Clinical Research Directory

Inclusion Criteria: * Adults age 18 years or older, any gender. Symptomatic joint hypermobility or instability attributable to one of the following: (a) hEDS diagnosed using the 2017 International Classification of the Ehlers-Danlos Syndromes diagnostic criteria; (b) HSD classified using the 2017 framework (generalized, peripheral, localized, or historical HSD) with Beighton scoring; or (c) post-traumatic joint instability with ligamentous injury documented by examination and/or imaging. Objective evidence of instability or clinically relevant hypermobility at one or more target joints, defined as at least one of: (i) a positive joint-specific instability provocation test on standardized physical examination; (ii) generalized hypermobility (Beighton score ≥ 5/9 for adults)\[1,28\] or documented joint-specific hypermobility at the target joint; or (iii) imaging evidence of ligamentous laxity or injury at the target joint (dynamic ultrasound, stress radiograph, or MRI). Pain attributable to the target joint for at least 3 months. Baseline pain score of 4 or greater on a 0-10 numeric rating scale. Failure of conservative treatment, including at least 6 weeks of physical therapy directed at the affected joint(s). Not currently using NSAIDs and willing to avoid NSAIDs during the active treatment period, when clinically appropriate. Able to provide informed consent and to comply with study procedures and follow-up. Additional Eligibility for the Hyaluronic Acid (HA) Alternative Pathway A participant may enter the HA pathway if ALL of the following apply, in addition to the inclusion criteria above: The participant has completed at least one regenerative medicine phase (dextrose, PRP, or doxycycline) and either (i) was classified as an inadequate responder at the phase decision point (GPI \< 40%) and declined further regenerative rotation, or (ii) completed all available regenerative phases without adequate response, or (iii) experienced an adverse reaction during a regenerative phase that, in the investigator's judgment, contraindicates further regenerative treatment. A minimum waiting period of 4 weeks has elapsed since the last regenerative medicine treatment attempted, to allow resolution of post-injection effects before HA administration. The target joint(s) have clinical or imaging features amenable to HA viscosupplementation (e.g., articular/osteoarthritic pain component identifiable on examination or imaging). No contraindication to HA (see Exclusion Criteria below). Exclusion Criteria: * Participants are excluded if any of the following apply: Impaired decision-making capacity that precludes valid informed consent. Active local or systemic infection. Known allergy or contraindication to study injections, local anesthetics, iodinated contrast (if fluoroscopy is planned), or required procedural materials. Known hypersensitivity to sodium hyaluronate or to the specific HA product to be used (Visco-3); active skin disease or infection over the planned injection site; venous or lymphatic stasis in the limb of the planned injection. Active malignancy or anticancer treatment within the prior 12 months; a prior malignancy in documented remission may be enrolled at the investigator's discretion with documented rationale. Uncontrolled diabetes mellitus, defined as HbA1c ≥ 8.5% on the most recent value within the prior 3 months; the investigator may also exclude for other objectively documented diabetes-related procedural or healing risk. Prior joint replacement at the target joint. Planned surgery during study participation. Corticosteroid injection to the target joint(s) within the prior 6 weeks. Concurrent enrollment in another interventional study for the same pain condition. Active litigation or disability claim related to the target condition (to limit secondary-gain confounding of self-reported outcomes). Pregnancy, or unwillingness to undergo pregnancy testing when fluoroscopy is planned (persons of childbearing potential). Inability to comply with study procedures or follow-up.