Are We Using Slow-Acting Symptomatic Chondroprotective Drugs Conscious Enough?

Seyit Ali Gumustas1, Kadir Oznam2, Cagri Ata Mutlu3, Yasin Emre Kaya4, Ibrahim Yilmaz5, *, Mehmet Isyar6, Aliye Yıldırım Guzelant7, Olcay Guler2, Semih Akkaya8, Mahir Mahirogullari9
1 Department of Orthopaedic and Traumatology, Dr.Lutfi Kirdar Kartal Training and Research Hospital, 34865, Istanbul, Turkey
2 Department of Orthopaedic and Traumatology, Istanbul Medipol University School of Medicine, 34214, Istanbul, Turkey
3 Department of Medical Sciences, Acibadem Universitiy School of Medicine, 34752, Istanbul, Turkey
4 Department of Orthopaedic and Traumatology, Republic of Turkey, Ministry of Health, State Hospital, Corlu, 59850, Tekirdag, Turkey.
5 Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, 34810, Istanbul, Turkey
6 Department of Orthopaedic and Traumatology, Acibadem Hospitals Group, Kadikoy, 34718, Istanbul, Turkey.
7 Department of Physical Medicine and Rehabilitation, Namik Kemal University School of Medicine, 59030, Tekirdag, Turkey
8 Department of Orthopaedic and Traumatology, Private Denizli Surgery Hospital, 20070, Denizli, Turkey
9 Department of Orthopaedic and Traumatology, Memorial Health Group, 34750, Istanbul, Turkey

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© 2017 Gumustas et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, 34810, Istanbul, Turkey; Tel: +9053 2701 2858; Fax: +9028 2262 5355; E-mail:



Osteochondral injuries constitute an entity that is widespread and can be seen in patients of all ages. Actual treatment modalities aim to relieve pain, obtain full range of movement of the joint, and improve the quality of life. There are many slow-acting chondroprotective agents prevalently used in the United States that are classified as nutritional support but not as medicines . This study presents the importance of clinical adverse effect profiles as well as the pharmacological mechanism of action and application of combinations of drugs that are widely prescribed and not subjected to control.


Electronic databases were searched with keywords about the chondroprotective drugs without any language restriction. Evaluations of the descriptive statistics were represented via Microsoft Office Excel 2010 lists in the form of a mean±standard deviation or frequency (%). The first evaluation showed that 1502 studies were potentially relevant. Following exclusion of the 1277 studies which were not clinical, full versions of the remaining 225 studies were subjected to further evaluation. No controlled, blinded, randomized and/or comparative studies met the inclusion criteria of the study, and no studies evaluated the comparative clinical results of the hyaluronan of different molecular weights.


The findings of this study concluded that especially when prescribing drugs with ingredients like GS and CS, many patients’ pre-existing conditions must be considered, such as whether the patient has a glucose intolerance or not. Additionally, mineral toxication should be considered since the drugs contain minerals, and after the application of injected hyaluronan, complications should be considered.


Clinical, controlled and comparative studies about the use of chondroprotective drugs must be performed to define the benefits of these drugs, if any, in order to determine the most suitable time for operative intervention.

Keywords: Adverse effects, Cartilage, Chondroitin sulphate, Glucosamine sulphate, Hyaluronic acid, Symptomatic slow-acting chondroprotective drugs.