JAMA : the journal of the American Medical Association
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Intra-articular hyaluronic acid is a US Food and Drug Administration-approved treatment for knee osteoarthritis (OA); however, its efficacy is controversial. ⋯ Intra-articular hyaluronic acid has a small effect when compared with an intra-articular placebo. The presence of publication bias suggests even this effect may be overestimated. Compared with lower-molecular-weight hyaluronic acid, the highest-molecular-weight hyaluronic acid may be more efficacious in treating knee OA, but heterogeneity of these studies limits definitive conclusions.