Knee Viscosupplementation

Call us at 281-633-8600.  This article is about minimally invasive treatments for arthritic knees. Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and Fellowship Trained Sports Medicine Doctor with offices in Houston and Sugar Land, TX.

Knee Viscosupplementation Can Help Arthritic Knees

The following is from an interview with Dr J. Michael Bennett:

As we get older and the more active we’ve been through our lives, the more likely we are to wear down and weaken the cartilage in the knee joint. That cartilage is the lining within the knee, and it provides the slick surface that allow the bones of the leg to work together without friction and pain. If the cartilage degeneration is bad enough, you get to the point where instead of a nice slick cartilaginous covering of the knee, you have more of a degenerative, bumpy type of surface, leading to exposed bone within the knee joint. With that exposed bone in the joint comes pain, swelling, and stiffness.

Osteoarthritis Image via Wikipedia

We have minimally invasive procedures to address these cartilage issues before they get to the point of bone-on-bone contact. With these minimally invasive procedures we can either stop the cartilage degeneration or slow it down, preventing or at least delaying major surgery to replace the knee joint.

Injections are one option and those injections can include steroid injections or viscosupplementation. Knee viscosupplementation is the injection of a preparation of hyaluronic acid to supplement or replace the natural synovial fluid in the knee joint. This injected fluid is very thick, viscous, and sticky and it acts to boost the effectiveness of the knee joint’s remaining synovial fluid to improve the function of the joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid. It acts as a lubricant to enable bones in the knee joint to move smoothly and the joint fluid is a shock absorber for the knee joint. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints. Knee viscosupplementation may be a minimally invasive treatment option for individuals with osteoarthritis of the knee.

These injections of hyaluronic acid are also known as rooster comb injections. The hyaluronic acid injections we use today are produced in a lab-controlled biochemical process, but the original versions were extracted from rooster combs and the name has stuck. Despite advances in medical technology and medical manufacturing over the years the name “rooster comb injections” is still used.

Capsule of right knee-joint (distended). Poste...
Knee Image via Wikipedia

Knee viscosupplementation or rooster comb injections can be very helpful for someone with moderate arthritis. Patients with severe arthritis of the knee tends to not do as well with these injections. You can get up to six months or even a year of relief with each rooster comb injection, and many patients decide to do the injections for awhile before they elect to do a knee replacement.


  1. Carrie Houser says

    I had the viscosupplementation a year ago and I am just beginning to have discomfort in my knees again. My insurance deductible is not fulfilled yet, so I will have to pay $1090 out of pocket to do it agian. What is your opinion of the tablet form of Hyaluronic Acid? I have found several different brands that incorporate the product into it, but the actual amount of Hyaluronic Acid seems very low. Flex-a-min is one such brand. The HA is listed last in the list of ingredients.
    What is your take on these products, and if you like them as an alternative to the injections, what product do you recommend?
    Thank you

    • says

      Carrie, thanks for your great question.  If your doctor found that it was necessary to treat you with viscosupplementation, the over-the-counter supplements probably won’t help you.  Although a supplement might list hyaluronic acid as an ingredient, as you noted there’s probably not enough of it in a daily dose to provide you with relief. I would add that oral supplements can vary significantly and are not regulated by the FDA so the quality of HA is not standardized and few are pharmaceutical grade with 95% or greater bioabsorption rate, so you may take the supplement but not absorb the full amount.

      There are some products out there that are better than others so you have to be vigilant in finding one that is pharmaceutical grade and follows FDA guidelines. Viscosupplementation is a larger dose going directly to the joint — the concentration is higher, therefore it is more effective. Most insurance companies will cover the injections every 6 months to a year.

      Many of my patients ask me about supplements when we discuss treatment options.  I’d like to use your question as the basis for a future blog post if you don’t mind.

      Thanks again for your question, 
      Dr. Jay Bennett

      • Carrie Houser says

        Thank you for your informative answer. I don’t know that my orthopedic doctor gave the injections because the supplements wouldn’t work or not. The option of supplements never came up. I just found out that the supplements exist. I’ll keep looking for supplements that meet FDA guidelines. My deductible is not fulfilled for the year, so I’d have to pay $1,090.00 out of pocket for my injections this year.

        You may continue to use my name for your future blogs.

        Thank you,

Leave a Reply