Efficacy of Prolotherapy for Osteoarthritis: A Systematic Review

Abstract

Objective: Current treatments for osteoarthritis do not resolve the underlying cause. Dextrose prolotherapy is an alternative method that has been proposed for treatment of osteoarthritis, due to its ability to aid tissue regeneration, improve clinical manifestations, and repair damaged tissue structures, which are pathological conditions in osteoarthritis. The aim of this systematic review was to evaluate the efficacy of dextrose prolotherapy compared with other interventions in the management of osteoarthritis.Methods: Electronic databases PubMed, Google Scholar, Cochrane, and BioMed Central were searched from inception to October 2021. Search terms included [(prolotherapy) OR (prolotherapies) OR (dextrose prolotherapy)] AND [(osteoarthritis) OR (osteoarthritides) OR (knee osteoarthritis) OR (hip osteoarthritis) OR (hand osteoarthritis) OR (shoulder osteoarthritis)]. Randomized controlled trials that compared the use of dextrose prolotherapy with other interventions (injection, placebo, therapy, or conservative treatment) in the treatment of osteoarthritis were included. Potential articles were screened for eligibility, and data were extracted by all authors. Risk of bias was assessed using the Cochrane Risk of Bias tool. Study population, methods, and results data were extracted and tabulated by 3 authors.Results: 12 studies reported that DPT was as effective or even more effective in improving functional outcomes compared with other interventions whilst others found that HA, PRP, EP, and ACS were more effective. 14 studies assessed the effectiveness of DPT and ten of them reported that DPT was more effective in reducing pain compared with other interventions.Conclusion: Dextrose prolotherapy in osteoarthritis confers potential benefits for pain and functional outcomes, but this systematic review found that the studies to date are at high risk of bias. LAY ABSTRACTOsteoarthritis is a long-term chronic illness defined by the degeneration of cartilage in joints, causing bones to rub together and causing stiffness, discomfort, and decreased movement. Current treatment options for osteoarthritis do not address the fundamental cause. Dextrose prolotherapy is a potential alternative approach for OA, due to its capacity to help tissue regeneration, improve clinical symptoms, and repair damaged tissue structures, which are pathogenic in osteoarthritis. Despite several comparison studies, the superiority of dextrose prolotherapy in osteoarthritis remains equivocal due to contradictory outcomes. Based on this review, dextrose prolotherapy should be considered as a possible treatment for osteoarthritis.

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

“…The study conducted a comprehensive systematic review and meta‐analysis on the impact of prolotherapy in patients with KOA. While the precise mechanisms of prolotherapy on soft tissues and joints are not fully understood, previous research has proposed several potential mechanisms 22,24,36,45,46 . One mechanism is the reduction of local inflammation, where the injection of a proliferative solution may aid in decreasing inflammation and promoting healing, potentially alleviating symptoms like pain and stiffness in KOA patients.…”

“…The comprehensive review of literature on prolotherapy highlights its potential benefits in managing OA symptoms, particularly in the knee joint. Despite the lack of homogeneity in studies, recent trials have demonstrated that dextrose prolotherapy can effectively reduce pain scores and improve stiffness, function, and quality of life in patients with KOA 20–25 . Dextrose, a cost‐effective and readily available substance, has gained prominence as an injection‐based therapeutic option for managing chronic painful musculoskeletal conditions.…”

Propolis as a Potential Therapeutic Agent to Counteract Age-Related Changes in Cartilage: An In Vivo Study

“…Currently, treatment options for osteoarthritis primarily focus on managing symptoms and slowing disease progression [ 64 , 65 ]. Despite the widespread use of certain medications like glucosamine and cortisone, their efficacy in significantly regenerating damaged articular cartilage remains limited [ 66 ].…”

Secondary and Iatrogenic Effects of Prolotherapy

“…Hasarlı olan tendon, ligament, kıkırdak dokularının tedavisinde kullanılır (Örsçelik & Solmaz, 2023). Proloterapinin etki mekanizması net olarak anlaşılamamış olsa da etkisini rejeneratif süreci aktive ederek gösterdiği düşünülmektedir (Waluyo, Artika, Insani Nanda, Gunawan, & Zainal, 2023).…”

“…Ancak uygulama sonrası uygulama alanındaki hücreler ortamda meydana gelen lokal inflamatuar yanıt sonrasında salınan TGF-beta, epidermal büyüme faktörü, insülin benzeri büyüme faktörü, fibroblast büyüme faktörü gibi çeşitli büyüme faktörleri salgılayarak fibroblastları aktive edip kollajen üretimini tetiklemektedir (Waluyo et al, 2023). Meydana gelen bu rejeneratif inflamatuar yanıt ile hasarlı dokudaki ağrı, ligament laksasyonu ve laksasyondaki azalmaya bağlı olarak eklem instabilitesi azalmaktadır (Dagenais, Yelland, Del Mar, & Schoene, 2007;Waluyo et al, 2023). Bu tedavi yönteminde temel prosedür proliferan solüsyonun hassas ligaman ve tendinöz yapılara ve bitişik eklem boşluklarına enjekte edilmesi esasına dayanır.…”