The Science Behind Cingal


man stretching in rain
Cingal® is uniquely formulated as a hyaluronic acid (HA) viscosupplement plus corticosteroid combination injection.

HA is one of the main lubricating components of synovial joint fluid and is an important component of healthy cartilage, where it helps the cartilage maintain elasticity and resiliency.

People who suffer from osteoarthritis (OA) have reduced amounts of HA in their joints. To combat this decrease, HA-based products developed for osteoarthritis (called viscosupplementation products) assist in pain relief and function to lubricate and cushion the joint.

Naturally-sourced hyaluronic acid forms the foundation of Anika’s proprietary purification and formulation processes, designed to supplement the natural HA lost from the synovial fluid in arthritic knee joints due to aging or injury.

Since corticosteroids are not soluble in water, steroid particles can be suspended in the HA gel. Both the steroid and HA components reside separately within Cingal and remain unchanged in the Cingal formulation.1

The Natural Choice

Cingal is a transparent gel made from natural, non-animal sourced, ultra-pure, high molecular weight HA combined with triamcinolone hexacetonide (TH) steroid.


Chosen for both its rapid action and longer duration compared to other corticosteroids, the effects of TH last for up to 21 days, compared to other corticosteroids which only last for 8-14 days.2


The hyaluronic acid (HA) in Cingal is lightly cross-linked to extend the residence time of the HA molecules in the knee joint space, providing pain relief that lasts longer.


Cingal is uniquely formulated to bind well with water, forming highly viscous polymers that increase the ability of the synovial fluid to cushion the knee joint and absorb shocks.


Cingal is formulated with a high concentration of HA (22 mg/mL), and a total delivered dose of 88 mg of HA, intended to mimic the high concentration of HA found in healthy synovial fluid.


HA is vital for maintaining the function and elasticity of the synovial fluid. Cingal is designed to supplement the reduced amount of natural hyaluronic acid found in the synovial fluid in osteoarthritic knee joints, while the steroid component treats inflammation and provides fast pain relief within days of injection.

The high concentration and total delivered dose of hyaluronic acid in Cingal combined with a well-established corticosteroid creates a fast acting high viscosity solution that helps provide cushioning from normal physical activities like walking and biking.

With one single-injection, Cingal lubricates, cushions and protects the knee joint, allowing patients to quickly return to their active lifestyles with reduced pain.*

* Patient experience may vary

1. R009-041, Technical Report, “Chemical Stability Evaluation of Cross-Linked Hyaluronic Acid and Triamcinolone Hexacetonide in Cingal Product”, December 2009. Appendix II of the device dossier.

2. Stephens M., et. al. Musculoskeletal Injections: A Review of the Evidence. Am Fam Physician. 2008 Oct 15;78(8):971-976.


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