The Effects of Dextrose Prolotherapy in Symptomatic Knee Osteoarthritis: A Randomized Controlled Study

Sert, Alketa Toska; Şen, Ekin İlke; Esmaeilzadeh, Sina; Özcan, Emel

doi:10.1089/acm.2019.0335

Cited by 23 publications

(40 citation statements)

References 40 publications

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“…Three studies did not report on adverse outcomes. 19,20,25 Overall, there were no serious adverse events reported apart from selflimiting post-injection pain and bruises.…”

Section: Adverse Outcomesmentioning

confidence: 93%

“…The five intercurrent studies have had relatively large participant numbers, with most findings favoring dextrose prolotherapy, but have also discussed other injectable and conventional treatments. 16,17,20,25,26 Results from our systematic review indicated that most authors favored intra-articular injections with a three-injection regime. Half of the studies used dextrose solutions of less than 20%, while the rest used dextrose solutions of between 20% and 25%.…”

Section: Current Practice and Understandingmentioning

confidence: 95%

“…Intra-articular dextrose prolotherapy was performed in seven studies. 16,17,19e23 Both intra and extra-articular dextrose prolotherapy were performed in three studies, 18,24,25 while extraarticular dextrose prolotherapy was performed in one study. 26…”

Section: Site(s) Of Injectionsmentioning

confidence: 99%

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Dextrose prolotherapy in knee osteoarthritis: A systematic review and meta-analysis

Wee

Neo

Tan

2021

Journal of Clinical Orthopaedics and Trauma

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Objective: To summarize the evidence for dextrose prolotherapy in knee osteoarthritis. Data sources: The authors searched PubMed and Embase from inception to September 2020. All publications in the English language were included without demographic limits. Study selection: Randomized clinical trials comparing the effects of any active interventions or placebo versus dextrose prolotherapy in patients with knee osteoarthritis were included. Data extraction: Potential articles were screened for eligibility, and data was extracted independently. The risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analysis was performed on clinical trials with similar parameters. The Strength of Recommendation Taxonomy (SORT) was used for evaluating the strength of recommendations. Data synthesis: In total, eleven articles (n ¼ 837 patients) met the search criteria and were included. The risk-of-bias analysis revealed two studies to be of low risk. The overall effectiveness was calculated using a meta-analysis method. Prolotherapy was no different from platelet-rich plasma on the pain subscale at the 6-month time point. Prolotherapy was inferior to platelet-rich plasma at 6 months (MD 0.45, 95% CI 0.06e0.85, p ¼ 0.03) on the stiffness subscale. Prolotherapy was found to be safe with no major adverse effects. Conclusion: Prolotherapy in knee osteoarthritis confers potential benefits for pain but the studies are at high risk of bias. Based on two well-designed studies, dextrose prolotherapy may be considered in knee osteoarthritis (strength of recommendation B). This treatment is safe and may be considered in patients with limited alternative options (strength of recommendation C).

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“…Three studies did not report on adverse outcomes. 19,20,25 Overall, there were no serious adverse events reported apart from selflimiting post-injection pain and bruises.…”

Section: Adverse Outcomesmentioning

confidence: 93%

Section: Current Practice and Understandingmentioning

confidence: 95%

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Dextrose prolotherapy in knee osteoarthritis: A systematic review and meta-analysis

Wee

Neo

Tan

2021

Journal of Clinical Orthopaedics and Trauma

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“…Knee osteoarthritis (KOA) is a chronic joint disease that leads to pain, disability and impaired quality of life, resulting in significant social and healthcare detriments worldwide [1][2][3]. Furthermore, these public and economic implications associated with KOA are expected to increase in the future [1,2].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided genicular nerve block versus physical therapy for chronic knee osteoarthritis: a prospective randomised study

et al. 2022

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To compare the effectiveness of ultrasound-guided genicular nerve block (GNB) and physical therapy (PT) in patients with chronic knee osteoarthritis. A prospective randomised study with 102 patients (45-70 years) was performed wherein the patients received ultrasound-guided GNB (n = 51) and PT (n = 51) along with a standard home exercise programme. Scores for pain on a Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 6-min walking test (6MWT) were assessed pre-treatment and at 2-and 12-weeks post-treatment. Both groups were comparable for sociodemographic characteristics. VAS scores (in mm) in the ultrasound-guided GNB group at 0, 2 and 12 weeks were 7.01 ± 1.36; 3.71 ± 2.18; 5.08 ± 2.22 (p < 0.001) and 6. 64 ± 1.99; 4.35 ± 1.09; 5.25 ± 1.33, (p < 0.001) in the PT group. While the increase in the 6MWT test in the 2nd week was similar for both groups (p = 0.073), the increase in walking distance was greater in the ultrasound-guided GNB group at 12 weeks (p = 0.046). As compared to PT, ultrasound-guided GNB is beneficial in reducing pain and increasing functional and physical capacity, with greater retention of effects on the physical capacity seen at 12 weeks. Trial registration number: ClinicalTrials.gov (NCT04782401).

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“…An example of a currently developing regenerative approach is prolotherapy, an injection-based modality for treating chronic musculoskeletal pain through the use of substances such as dextrose, phenol-glycerine-glucose (P2G), or sodium morrhuate ( 9 ). Previous reports have demonstrated the effectivity of prolotherapy in significantly reducing the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score relative to saline injections and at-home exercise over 18 weeks after injection ( 10 – 12 ). In line with these findings, other reports have shown the promising effects of prolotherapy for tissue regeneration through radiological and arthroscopy-based assessments of cartilage repair ( 13 ).…”

mentioning

confidence: 99%

Changes in levels of cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen in subjects with knee osteoarthritis after dextrose prolotherapy: A randomized controlled trial

Waluyo¹,

Budu²,

Bukhari³

et al. 2021

JRM

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Objective: To assess the effects of dextrose prolotherapy in patients with knee osteoarthritis on the levels of serum cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen, and on the Western Ontario McMaster Universities Index and numerical rating scale score for pain. Methods: A randomized controlled trial, in which participants were randomly allocated into 2 groups, receiving injections of either hyaluronic acid or dextrose prolotherapy. The hyaluronic acid group received 5 injections, 1 each on weeks 1, 2, 3, 4 and 5, and the dextrose prolotherapy group received 3 injections, 1 each on weeks 1, 5 and 9. Serum cartilage oligomeric proteinase, urinary C-terminal telopeptide of type II collagen, Western Ontario McMaster Universities Index score, and numerical rating scale score for pain were measured at baseline and 3 weeks after the last injection. Comparative analysis was conducted using Wilcoxon test within groups and analysis of covariance (ANCOVA) test between groups. Results: A total of 47 participants (21 allocated to hyaluronic acid, 26 allocated to dextrose prolotherapy) completed the protocol. Both interventions resulted in significant improvements in numerical rating scale scores for pain, total Western Ontario McMaster Universities Index scores, and its subscales score. However, the dextrose prolotherapy outperformed hyaluronic acid in numerical rating scale score for pain and level of urinary C-terminal telopeptide of type II collagen, with score changes differences of 0.93 (p?=?0.042) and 0.34 (p?=?0.048), respectively. No significant changes in level of serum cartilage oligomeric proteinase were found in either group. Conclusion: Dextrose prolotherapy is an alternative injection therapy for knee osteoarthritis, which was found to be associated with a significant reduction in urinary C-terminal telopeptide of type II collagen compared with hyaluronic acid injection. Neither injection method resulted in reduced serum cartilage oligomeric proteinase.

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The Effects of Dextrose Prolotherapy in Symptomatic Knee Osteoarthritis: A Randomized Controlled Study

Cited by 23 publications

References 40 publications

Dextrose prolotherapy in knee osteoarthritis: A systematic review and meta-analysis

Dextrose prolotherapy in knee osteoarthritis: A systematic review and meta-analysis

Ultrasound-guided genicular nerve block versus physical therapy for chronic knee osteoarthritis: a prospective randomised study

Changes in levels of cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen in subjects with knee osteoarthritis after dextrose prolotherapy: A randomized controlled trial

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