Karatosun 2008.

Methods	Randomised controlled trial, blinded, parallel group of 3 weeks.
Participants	30 participants; 15 in HA group (mean age 52.1 (SD 11.3), 9 female, 6 male) and 15 in exercise group (mean age 58.1 (SD 12.1), 12 female, 3 male) Kellgren Lawrence III Osteoarthritis (OA) Ankle OA could be bilateral.
Interventions	HA intra‐articular 2.5 mg 3 weekly injections versus 6 weeks of daily exercise therapy
Outcomes	Primary outcome AOFAS score. Follow‐up 1, 2, 3 weeks and 2, 3, 6 and 12 months. Safety (recording of adverse effects), Pain and Physical function as described in the AOFAS: and separated in subsections: VAS testing motion, activity limitation, walking distance, walking surface, gait abnormality, sagittal motion.
Notes	Not clear if there was a minimum age required to be eligible for the study. Not described in Method section 43 ankles and 30 participants, some people had bilateral involvement No funding information available.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomization by drawing lots using a computer program
Allocation concealment (selection bias)	Low risk	Well described process. participants were randomised by drawing lots using a computer program.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	It is very possible that participants told the therapist of the treatment they got. There is insufficient information to permit judgement of low risk or high risk of bias.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	It is possible that participants told the therapist of the treatment they got. There is insufficient information to permit judgement of low risk or high risk of bias.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No missing outcome data.
Selective reporting (reporting bias)	Low risk	No selective outcome reporting. Outcome is consistent with method section.
Other bias	Unclear risk	The group that was assigned to exercises had a significantly higher AOFAS score at baseline. Some participants had bilateral involvement of ankle OA which makes judgement of efficacy difficult. There is insufficient information to permit judgement of low risk or high risk of bias.