The treatment of early osteoarthritis in middle-aged athletes with intra-articular (IA) viscosupplementation using hyaluronic acid (HA) has been used since the late 1980s. Administration of IA HA has demonstrated anti-inflammatory, anabolic, and analgesic effects. Treatment of acute injuries such as anterior cruciate ligament reconstruction and full thickness chondral lesions have benefited with the addition of IA HA. Use of IA HA has also been shown to delay total knee arthroplasty. Although IA HA has shown significant benefits in the middle-aged athletes, it is not a ubiquitous treatment option. Success with corticosteroid injections can be used as a clinical marker for subsequent success with HA injections.