acid\u2013sorbitol as a feasible, well-tolerated option for athletes with PFP, regardless of body weight. Controlled trials are needed to confirm the treatment\u2019s contribution, given the single-arm design.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n CEI\/0504\/PI\/2022; ClinicalTrials.gov\n NCT05450458<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0346269","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:32:54Z","timestamp":1790789574000},"page":"e0346269","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical outcomes of hyaluronic acid\u2013sorbitol injection in athletes with patellofemoral pain: Evaluation of the potential influence of body mass index"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4443-7565","authenticated-orcid":true,"given":"Julio Carlos","family":"V\u00e9lez de Lachica","sequence":"first","affiliation":[{"name":"Social Security Institute of the State of Mexico and its Municipalities (ISSEMyM)","place":["Tlalnepantla, M\u00e9xico"]},{"name":"Star Medica Tlalnepantla","place":["Tlalnepantla, M\u00e9xico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Serrano","sequence":"additional","affiliation":[{"name":"Star Medica Tlalnepantla","place":["Tlalnepantla, M\u00e9xico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Vidovic","sequence":"additional","affiliation":[{"name":"Aptissen SA","place":["Plan-les-Ouates, Switzerland"],"department":["Medical Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7882-9589","authenticated-orcid":true,"given":"Antonio","family":"Farfan","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Rehabilitaci\u00f3n","place":["Ciudad de M\u00e9xico, M\u00e9xico"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"1","key":"pone.0346269.ref001","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s40798-019-0189-9","article-title":"Winning at all costs: a review of risk-taking behaviour and sporting injury from an occupational safety and health perspective","volume":"5","author":"Y Chen","year":"2019","journal-title":"Sports Med Open"},{"issue":"1","key":"pone.0346269.ref002","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s40141-014-0044-3","article-title":"Patellofemoral pain syndrome: an update","volume":"2","author":"D Hryvniak","year":"2014","journal-title":"Curr Phys Med Rehabil Rep"},{"issue":"3","key":"pone.0346269.ref003","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1590\/1413-78522014220300475","article-title":"Common injuries in athletes\u2019 knee: experience of a specialized center","volume":"22","author":"AP Nicolini","year":"2014","journal-title":"Acta Ortop Bras"},{"issue":"6","key":"pone.0346269.ref004","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.3899\/jrheum.090058","article-title":"Land-based exercise for osteoarthritis of the knee: a metaanalysis of randomized controlled trials","volume":"36","author":"M Fransen","year":"2009","journal-title":"J Rheumatol"},{"issue":"3","key":"pone.0346269.ref005","doi-asserted-by":"crossref","first-page":"190","DOI":"10.21037\/tp.2017.04.05","article-title":"Evaluation and management of knee pain in young athletes: overuse injuries of the knee","volume":"6","author":"DR Patel","year":"2017","journal-title":"Transl Pediatr"},{"issue":"4","key":"pone.0346269.ref006","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.mric.2009.06.010","article-title":"Overuse injuries of the knee","volume":"17","author":"SA O\u2019Keeffe","year":"2009","journal-title":"Magn Reson Imaging Clin N Am"},{"issue":"3","key":"pone.0346269.ref007","first-page":"263","article-title":"A prospective study of overuse knee injuries among female athletes with muscle imbalances and structural abnormalities","volume":"39","author":"MR Devan","year":"2004","journal-title":"J Athl Train"},{"issue":"1","key":"pone.0346269.ref008","first-page":"29","article-title":"Overuse knee injuries in athletes","volume":"2","author":"M Kezunovic","year":"2013","journal-title":"Montenegr J Sports Sci Med"},{"key":"pone.0346269.ref009","first-page":"259","article-title":"Chronic and overuse knee injuries.","author":"RA Demorest","year":"2024","journal-title":"Pediatric sports medicine: essentials for office evaluation. 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