Which Injectable Technology Is Best in the Non-surgical Management of Ankle Osteoarthritis: A Systematic Review

ObjectiveTo compare the efficacy and safety of different intra-articular injections in the non-surgical management of ankle osteoarthritis (AOA) in adults.MethodsCINAHL, Medline, PubMed, Embase, and the Cochrane Library were used as our databases from conception to May 2025 using the following string ((Ankle joint) AND (osteoarthritis)) AND (injection OR injectable technology OR intraarticular injection OR stem cell OR MSC OR mesenchymal STEM cell OR PRP OR corticosteroid OR botulinum toxin A) searching for randomized control trials which were manually screened for eligibility and then risk of bias. Eight studies were included, 4 placebo trials (3 comparing hyaluronic acid (HA) with saline, 1 comparing platelet-rich plasma (PRP) with saline) and 4 randomized comparative trials (comparing differing HA regimens, HA with exercise, botulinum toxin type-A (BoNT-A) with exercise + HA and corticosteroids (CS) with CS + HA, respectively).ResultsHA seems to be an effective form of management for AOA, either alone as multiple small doses or combined with either CS or exercise therapy. BoNT-A also seems effective (compared with the current recommended treatment); however, PRP and CS alone do not have any evidence of being effective.ConclusionHA seems to be the most effective in managing AOA symptoms. However, this could not be very objective due to how little research there is on the other forms of injectable technologies.Level of Evidence:Level II: Systematic review of all relevant RCTs (of varying quality).