A Comprehensive Update of Prolotherapy in the Management of Osteoarthritis of the Knee

Abstract

This is a comprehensive review of the literature focusing on the use of prolotherapy in the treatment of osteoarthritis of the knee. It covers the background, efficacy, and advantages of prolotherapy in the management of osteoarthritis symptoms and then covers the existing evidence of the use of prolotherapy for this purpose. Current treatments for osteoarthritis of the knee are numerous, yet patients continue to endorse chronic pain and poor quality of life. Prolotherapy is a treatment that has been inadequately studied with poor sample sizes and lack of standardization between trials. However, in recent years the literature on prolotherapy in the treatment of knee osteoarthritis has grown. Although there is still a lack of homogeneity, trials have shown that dextrose prolotherapy, autologous conditioned serum, hyaluronic injections, and normal saline administered either intra- or peri-articularly are comparable in reducing pain scores to other primary treatment options. The mechanism of action for prolotherapy is still unclear, but researchers have found that prolotherapy plays some role in cartilage growth or chondrogenesis and has been shown to have improved radiographic outcomes. Prolotherapy appears to be a safe treatment alternative that has been shown to improve stiffness, pain, function, and quality of life in osteoarthritis of the knee. Knee osteoarthritis is remarkably prevalent in the United States and is one of the most common causes of disability in the elderly population. Although there are many treatment options, patients continue to live with chronic pain which can incur high costs for patients. A safe, long-term, and effective solution has not yet been identified. Prolotherapy has been shown to be a safe option for improving pain, function, and quality of life as effectively as other treatment options.

The effect of dextrose prolotherapy on patients diagnosed with knee osteoarthritis: A comprehensive systematic review and meta‐analysis of interventional studies

“…In addition, research has shown that dextrose solutions can stimulate the production of growth factors essential for the repair and growth of tendons, ligaments, and other soft tissues, indirectly supporting the idea of a prechondrogenic effect. It is important to note, however, that while the regenerative potential of dextrose in prolotherapy has been demonstrated, the claim of direct cartilage regeneration must be approached with caution 50,54,55 . The third hypothesis regarding the effect of prolotherapy is related to its modulating effect on pain.…”

“…While the precise mechanisms underlying these effects require further investigation, prolotherapy has shown promise as a therapeutic option for individuals with KOA. 20 , 27 , 49 , 50 , 51 Indeed, one of the hypotheses regarding the effect of prolotherapy on joints and tissues is that it promotes soft tissue proliferation, leading to tissue repair, recovery, and a reduction in edema and inflammation. Studies have demonstrated that dextrose 20% has a regenerative effect on healing damaged Achilles tendons by promoting fibroblast proliferation.…”

“…It is important to note, however, that while the regenerative potential of dextrose in prolotherapy has been demonstrated, the claim of direct cartilage regeneration must be approached with caution. 50 , 54 , 55 The third hypothesis regarding the effect of prolotherapy is related to its modulating effect on pain. However, there is conflicting information regarding this hypothesis as well.…”

“…Ultimately, the improvements in pain, function, and overall quality of life observed in patients who receive prolotherapy contribute to increased satisfaction with the treatment. While the precise mechanisms underlying these effects require further investigation, prolotherapy has shown promise as a therapeutic option for individuals with KOA 20,27,[49][50][51]. Indeed, one of the hypotheses regarding the effect of prolotherapy on joints and tissues is that it promotes soft tissue proliferation, leading to tissue repair, recovery,and a reduction in edema and inflammation.…”

The Effect of Intra-articular Hypertonic Dextrose Prolotherapy on Pain, Quality of Life, and Functional Outcomes Scores in Patients With Knee Osteoarthritis

“…The sample size of 20 achieves 81% power to detect a mean of paired differences of 0.7 with an estimated standard deviation of differences of 1.0 and with a significance level (alpha) of 0.05000 using a two-sided paired t-test. We assumed a dropout rate of 10%, then the recruited samples will be 15 samples [18,19].…”