Clinical outcomes of hyaluronic acid–sorbitol injection in athletes with patellofemoral pain: Evaluation of the potential influence of body mass index

Background: Patellofemoral pain (PFP) is a frequent cause of activity-related knee pain and functional limitation in athletic populations. Elevated body mass index (BMI) may contribute to patellofemoral joint loading, but evidence on hyaluronic acid–sorbitol injection outcomes in athletes with elevated BMI remains limited. Objective: To describe longitudinal changes in knee function and symptoms over 6 months after intra-articular hyaluronic acid–sorbitol injection in athletes with PFP, and to explore whether baseline BMI was associated with post-injection improvement. Methods: This prospective, single-arm, non-randomized interventional study included 60 athletes aged 30–55 years who received a single 4 mL intra-articular hyaluronic acid–sorbitol injection. IKDC and KOOS scores were assessed at baseline, 15 days, 3 months, and 6 months. Longitudinal changes were evaluated using linear mixed models, with generalized estimating equations as a sensitivity analysis; exploratory regression and subgroup analyses assessed the association between BMI and improvement. Results: Mean IKDC and KOOS scores increased from baseline to 6 months, with estimated changes of +18.58 points for IKDC (95% CI 16.81–20.36) and +19.28 points for KOOS (95% CI 17.52–21.04; both p