title: Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up.
abstract: OBJECTIVE
  The objective of this study was to determine whether prolotherapy, an injection-based complementary treatment for chronic musculoskeletal conditions, improves pain, stiffness, and function in adults with symptomatic knee osteoarthritis (KOA) compared to baseline status.
  
  
  METHODS
  This was a prospective, uncontrolled study with 1-year follow-up.
  
  
  METHODS
  The study was conducted in an outpatient setting.
  
  
  METHODS
  Adults with at least 3 months of symptomatic KOA, recruited from clinical and community settings, participated in the study.
  
  
  METHODS
  Participants received extra-articular injections of 15% dextrose and intra-articular prolotherapy injections of 25% dextrose at 1, 5, and 9 weeks, with as-needed treatments at weeks 13 and 17.
  
  
  METHODS
  Primary outcome measure was the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC). Secondary outcome measure was the validated Knee Pain Scale (KPS). Tertiary outcome measure was procedure-related pain severity and participant satisfaction.
  
  
  RESULTS
  Thirty-six (36) participants (60 ± 8.7 years old, 21 female) with moderate-to-severe KOA received an average of 4.3 ± 0.7 prolotherapy injection sessions over a 17-week treatment period and reported progressively improved scores during the 52-week study on WOMAC and KPS measures. Participants reported overall WOMAC score improvement 4 weeks after the first injection session (7.6 ± 2.4 points, 17.2%), and continued to improve through the 52-week follow-up (15.9 ± 2.5 points, p<0.001, 36.1%). KPS scores improved in both injected (p<0.001) and uninjected knees (p<0.05). Prescribed low-dose opioid analgesia effectively treated procedure-related pain. Satisfaction was high and there were no adverse events. Female gender, age 46-65 years old, and body-mass index of 25 kg/m(2) or less were associated with greater improvement on the WOMAC instrument.
  
  
  CONCLUSIONS
  In adults with moderate to severe KOA, dextrose prolotherapy may result in safe, significant, sustained improvement of knee pain, function, and stiffness scores. Randomized multidisciplinary effectiveness trials including evaluation of potential disease modification are warranted to further assess the effects of prolotherapy for KOA.
authors.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, USA. David.rabago@fammed.wisc.edu
authors.forename: David
authors.initials: D
authors.lastname: Rabago
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zgierska
authors.forename: Luke
authors.initials: L
authors.lastname: Fortney
authors.forename: Richard
authors.initials: R
authors.lastname: Kijowski
authors.forename: Marlon
authors.initials: M
authors.lastname: Mundt
authors.forename: Michael
authors.initials: M
authors.lastname: Ryan
authors.forename: Jessica
authors.initials: J
authors.lastname: Grettie
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Patterson
mesh_terms: D000367:Age Factors; D000368:Aged; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D018771:Arthralgia / Q000188:drug therapy*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects; D007717:Knee; D007719:Knee Joint / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D017060:Patient Satisfaction; D011446:Prospective Studies; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D005947:Glucose