title: Dextrose and morrhuate sodium injections (prolotherapy) for knee osteoarthritis: a prospective open-label trial.
abstract: OBJECTIVE
  This study determined whether injection with hypertonic dextrose and morrhuate sodium (prolotherapy) using a pragmatic, clinically determined injection schedule for knee osteoarthritis (KOA) results in improved knee pain, function, and stiffness compared to baseline status.
  
  
  METHODS
  This was a prospective three-arm uncontrolled study with 1-year follow-up.
  
  
  METHODS
  The setting was outpatient.
  
  
  METHODS
  The participants were 38 adults who had at least 3 months of symptomatic KOA and who were in the control groups of a prior prolotherapy randomized controlled trial (RCT) (Prior-Control), were ineligible for the RCT (Prior-Ineligible), or were eligible but declined the RCT (Prior-Declined).
  
  
  METHODS
  The injection sessions at occurred at 1, 5, and 9 weeks with as-needed treatment at weeks 13 and 17. Extra-articular injections of 15% dextrose and 5% morrhuate sodium were done at peri-articular tendon and ligament insertions. A single intra-articular injection of 6 mL 25% dextrose was performed through an inferomedial approach.
  
  
  METHODS
  The primary outcome measure was the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC). The secondary outcome measure was the Knee Pain Scale and postprocedure opioid medication use and participant satisfaction.
  
  
  RESULTS
  The Prior-Declined group reported the most severe baseline WOMAC score (p=0.02). Compared to baseline status, participants in the Prior-Control group reported a score change of 12.4±3.5 points (19.5%, p=0.002). Prior-Decline and Prior-Ineligible groups improved by 19.4±7.0 (42.9%, p=0.05) and 17.8±3.9 (28.4%, p=0.008) points, respectively; 55.6% of Prior-Control, 75% of Prior-Decline, and 50% of Prior-Ineligible participants reported score improvement in excess of the 12-point minimal clinical important difference on the WOMAC measure. Postprocedure opioid medication resulted in rapid diminution of prolotherapy injection pain. Satisfaction was high and there were no adverse events.
  
  
  CONCLUSIONS
  Prolotherapy using dextrose and morrhuate sodium injections for participants with mild-to-severe KOA resulted in safe, significant, sustained improvement of WOMAC-based knee pain, function, and stiffness scores compared to baseline status.
authors.affiliation: 1 Department of Family Medicine, University of Wisconsin School of Medicine and Public Health , Madison WI.
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: Aleksandra
authors.initials: A
authors.lastname: Zgierska
authors.forename: Luke
authors.initials: L
authors.lastname: Fortney
authors.forename: Jessica
authors.initials: J
authors.lastname: Grettie
authors.forename: Richard
authors.initials: R
authors.lastname: Kijowski
mesh_terms: D000529:Complementary Therapies / Q000379:methods*; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012976:Sodium Morrhuate / Q000008:administration & dosage*
chemical_list: D012976:Sodium Morrhuate; D005947:Glucose