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PM R. 2016 Nov;8(11):1072-1082. doi: 10.1016/j.pmrj.2016.03.008. Epub 2016 Apr 4.

Chondrogenic Effect of Intra-articular Hypertonic-Dextrose (Prolotherapy) in Severe Knee Osteoarthritis.

Author information

1
Department of Physical Medicine and Rehabilitation, National University of Rosario, Rosario, Argentina(∗).
2
Department of Orthopaedics, National University of Rosario, Rosario, Argentina(†).
3
Private Practice Physical Medicine and Rehabilitation, Roeland Park, Kansas City, KS 66205; Department of PM&R, University of Kansas Medical Center, Kansas City, KS(‡). Electronic address: DeanReevesMD@gmail.com.
4
Department of PM&R, Hospital Provincial de Rosario, Rosario, Argentina(§).
5
Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI; Department of Orthopaedic Surgery, Michigan State University, East Lansing, MI(‖).
6
Deceased; previously private practice anatamopathology consultation, Rosario, Argentina; Provincial Hospital Domingo Funes, Santa Maria de Punilla, Argentina(¶).
7
Department of Radiology, Hospital Emergencia Clemente Alvarez, Rosario, Argentina(#).
8
Private practice ultrasonographic training, Vista, CA(∗∗).
9
Department of Family Medicine and Community Health, University of Wisconsin, School of Medicine and Public Health, Madison, WI(††).

Abstract

BACKGROUND:

Dextrose injection is reported to improve knee osteoarthritis (KOA)-related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed.

OBJECTIVE:

To assess biological and clinical effects of intra-articular hypertonic dextrose injections (prolotherapy) in painful KOA.

DESIGN:

Case series with blinded arthroscopic evaluation before and after treatment.

SETTING:

Physical medicine and day surgery practice.

PARTICIPANTS:

Symptomatic KOA for at least 6 months, arthroscopy-confirmed medial compartment exposed subchondral bone, and temporary pain relief with intra-articular lidocaine injection.

INTERVENTION:

Four to 6 monthly 10-mL intra-articular injections with 12.5% dextrose.

MAIN OUTCOME MEASURES:

Visual cartilage growth assessment of 9 standardized medial condyle zones in each of 6 participants by 3 arthroscopy readers masked to pre-/postinjection status (total 54 zones evaluated per reader); biopsy of a cartilage growth area posttreatment, evaluated using hematoxylin and eosin and Safranin-O stains, quantitative polarized light microscopy, and immunohistologic cartilage typing; self-reported knee specific quality of life using the Western Ontario McMaster University Osteoarthritis Index (WOMAC, 0-100 points).

RESULTS:

Six participants (1 female and 5 male) with median age of 71 years, WOMAC composite score of 57.5 points, and a 9-year pain duration received a median of 6 dextrose injections and follow-up arthroscopy at 7.75 months (range 4.5-9.5 months). In 19 of 54 zone comparisons, all 3 readers agreed that the posttreatment zone showed cartilage growth compared with the pretreatment zone. Biopsy specimens showed metabolically active cartilage with variable cellular organization, fiber parallelism, and cartilage typing patterns consistent with fibro- and hyaline-like cartilage. Compared with baseline status, the median WOMAC score improved 13 points (P = .013). Self-limited soreness after methylene blue instillation was noted.

CONCLUSIONS:

Positive clinical and chondrogenic effects were seen after prolotherapy with hypertonic dextrose injection in participants with symptomatic grade IV KOA, suggesting disease-modifying effects and the need for confirmation in controlled studies. Minimally invasive arthroscopy (single-compartment, single-portal) enabled collection of robust intra-articular data.

LEVEL OF EVIDENCE:

IV.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01210183.

PMID:
27058744
DOI:
10.1016/j.pmrj.2016.03.008
[Indexed for MEDLINE]

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