Synvisc-One for Younger, Active Patients With Osteoarthritis

This study will be an open label longitudinal cohort study with natural history over 3
years. Screening data will be reviewed to determine subject eligibility. Subjects who meet
all inclusion criteria and none of the exclusion criteria will be entered into the study.
Subjects enrolled in the cohort will have baseline functional testing performed including a
motion gait analysis, 12 minute walk test, and 3-day accelerometer data. Subjects will
receive a single 6 mL intra-articular injection of hylan G-F 20 in the target knee at
baseline. All ongoing treatments will be monitored at 6 month intervals over the 3 year
duration of the study. Patients can receive any other conservative treatments (e.g., oral
medications, physical or other therapy, acupuncture, etc., except other injection
treatments) and current treatments will be documented during each patient encounter. An
initial injection of hylan G-F 20 will be injected in the symptomatic knee using a standard
supine lateral approach using a 20 gauge needle. A face to face follow up visit will be
carried out 6 months after first injection with additional face to face meetings every 6
months thereafter unless the subject requires an additional injection of hylan G-F 20. Hylan
G-F 20 treatments can be administered up to three times each year during the study duration.
After each injection, follow up measures will be carried out using secure e-mail or phone
contact at 6 weeks, 12 weeks, 18 weeks after each in-office evaluation or injection. Follow
up will consist of WOMAC, Lysholm score, and Tegner score. Patients may return for
retreatment of hylan G-F 20 if symptoms recur after at least 4 months following their
previous injection and they meet the inclusion criteria with pain levels of WOMAC A1, C8,
C9, C10 and/or C23 equaling 2 or more. Patients requiring three injections of hylan G-F 20
in 4 months or less will be allowed to exit the cohort after their six-month follow up
following the third injection. Otherwise, patients will be followed until they reach the 3
year follow up, or drop out for other injection treatments or surgical treatment. Therefore,
patients would potentially be able to receive up to 9 injections during the 3 year study.

Inclusion Criteria:

- Male or female patients aged 30-50 years

- History of symptomatic unilateral primary or secondary knee OA for more than 6 months

- Signed written informed consent

- Radiographic evidence of Kellgren-Lawrence Grade I or II OA of the target knee

- Body Mass Index (BMI) < 30 kg/m2

- Activity criteria (Tegner score > 3)

- Continued target knee OA pain despite conservative treatment ≥ 3 months (e.g., weight
reduction, physical therapy, analgesics)

- Willing to withhold intake of NSAIDs (including COX-2 inhibitors) and analgesics, for
a washout period of minimum 3 days up to 21 days prior to baseline visit (depending
on medication)

- Willing to discontinue prohibited treatments and medications throughout study period

Baseline inclusion criteria

- Completed OA medication washout period

- Target knee pain 4-8 (0-10 NRS) during most painful knee movement (Worst Knee Pain)

- If female, must have had a negative urine pregnancy test and used a medically
acceptable form of contraception for at least 1 month prior to baseline and agree to
continued use of contraception for the duration of the study. Otherwise, females must
be surgically sterile, or postmenopausal (as documented in medical history) for at
least 1 year. The fetal safety profile for G-F 20 is unknown. Pregnancy will affect
the individual's regular activity levels. Females who become pregnant during the
study will be excluded from the study. Subjects who become pregnant will be followed
up by telephone every 3 months to check for any adverse effects. They will also be
recommended to follow routine obstetric visits. Males should be able to father
children as it has no expected effects on activity levels.

Exclusion Criteria:

- Known allergy to hylan G-F 20 or any of its components, or to avian proteins, eggs,
feathers, down, or poultry

- Clinically apparent tense effusion or other acute inflammation of the target knee at
baseline

- History of target knee viscosupplementation treatment

- History of major surgery for OA in target knee including arthroplasty or tibial
osteotomy

- Arthroscopic surgery or intraarticular steroid injection in target knee within six
months of baseline visit

- Significant (as judged by the Investigator) alignment deformity of target knee

- Ipsilateral symptomatic OA of hip or ankle; contralateral symptomatic OA of hip,
knee, or ankle

History of:

- Septic OA of any joint

- Inflammatory arthropathy such as RA, gout, pseudogout, lupus, crystalline
inflammatory arthropathy

- Active infection of lower extremity

- Known significant acute and/or concurrent medical disease including, but not limited
to current malignancy, history of transplant surgery, congestive heart failure,
significant unstable cardiovascular disease, renal hepatic pulmonary, endocrine,
metabolic, or GI condition

- Any known contraindication to acetaminophen

- Venous or lymphatic stasis in either leg

- Peripheral vascular disease

- Patient has been prescribed chronic opioid analgesics at time of baseline visit

- Concurrent multi-system or multi-limb trauma

- Patient plans to become pregnant during study period

- Patient plans to move significantly out of area, have surgery, or initiate or cease
other OA treatments

- Knee pain improves during washout period

- Workman's Comp patient