title: Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial.
abstract: OBJECTIVE
  Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis.
  
  
  METHODS
  Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used.
  
  
  RESULTS
  No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events.
  
  
  CONCLUSIONS
  Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.
authors.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53715, USA. david.rabago@fammed.wisc.edu
authors.forename: David
authors.initials: D
authors.lastname: Rabago
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Patterson
authors.forename: Marlon
authors.initials: M
authors.lastname: Mundt
authors.forename: Richard
authors.initials: R
authors.lastname: Kijowski
authors.forename: Jessica
authors.initials: J
authors.lastname: Grettie
authors.forename: Neil A
authors.initials: NA
authors.lastname: Segal
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zgierska
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D018771:Arthralgia / Q000188:drug therapy*; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000187:drug effects*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D005947:Glucose
keywords: dextrose; knee; osteoarthritis; prolotherapy; randomized controlled trial