Comparison of Efficacy between Dextrose Neurofascial Prolotherapy and Intra-articular Corticosteroid Injection in Patients with Moderate to Severe Knee Osteoarthritis: A Double-Blind Randomized Clinical Trial

Abstract

Background: Considering the large variety of medications prescribed in the treatment of knee osteoarthritis ‎(OA) and uncertainty about their efficacy, the present study was conducted to compare the efficacy of dextrose neurofascial prolotherapy and intra-articular corticosteroid injection in patients with moderate to severe knee OA. Methods: Qualified patients were randomly allocated to one of the two groups. The first group received one intra-articular injection of corticosteroid 40 mg plus 1cc lidocaine 1%. The second group received one intra-articular injection of 5 cc dextrose 20% through the lateral mid-patellar approach and four periarticular ‎subcutaneous injections of dextrose 16% (4 cc dextrose 20% plus 1 cc lidocaine 1%) in 4 areas around the knee. Results: The findings showed a significant improvement in all measured outcomes in steroid groups, but not in the function component and overall Western Ontario and McMaster Universities Arthritis Index ‎(WOMAC) score of the prolotherapy group. No significant differences were observed between the groups in terms of the visual analog scale (VAS) and the WOMAC components of stiffness and function one month after treatment. In terms of the overall WOMAC score and pain component of WOMAC, the corticosteroid group showed significantly better results after one month (P = 0.046 and P = 0.007, respectively). Conclusion: The results showed that both dextrose prolotherapy and corticosteroid intra-articular injection reduced pain and stiffness in patients with moderate to severe knee OA. In the short term, corticosteroid injection is superior to dextrose prolotherapy. To more precisely compare the effectiveness of these treatments in the long term, we recommend further studies with longer follow-up periods and larger sample sizes.