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.
Highlights
Hypertonic dextrose injections is an emerging treatment for symptomatic knee osteoarthritis (OA) but its efficacy is uncertain
Prolotherapy is practiced throughout the world; the strongest interest appears to be among physicians and patients in primary care[18,19]
Systematic reviews of the clinical effectiveness of prolotherapy in chronic low back pain and lateral epicondylitis had been conducted in the past which yielded mixed and positive results respectively, though the strength of evidence was limited by clinical heterogeneity amongst studies and the presence of co-interventions[25,26]
Summary
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. Systematic reviews of the clinical effectiveness of prolotherapy in chronic low back pain and lateral epicondylitis had been conducted in the past which yielded mixed and positive results respectively, though the strength of evidence was limited by clinical heterogeneity amongst studies and the presence of co-interventions[25,26]. We conducted a systematic review with the aim of more comprehensively assessing the efficacy of prolotherapy for knee OA in order to clarify its potential role as a non-surgical treatment modality
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