title: Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and meta-analysis.
abstract: Hypertonic dextrose injections (prolotherapy) is an emerging treatment for symptomatic knee osteoarthritis (OA) but its efficacy is uncertain. We conducted a systematic review with meta-analysis to synthesize clinical evidence on the effect of prolotherapy for knee OA. Fifteen electronic databases were searched from their inception to September 2015. The primary outcome of interest was score change on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Three randomized controlled trials (RCTs) of moderate risk of bias and one quasi-randomized trial were included, with data from a total of 258 patients. In the meta-analysis of two eligible studies, prolotherapy is superior to exercise alone by a standardized mean difference (SMD) of 0.81 (95% CI: 0.18 to 1.45, p = 0.012), 0.78 (95% CI: 0.25 to 1.30, p = 0.001) and 0.62 (95% CI: 0.04 to 1.20, p = 0.035) on the WOMAC composite scale; and WOMAC function and pain subscale scores respectively. Moderate heterogeneity exists in all cases. Overall, prolotherapy conferred a positive and significant beneficial effect in the treatment of knee OA. Adequately powered, longer-term trials with uniform end points are needed to better elucidate the efficacy of prolotherapy.
authors.affiliation: The Chinese University of Hong Kong, The Jockey Club School of Public Health and Primary Care, Hong Kong.
authors.forename: Regina Ws
authors.initials: RW
authors.lastname: Sit
authors.affiliation: The Chinese University of Hong Kong, The Jockey Club School of Public Health and Primary Care, Hong Kong.
authors.forename: Vincent Ch
authors.initials: VCh
authors.lastname: Chung
authors.affiliation: The University of Kansas, Department of Physical Medicine and Rehabilitation (1986-2015), Kansas City, USA.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Reeves
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Medicine, Madison, Wisconsin, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rabago
authors.affiliation: The Chinese University of Hong Kong, The Jockey Club School of Public Health and Primary Care, Hong Kong.
authors.forename: Keith Kw
authors.initials: KK
authors.lastname: Chan
authors.affiliation: The Chinese University of Hong Kong, The Jockey Club School of Public Health and Primary Care, Hong Kong.
authors.forename: Dicken Cc
authors.initials: DC
authors.lastname: Chan
authors.affiliation: The Chinese University of Hong Kong, The Jockey Club School of Public Health and Primary Care, Hong Kong.
authors.forename: Xinyin
authors.initials: X
authors.lastname: Wu
authors.affiliation: The Chinese University of Hong Kong, The Jockey Club School of Public Health and Primary Care, Hong Kong.
authors.forename: Robin St
authors.initials: RS
authors.lastname: Ho
authors.affiliation: The Chinese University of Hong Kong, The Jockey Club School of Public Health and Primary Care, Hong Kong.
authors.forename: Samuel Ys
authors.initials: SY
authors.lastname: Wong
mesh_terms: D002986:Clinical Trials as Topic; D005950:Glucose Solution, Hypertonic / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D009864:Ontario; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D000075527:Prolotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005950:Glucose Solution, Hypertonic