Monovisc vs Gel-One: Comparing Single-Injection HA Options

Key Takeaways

• Both Monovisc and Gel-One are single-injection hyaluronic acid (HA) treatments for knee osteoarthritis
• The main difference is their source: Monovisc comes from bacterial fermentation, while Gel-One is derived from rooster combs
• Both products are covered by Medicare and most insurance plans
• Clinical studies show similar effectiveness between the two treatments
• The choice between them often comes down to doctor preference and potential allergies

If you’re exploring knee pain relief options, you’ve probably heard about hyaluronic acid injections—sometimes called “gel shots” or “viscosupplementation.” These treatments help restore the natural cushioning in your knee joint that arthritis wears away.

Two popular single-injection options are Monovisc and Gel-One. Unlike older treatments that require three to five weekly injections, these newer products deliver the full treatment in just one visit. But what makes them different from each other? Let’s break it down.

What Are Single-Injection HA Treatments?

Traditional hyaluronic acid treatments like Synvisc or Euflexxa require multiple injections over several weeks. Single-injection options like Monovisc and Gel-One were developed to make treatment more convenient—one office visit instead of three to five.

The hyaluronic acid in these injections works like a lubricant and shock absorber in your knee joint. It helps reduce pain and may slow down the progression of arthritis by protecting the remaining cartilage.

Side-by-Side Comparison

Feature	Monovisc	Gel-One
Manufacturer	Anika Therapeutics	Zimmer Biomet
Source	Bacterial fermentation	Avian (rooster comb)
Molecular Weight	1,000-2,900 kDa	500-730 kDa
Number of Injections	1	1
Volume per Injection	4 mL	3 mL
Duration of Relief	Up to 6 months	Up to 6 months
Medicare Coverage	Yes	Yes
FDA Approved	2014	2011
Cross-Linked	Yes	No
Allergy Concerns	Rare	Possible bird protein allergy

Key Differences Explained

Source Material

The most significant difference between these two products is where the hyaluronic acid comes from.

Monovisc is made through bacterial fermentation. Scientists use bacteria to produce hyaluronic acid in a lab setting. This process creates a product that’s highly purified and consistent from batch to batch.

Gel-One is derived from rooster combs (the red crest on a rooster’s head). While this might sound unusual, it’s been a common source for HA products for years. The material is highly purified to remove proteins and other substances.

For most people, the source doesn’t matter much. However, if you have a known allergy to bird proteins or feathers, Monovisc might be the safer choice.

Molecular Weight and Structure

Think of molecular weight as the “size” of the HA molecules. Monovisc has larger molecules (higher molecular weight) than Gel-One.

Monovisc is also “cross-linked,” meaning its molecules are chemically bonded together. This creates a gel that stays in your joint longer before breaking down.

Gel-One has smaller molecules and isn’t cross-linked. Some doctors believe this makes it easier for the product to spread throughout the joint.

Research hasn’t definitively proven that one approach is better than the other. Both products provide similar relief for most patients.

Volume and Viscosity

Monovisc delivers 4 mL of product, while Gel-One delivers 3 mL. Monovisc is also thicker (more viscous) because of its cross-linked structure.

Some doctors prefer the higher volume and thicker consistency, believing it provides better cushioning. Others find the lower volume easier to inject and prefer the thinner consistency for better joint coverage.

Effectiveness and Clinical Evidence

Both Monovisc and Gel-One have been studied in clinical trials and show good results for knee osteoarthritis pain relief.

Monovisc studies show that about 6 out of 10 patients experience significant pain relief lasting up to six months. Many patients also report improved mobility and reduced stiffness.

Gel-One studies demonstrate similar outcomes, with most patients experiencing pain reduction for four to six months. Some studies suggest up to 70% of patients get meaningful relief.

When researchers have directly compared single-injection HA products, they’ve found minimal differences in effectiveness. What matters more is:

• The severity of your arthritis
• How your body responds to HA treatment
• Proper injection technique
• Whether imaging guidance is used

Cost and Insurance Coverage

Good news: both Monovisc and Gel-One are covered by Medicare Part B when deemed medically necessary. This typically means:

• You have a documented diagnosis of knee osteoarthritis
• You’ve tried conservative treatments like physical therapy and pain relievers for at least 6 weeks
• Your doctor recommends HA injections as appropriate

Private insurance plans also generally cover both products, though specific coverage can vary. Always check with your insurance provider before treatment.

Out-of-pocket costs without insurance typically range from $800 to $1,500 per injection for either product. However, these prices can vary significantly by location and provider.

Which One Is Right for You?

Your doctor will help determine which product makes the most sense for your situation. Here are factors they might consider:

You might be a good candidate for Monovisc if:

• You have a known allergy to bird products
• Your doctor prefers cross-linked, high-molecular-weight products
• Previous HA treatments with bacterial-source products worked well for you

You might be a good candidate for Gel-One if:

• You’ve had success with avian-source HA products before
• Your doctor prefers non-cross-linked formulations
• You have no concerns about bird-derived products

For most patients, either option can work well. The decision often comes down to:

• Your doctor’s experience and preference
• What your clinic has in stock
• Your insurance formulary (which products they prefer to cover)

The Single-Injection Advantage

Whether you choose Monovisc or Gel-One, the main benefit is convenience. Single-injection treatments offer:

• One office visit instead of three to five – Fewer trips to the doctor means less time away from activities you enjoy
• Lower overall costs – While the per-injection cost is higher, you’re only paying one copay and one office visit fee
• Better compliance – It’s easier to complete treatment when it only requires one appointment
• Faster return to activities – You can resume normal activities sooner without multiple injection appointments

What to Expect During Treatment

The injection process is the same whether you receive Monovisc or Gel-One:

1. Preparation – Your doctor will clean your knee with antiseptic solution
2. Numbing – A local anesthetic may be used to minimize discomfort
3. Injection – The HA product is injected into your knee joint (some doctors use imaging guidance for precise placement)
4. Recovery – You’ll rest briefly, then can go home with aftercare instructions

Most people describe the injection as a brief pressure sensation rather than sharp pain. The entire process typically takes 15-30 minutes.

Potential Side Effects

Both products have similar side effect profiles. Common reactions include:

• Mild pain or swelling at the injection site (usually resolves in 1-2 days)
• Temporary increase in knee pain (affects about 1 in 10 patients)
• Warmth or redness around the knee

Serious complications like infection or allergic reactions are rare, occurring in less than 1% of patients.

If you develop severe pain, significant swelling, fever, or signs of infection after your injection, contact your doctor immediately.

Maximizing Your Results

Regardless of which product you receive, these steps can help you get the best results:

• Avoid strenuous activity for 48 hours after injection
• Continue gentle exercises recommended by your doctor or physical therapist
• Maintain a healthy weight to reduce stress on your knee
• Use ice if you experience swelling after the injection
• Give it time – Full benefits may take 2-4 weeks to appear

Questions to Ask Your Doctor

Before deciding on treatment, consider asking:

1. Which HA product do you use most often, and why?
2. Do you use imaging guidance for injections?
3. What’s your success rate with single-injection HA treatments?
4. Will my insurance cover this treatment?
5. What should I do if I don’t get relief after the injection?
6. How long should I wait before considering a repeat injection?

Frequently Asked Questions

Can I switch between Monovisc and Gel-One for repeat treatments?

Yes, you can switch between different HA products for future injections. Some patients try different brands to see which works best for them.

How long do I need to wait between injections?

Most doctors recommend waiting at least 6 months between HA injections. Medicare typically covers repeat injections once every 6 months if medically necessary.

Are single-injection treatments more effective than multi-injection products?

Research shows similar overall effectiveness between single-injection and multi-injection HA products. The main difference is convenience, not pain relief.

Will I need these injections forever?

Not necessarily. Some patients get long-lasting relief and don’t need repeat injections. Others find HA treatments work well as part of an ongoing arthritis management plan. Your experience will be individual.

What if neither Monovisc nor Gel-One works for me?

If single-injection HA treatments don’t provide adequate relief, your doctor might recommend trying a multi-injection product, exploring other non-surgical options, or discussing surgical alternatives if appropriate.

The Bottom Line

Both Monovisc and Gel-One are excellent single-injection options for knee osteoarthritis pain relief. They offer similar effectiveness, Medicare coverage, and convenience benefits.

The choice between them often comes down to your doctor’s preference and experience rather than significant differences in how they work. What matters most is finding a qualified provider who uses proper injection techniques—ideally with imaging guidance—and who takes time to ensure you’re a good candidate for HA treatment.

If you’re considering hyaluronic acid injections, talk with your doctor about whether Monovisc, Gel-One, or another HA product might be right for your knee arthritis. Learn more about all your viscosupplementation brand options to make an informed decision.

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This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before starting any new treatment for knee osteoarthritis.

Last medically reviewed: February 2025