• David Rabago, Aleksandra Zgierska, Luke Fortney, Richard Kijowski, Marlon Mundt, Michael Ryan, Jessica Grettie, and Jeffrey J Patterson.
• Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, USA. David.rabago@fammed.wisc.edu
• J Altern Complement Med. 2012 Apr 1;18(4):408-14.

ObjectiveThe objective of this study was to determine whether prolotherapy, an injection-based complementary treatment for chronic musculoskeletal conditions, improves pain, stiffness, and function in adults with symptomatic knee osteoarthritis (KOA) compared to baseline status.DesignThis was a prospective, uncontrolled study with 1-year follow-up.SettingThe study was conducted in an outpatient setting.ParticipantsAdults with at least 3 months of symptomatic KOA, recruited from clinical and community settings, participated in the study.InterventionsParticipants received extra-articular injections of 15% dextrose and intra-articular prolotherapy injections of 25% dextrose at 1, 5, and 9 weeks, with as-needed treatments at weeks 13 and 17.Outcome MeasuresPrimary outcome measure was the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC). Secondary outcome measure was the validated Knee Pain Scale (KPS). Tertiary outcome measure was procedure-related pain severity and participant satisfaction.ResultsThirty-six (36) participants (60 ± 8.7 years old, 21 female) with moderate-to-severe KOA received an average of 4.3 ± 0.7 prolotherapy injection sessions over a 17-week treatment period and reported progressively improved scores during the 52-week study on WOMAC and KPS measures. Participants reported overall WOMAC score improvement 4 weeks after the first injection session (7.6 ± 2.4 points, 17.2%), and continued to improve through the 52-week follow-up (15.9 ± 2.5 points, p<0.001, 36.1%). KPS scores improved in both injected (p<0.001) and uninjected knees (p<0.05). Prescribed low-dose opioid analgesia effectively treated procedure-related pain. Satisfaction was high and there were no adverse events. Female gender, age 46-65 years old, and body-mass index of 25 kg/m(2) or less were associated with greater improvement on the WOMAC instrument.ConclusionsIn adults with moderate to severe KOA, dextrose prolotherapy may result in safe, significant, sustained improvement of knee pain, function, and stiffness scores. Randomized multidisciplinary effectiveness trials including evaluation of potential disease modification are warranted to further assess the effects of prolotherapy for KOA.

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