Skip to main content
Egyptian Rheumatology and Rehabilitation
Download PDF

Healing effects of prolotherapy in treatment of knee osteoarthritis healing effects of prolotherapy in treatment of knee osteoarthritis

Egyptian Rheumatology and Rehabilitation volume 43, pages 47–52 (2016)Cite this article

Abstract

Purpose

Pelotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a two-arm controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis (OA).

Materials and methods

A total of 104 adults with at least 6 months of painful primary knee OA were treated with dextrose prolotherapy (group I). They were divided into two subgroups: Ia and Ib. Subgroup Ia was treated with both techniques of prolotherapy (Hackett technique – classic, traditional prolotherapy – and Lyftgot technique – neural prolotherapy), whereas subgroup Ib was treated with the Hackett technique only. Extra-articular and intra-articular injections were administered at 1, 2, and 3 months, with as needed additional treatments at months 4 and 5. A total of 24 adults with at least 6 months of painful primary knee OA were treated with physiotherapy (group II). Outcome measures included the following: clinical assessment; visual analogue scale (VAS), 10; Western Ontario McMaster University Osteoarthritis Index (WOMAC), 96 points; plain radiographs; and musculoskeletal ultrasound. Postprocedure hot packs were applied, and at-home massage and exercises were taught.

Results

128 Patients enrolled in the study were matched with each other for sex, age, disease durations, and BMI. Subgroups Ia and Ib reported a significant improvement as regards the clinical assessment, VAS, WOMAC, and radiological assessment at 12 months, compared with their baseline at month 0 and compared with group II (P ≤ 0.001). At 12 months, the mean ± SD of VAS was 0.32 ± 0.27 for subgroup Ia, 0.44 ± 0.5 for subgroup Ib, and 9.9 ± 1.65 for group II, and the mean ± SD of WOMAC was 11.32 ± 10.3 for subgroup Ia, 18.5 ± 10.25 for subgroup Ib, and 79.5 ± 22.63 for group II. Postprocedure application of hot packs, massage, and paracetamol resulted in diminution of injection-related pain. There were no adverse events.

Conclusion

Prolotherapy resulted in clinically sustained improvement of pain, function, and radiological assessment, which means that the healing effects of prolotherapy is better than that of physiotherapy. The combination of the two prolotherapy techniques results in quicker and better improvement for patients in terms of the clinical assessment, VAS, and WOMAC.

References

  1. Rabago D, Zgierska A, Fortney L et al. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-armed uncontrolled study with 1-year follow-up. J Altern Complement Med 2012; 18:408–414.

    Article  Google Scholar 

  2. Rabago D, JJ Patterson, Marlon Mundt et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med 2013; 11:229–237.

    Article  Google Scholar 

  3. Hackett G. Joint stabilization through induced ligament sclerosis. Ohio State Med J 1953; 49:877–884.

    CAS  PubMed  Google Scholar 

  4. Felson DT. The sources of pain in knee osteoarthritis. Curr Opin Rheumatol 2005; 17:624–628.

    Article  Google Scholar 

  5. AD Weglein. Neural prolotherapy. J Prolother 2011; 3:639–643.

    Google Scholar 

  6. Hauser R. Standard clinical X-ray studies document cartilage regeneration in five degenerated knees after prolotherapy. J Prolother 2009; 1:22–28.

    Google Scholar 

  7. Hauser Ross A, JJ Cukla. Standard clinical X-ray studies document cartilage regeneration in five degenerated knees after prolotherapy. J Prolother 2009; 1:22–28.

    Google Scholar 

  8. Reeves KD, Hassanein KM. Long-term effects of dextrose prolotherapy for anterior cruciate ligament laxity: a prospective and consecutive patient study. Altern Ther Health Med 2003; 9:58–62.

    PubMed  Google Scholar 

  9. Lyftogt J. Subcutaneous prolotherapy treatment of refractory knee, shoulder and lateral elbow pain. Aust Musculoskeletal Med 2007; 12:110–112.

    Google Scholar 

  10. Altman RD. Criteria for classification of clinical osteoarthritis. J Rheumatol Suppl 1991; 27:10–12.

    CAS  PubMed  Google Scholar 

  11. Banks A. A rationale for prolotherapy. J Orthop Med 1991; 13:54–59.

    Google Scholar 

  12. Rabago D, Jensen K, Patterson JJ, Best T, Vanderby R. Response of knee ligaments to prolotherapy in a rat injury model. Am J Sports Med 2008; 36:1347–1357.

    Article  Google Scholar 

  13. H Ross, I Schaefer. Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function. Clin Med Insights Arthritis Musculoskeletal Disord 2014; 7:13–20.

    Google Scholar 

  14. L Shamir, SM Ling, WW Scott, A Bos, N Orlov, et al. Knee x-ray image analysis method for automated detection of osteoarthritis. IEEE Trans Biomed Eng 2009; 56:407–415.

    Article  Google Scholar 

  15. Solmaz I, Deniz S, Cifci OT. Treatment of advanced stage gonarthrosis with prolotherapy: case report. Anesth Pain Med 2013; 4:e9171.

    PubMed  PubMed Central  Google Scholar 

  16. Reeves KD, Hassanein K): Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 2000; 6 :68–74. 77–80

    Google Scholar 

  17. Veronesi B, Oortgiesen M. Neurogenic inflammation and particulate matter (PM) air pollutants. Neurotoxicology 2001; 22:795 – 810.

    Article  CAS  Google Scholar 

  18. Gould D et al. Visual analogue scale (VAS). J Clin Nurs 2001; 10:697–706.

    Article  CAS  Google Scholar 

  19. Bellamy N, Bell M, Goldsmith C et al. Evaluation of WOMAC 20, 50, 70 response criteria in patients treated with hylan G-F 20 for knee osteoarthritis. Ann Rheum Dis 2005; 64:881–885.

    Article  CAS  Google Scholar 

  20. Aneja A, Karas SG, Weinhold PS, Afshari HM, Dahners LE. Suture plication, thermal shrinkage, and sclerosing agents: effects on rat patellar tendon length and biomechanical strength. Am J Sports Med 2005; 33 :1729–1734.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Diplomat of the American Board of Regenerative Medicine, Member of American Academy of Regenerative Medicine, Member of American Association of Orthopedic Medicine “AAOM”, Cairo, Egypt

    D. M. I. Soliman M.B.B.CH. (Honor Degree), M.Sc., N. M. Sherif & A. K. El Zohiery

  2. Department of Radiology, Ain Shams University, Cairo, Egypt

    O. H. Omar

Authors
  1. D. M. I. Soliman M.B.B.CH. (Honor Degree), M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. M. Sherif
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. H. Omar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. K. El Zohiery
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. M. I. Soliman M.B.B.CH. (Honor Degree), M.Sc..

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Soliman, D.M.I., Sherif, N.M., Omar, O.H. et al. Healing effects of prolotherapy in treatment of knee osteoarthritis healing effects of prolotherapy in treatment of knee osteoarthritis. Egypt Rheumatol Rehabil 43, 47–52 (2016). https://doi.org/10.4103/1110-161X.181858

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-161X.181858

Keywords