title: Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes.
abstract: OBJECTIVE
  Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy (p<0.05). However, long term effects of prolotherapy for knee OA are unknown. We therefore assessed long-term effects of prolotherapy on knee pain, function and stiffness among adults with knee OA.
  
  
  METHODS
  Post clinical-trial, open-label follow-up study.
  
  
  METHODS
  Outpatient; adults with mild-to-severe knee OA completing a 52-week prolotherapy study were enrolled.
  
  
  METHODS
  Participants received 3-5 monthly interventions and were assessed using the validated Western Ontario McMaster University Osteoarthritis Index, (WOMAC, 0-100 points), at baseline, 12, 26, 52 weeks, and 2.5 years.
  
  
  RESULTS
  65 participants (58±7.4 years old, 38 female) received 4.6±0.69 injection sessions in the initial 17-week treatment period. They reported progressive improvement in WOMAC scores at all time points in excess of minimal clinical important improvement benchmarks during the initial 52-week study period, from 13.8±17.4 points (23.6%) at 12 weeks, to 20.9±2.8 points, (p<0.05; 35.8% improvement) at 2.5±0.6 years (range 1.6-3.5 years) in the current follow-up analysis. Among assessed covariates, none were predictive of improvement in the WOMAC score.
  
  
  CONCLUSIONS
  Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness scores among most participants through a mean follow-up of 2.5 years and may be an appropriate therapy for patients with knee OA refractory to other conservative care.
authors.affiliation: Department of Family Medicine University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, United States. Electronic address: david.rabago@fammed.wisc.edu.
authors.forename: David
authors.initials: D
authors.lastname: Rabago
authors.affiliation: Department of Family Medicine University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, United States.
authors.forename: Marlon
authors.initials: M
authors.lastname: Mundt
authors.affiliation: Department of Family Medicine University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, United States.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zgierska
authors.affiliation: Wisconsin Center for Education Research University of Wisconsin, Madison, WI 53706, United States.
authors.forename: Jessica
authors.initials: J
authors.lastname: Grettie
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000503:physiopathology; D000529:Complementary Therapies / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007717:Knee / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D016896:Treatment Outcome
chemical_list: D005947:Glucose
keywords: NCT00085722