Optimization of Synvisc-One for Knee OA

This is a prospective, randomized, double-blind (subject and physical therapist), sham
needle injection controlled, single center, multi-site study.

Subjects with primary osteoarthritis knee pain will be randomly assigned to a 6 ml
intra-articular injection of Synvisc-One or sham needle injection.

The post-treatment course of physical therapy will begin between Day 3 and Day 14 and will
last up to 12 weeks in duration (PT ends at study Week 12). Subjects are encouraged to
complete between 6 and 16 physical therapy visits within 10-12 weeks of physical therapy
treatment as determined by the treating Physical Therapist.

Inclusion Criteria:

- Male or female subjects meeting the American College of Rheumatology (ACR) criteria
for primary knee OA who are age 21 or greater with radiographic and symptomatic
evidence of tibio-femoral OA for more than 6 months (unilateral, single joint,
Kellgren-Lawrence Grading Scale Score of 2 or 3, medial or lateral +/-
patellofemoral).

- Subjects with persistent target knee OA pain despite treatment ≥ 3 months with
acetaminophen 4 grams or less or other OA pain treatments.

- Subjects willing to discontinue all prohibited treatments and medications (e.g.
opioids, narcotic analgesics, Tramadol) throughout the study period.

- Subjects currently on prescription strength NSAIDs (Non steroidal antiinflammatory
drugs) must maintain a stable regimen (no dose increase and no new analgesics) during
the entire study period.

- Female subjects of child bearing potential must have a negative serum or urine
pregnancy test prior to Synvisc-One® or sham injection.

- Female subjects of child bearing potential must agree to use a medically acceptable
form of contraception for at least 1 month prior to Synvisc-One® or sham injection
and must agree to continue the use of an acceptable form 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.

- Subjects willing and able to commit to a standard 10 week course of physical therapy.

- Subjects willing and able to sign written informed consent.

Exclusion Criteria:

- Kellgren-Lawrence Grading Scale score of Grade 1 or Grade 4 given the low efficacy of
viscosupplements in this population and the KOOS is not validated in this patient
population.

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

- History of viscosupplementation in the target knee joint within 3 months of the
baseline visit.

- Isolated patellofemoral OA or isolated anterior knee pain (patellofemoral OA
coexisting with tibiofemoral knee OA may be included).

- Symptomatic bilateral knee OA (unless the contralateral knee involvement is limited
to radiographic OA and not symptomatic).

- Ipsilateral symptomatic OA of hip or ankle; contralateral symptomatic OA of hip,
knee, or ankle, or clinical evidence of hip disease.

- Clinically apparent knee joint infection, tense effusion or other acute inflammation
of the target knee at baseline.

- History of septic OA of any joint; and / or Inflammatory arthropathy such as RA
(Rheumatoid Arthritis), gout, pseudogout, lupus, crystalline inflammatory
arthropathy, chondrocalcinosis etc.

- Active infection of a lower extremity (e.g. cellulitis).

- Prosthetic implant in either knee.

- Subjects with any clinical indication for arthroscopic surgery.

- Subjects with a planned or scheduled surgery during the course of the study
(scheduled or awaiting for arthroscopy or a knee replacement procedure for OA of the
knee).

- Subjects with plans to initiate or cease other OA treatments including, but not
limited to non- pharmacologic, pharmacologic, surgical, chiropractic, or acupuncture
during the course of the study.

- Subjects with plans to initiate, cease or continue any other intra-articular knee
joint injection during the course of the study.

- History of systemic and/or intra-articular steroid injection in target knee within
one month prior to the baseline visit.

- History of open knee surgery in affected knee or history of arthroscopic surgery in
affected knee in past year.

- History of complete menisectomy.

- Suspected meniscus injury, including a positive McMuray's test or significant joint
line tenderness.

- Cruciate / collateral knee ligament instability, ligament laxity, or meniscal
instability of target knee.

- Obvious cartilage defects producing mechanical symptoms (i.e. locking).

- Patellar tendonitis.

- Significant alignment deformity such as varus / valgus of target knee in the judgment
of the investigator.

- Venous or lymphatic stasis in either leg.

- Past or current history of peripheral vascular disease pertaining to the involved
limb.

- Concurrent multisystem or multilimb trauma.

- Known significant acute and / or concurrent medical comorbidities including, but not
limited to current malignancy, history of transplant surgery, congestive heart
failure, significant unstable cardiovascular disease, renal, hepatic, pulmonary,
endocrine, metabolic, gastrointestinal, or neurological condition that in the
judgment of the investigator would significantly impact life expectancy and / or the
conduct of the trial.

- Known psychiatric disorder.

- Body mass index (BMI) > 40.

- Female subjects interested in conceiving a child during the study period.

- Currently pregnant or new mothers who are breastfeeding.

- Subjects currently prescribed chronic opioid analgesics at time of baseline visit
that cannot be discontinued.

- Use of prohibited pain medications.

- Any known contraindication to acetaminophen.

- Subjects currently enrolled in any other experimental clinical trial or history of
trial enrollment within three months of baseline.

- Subjects who plan to move or relocate out of area inhibiting their ability to
complete the entire physical therapy regimen as defined by the protocol and
prescribed by the investigator.

- Knee pain is associated with a Worker's Compensation Claim.