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(4) Furthermore, the oxidative stress imbalance, caused by excessive ROS production, impairs the antioxidant defense system by directly damaging antioxidant enzymes (such as SOD and GPx) and depleting key antioxidant molecules like glutathione, leading to fragmentation of hyaluronic acid in the extracellular matrix and abnormal collagen cross-linking, thereby reducing the mechanical properties of cartilage (6, 22, 23)

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A thinner needle (higher gauge) causes less discomfort but draws medication more slowly, which is why many patients use a wider drawing needle and switch to a thinner needle before injecting