Combined Prolotherapy and Physical Therapy in a 60-Year-Old Man with Left Shoulder Pain and Limited Range of Motion (Frozen Shoulder) Following a Hemiplegic Stroke: A Case Report.

BACKGROUND Frozen shoulder with limited range of motion is a common and debilitating condition that occurs on the affected side following a stroke. The effectiveness of therapy was reported to be negatively correlated with the complexity of pathogenesis. Prolotherapy involves injection into the joint of a small amount of irritant, such as dextrose, which enhances tissue strength and facilitates healing by targeting joint spaces. The treatment is used to relieve pain. This report describes the effects of combined prolotherapy and physical therapy in a 60-year-old man with left shoulder pain and limited range of motion (frozen shoulder) following a hemiplegic stroke. CASE REPORT A 60-year-old man had left shoulder pain and limited ROM for 9 months, which disrupted daily life, with a NRS of 7 and a DASH score of 58.3%. The patient had an ischemic stroke 1 year ago, with left extremity weakness. On physical examination, joint active ROM was significantly restricted and the joint was tender upon palpation. Therapy is carried out using prolotherapy combined with exercise and physical therapy for 6 weeks. At the 6-week follow-up, he had good outcomes for pain relief, increasing ROM, and quality of life. CONCLUSIONS The use of prolotherapy with physical therapy may be an effective treatment for painful frozen shoulder following a hemiplegic stroke.

Demonstrating the effectiveness of intra-articular prolotherapy combined with peri-articular perineural injection in knee osteoarthritis: a randomized controlled trial.

BACKGROUND: This study aimed to compare the efficacy of intra-articular prolotherapy (IG) combined with peri-articular perineural injection (PG) in the management of knee osteoarthritis (KOA). METHODS: A total of 60 patients with the diagnosis of KOA were included in this double-blinded randomized controlled clinical trials. The inclusion criteria were as follow: (1) 48-80 years old; (2) the diagnose of KOA; (3) the grade 2 and 3 of the Kellgern-Lawrence grading scale; (4) the pain, crepitation, and knee joint stiffness continuing for 3 months at least. The main exclusion criteria were as follow: (1) any infection involving the knee skin; (2) history of any Influencing factors of disease. All patients were divided into three groups and received either IG, PG and I + PG under the ultrasound guidance and the 2, 4 and 8 weeks follow-up data of patients were available. (IG n = 20 or PG n = 20, I + PG n = 20). Visual Analogue Scale (VAS), The Western Ontario McMaster University Osteoarthritis Index (WOMAC) and the pressure pain threshold (PPT) were used as outcome measures at baseline, 2, 4 and 8 weeks. RESULTS: There were no statistically significant differences in terms of age, sex, BMI, duration of current condition and baseline assessments of pain intensity, WOMAC scores and PPT. After treatment, the improvement of VAS activity, WOMAC and PPT values was showed compared with pre-treatment in all groups (p < 0.05). At 4 and 8 weeks after treatment, the VAS and WOMAC scores of the I + PG were significantly lower than those of the PG or IG, and the difference was statistically significant (p < 0.05). The PPT values of PG and I + PG were significantly improved compared to IG at 2, 4, and 8 weeks after treatment. CONCLUSION: The ultrasound guided I + PG of 5% glucose seem to be more effective to alleviate pain and improve knee joint function than single therapy in short term. Clinical rehabilitators could clinically try this combination of I + PG to improve clinical symptoms in patients with KOA.

Regenerative Medicine Solutions for Rotator Cuff Injuries in Athletes: Indications and Outcomes.

Rotator cuff (RC) injuries include a wide range of pathologic states. Athletes are perhaps the most susceptible to RC injuries ranging from tendinopathy to partial or full-thickness tears, due to functional overload and repetitive movements, causing abstention from sports for long periods. Regenerative medicine keeps giving us multiple choices to fight the disability caused by these pathologies. A literature search was performed, and findings related to the structure-function of rotator cuff units, pathophysiology of injuries, regenerative medicine treatments, and future strategies were outlined. Platelet-rich plasma (PRP) has a greater number of articles and clinical trials, accompanied by stem cells progenitor, prolotherapy, and new approaches such as microfragmented adipose tissue and exosomes. RC injuries in athletes can cause pain, functional impotence, and the risk of recurrence, and can lead them to stop playing sports. Regenerative medicine offers a range of treatments, but some of them need further studies to underline their actual validity.

Ultrasound-Guided Vs Non-Guided Prolotherapy for Internal Derangement of Temporomandibular Joint. A Randomized Clinical Trial.

OBJECTIVES: This randomized clinical trial study aims to compare ultrasound-guided versus non-guided Dextrose 10% injections in patients suffering from internal derangement in the temporomandibular joint (TMJ). MATERIAL AND METHODS: The study population included 22 patients and 43 TMJs suffering from unilateral or bilateral TMJ painful clicking, magnetic resonance imaging (MRI) proved disc displacement with reduction (DDWR), refractory to or failed conservative treatment. The patients were divided randomly into two groups (non-guided and ultrasound (US)-guided groups). The procedure involved injection of 2 mL solution of a mixture of 0.75 mL 0.9% normal saline solution, 0.3 mL 2% lidocaine and 0.75 mL dextrose 10% using a 25G needle in the joint and 1 mL intramuscular injection to the masseter muscle at the most tender point. The Visual Analogue Score (VAS) was used to compare joint pain intensity over four different periods, beginning with pre-injection, 1-, 2-, and 6-months postinjection. RESULTS: Twenty-two patients 5 males (n = 5/22, 22.7%) and 17 females (n = 17/22, 77.2%) were included in this study. The mean age was 27.3 ± 7.4 years (30.2 ± 7.0) for the non-guided group and 24.3 ± 6.9 for the US-guided group. The dextrose injection reduced intensity over time in both groups with statistically significant improvement (P value <.05) at 2 and 6 months in both groups. There was no statistically significant difference in VAS assessment between both groups. CONCLUSION: Intra-articular injection of dextrose 10% for patients with painful clicking and DDWR resulted in reduced pain intensity in both US-guided and non-guided groups with significant symptomatic improvement over time in both groups. US guidance allowed accurate anatomical localization and safe procedure with a single joint puncture.

Evaluation of the efficacy of autologous conditioned serum versus dextrose prolotherapy in internal derangement of the TMJ - A pilot study.

It was the aim of the study to compare the effectiveness of autologous conditioned serum (ACS) and dextrose prolotherapy (DP) solutions, in treating patients with TMJ internal derangement (ID). 24 participants with TMJ ID (Wilkes II-V) were recruited and randomized into study and control groups, with 12 patients each, treated with IA injection of ACS and DP, respectively. Pain, mouth opening, joint sounds, and jaw deviation were evaluated, with patients reviewed at 2 weeks, 1 month, and 2 months intervals. Based on the nature of the variables, appropriate descriptive statistics and statistical tests were applied. The pain score was zero in the study group after 2 months of treatment, which was statistically significant (p = 0.006). Deviation was also significantly reduced (p < 0.001) and mouth opening significantly improved (p = 0.004) in the ACS-treated patients. ACS demonstrated superiority over DP in the management of TMJ dysfunction. Therefore, ACS can be considered an ideal, minimally invasive treatment option for TMJ ID. Clinical trial registry number: (CTRI/2021/10/037043).

Ultrasound-Guided Pes Anserine Bursitis Injection Choices: Prolotherapy or Oxygen-Ozone or Corticosteroid: A Randomized Multicenter Clinical Trial.

OBJECTIVE: Pes anserine bursitis is the most common cause of periarticular knee pain. The aim of the study was to evaluate the efficacy of local injection-based therapies with different materials. DESIGN: The enrolled patients were randomly allocated to three groups to receive different interventions. Outcome measures included pain severity using the visual analog scale and the Western Ontario and McMaster Universities osteoarthritis index that was evaluated before the intervention, 1 and 8 wks after that. RESULTS: This trial was performed on 72 participants, with male-to-female ratio of 0.14 and with a mean age of 61.49 ± 9.35 yrs. Corticosteroids in the first group, oxygen-ozone in the second group, and dextrose 20% in the third group, were injected into the pes anserine bursa under ultrasound guidance. Interaction between time and group showed a statistically significant improvement in visual analog scale and Western Ontario and McMaster Universities Arthritis Index ( P ≤ 0.05) in favor of corticosteroids and oxygen-ozone groups after 1 wk and in favor of oxygen-ozone and prolotherapy groups after 8 wks. CONCLUSIONS: All three treatment options are effective for patients with pes anserine bursitis. This study showed that the effects of oxygen-ozone injection and prolotherapy last longer than those of corticosteroid injection.

[Functionality/isokinetic work of quadriceps in patients with gonarthrosis managed with prolotherapy]. / Funcionalidad/trabajo isocinético de cuádriceps de pacientes con gonartrosis manejados con proloterapia.

Background: Prolotherapy may be a good option in the complementary treatment of knee osteoarthritis (OA) patients, specifically for the increase of functionality. Objective: To determine the effectiveness of prolotherapy in OA grade II - III in the functionality and muscular work of knee flexors and extensors. Material and methods: a double-blind randomized controlled clinical trial was conducted. It included patients diagnosed with OA grades II-III. The experimental group was infiltrated in both knees with 6 ml of 25% glucose solution and 0.05% lidocaine; control group with 0.45% saline solution and 0.05% lidocaine. All patients received a comprehensive rehabilitation program. The isokinetic work of the knee flexor and extensor muscles, pain and functionality were measured, prior to infiltration and at 3-month follow-up. To compare the difference in means, the Student's T test was applied, considering P<0.05 as significant. The project was approved by the local ethics and research committee. Results: 37 patients were recruited, 17 in the prolotherapy group. There were no intergroup differences in functionality, isokinetic knee flexor/extensor work, and pain at baseline, or during follow-up up to 12 weeks. Conclusions: In the present study we identify that both prolotherapy and saline infiltration increased functionality, strength, and decreased pain; however, no statistically significant difference was found between the two group.

Introducción: la proloterapia puede ser buena opción en el tratamiento complementario de pacientes con osteoartrosis de rodilla (OA), específicamente para el incremento de la funcionalidad. Objetivo: determinar la efectividad de la proloterapia en OA grado II-III en la funcionalidad y en el trabajo muscular de flexores y extensores de rodilla. Material y métodos: se realizó un ensayo clínico controlado aleatorizado a doble ciego. Incluyó a pacientes con el diagnostico de OA grados II-III. Al grupo experimental se les infiltraron 6 mL de solución glucosada al 25% y lidocaína al 0.05% en ambas rodillas; al grupo control con solución salina al 0.45% y lidocaína al 0.05%. Todos los pacientes recibieron un programa integral de rehabilitación. Se midió el trabajo isocinético de los músculos flexores y extensores de rodilla, dolor y funcionalidad, previa infiltración y a los tres meses de seguimiento. Para comparar la diferencia de medias, se aplicó la prueba de t de Student, considerando p < 0.05 como significativo. El proyecto se aprobó en el comité local de ética e investigación. Resultados: se reclutaron 37 pacientes, 17 en el grupo de proloterapia. No hubo diferencias intergrupo en la funcionalidad, trabajo isocinético de flexores/extensores de rodilla y dolor iniciales, ni durante el seguimiento hasta las 12 semanas. Conclusiones: en el presente estudio identificó que tanto la proloterapia como la infiltración con solución salina incrementaron la funcionalidad, fuerza y disminuyeron el dolor; sin embargo, no se encontró diferencia estadísticamente significativa entre los dos grupos.

Comparison of the effect of prolotherapy and paraffin wax for hand osteoarthritis.

OBJECTIVE: Hand osteoarthritis (OA) is associated with considerable disability, especially in the elderly patient population. Paraffin wax (PW) and prolotherapy (P) are non-pharmacological treatment methods used in this setting. This study aimed to compare the therapeutic efficacy of P and PW in hand osteoarthritis. PATIENTS AND METHODS: This study was designed as a single-center, randomized-controlled trial conducted at our Physical Medicine and Rehabilitation Clinic between February 2019 and July 2020. Patients with bilateral hand OA were divided into PW and P treatment groups. The PW group was treated 5 days per week for 2 weeks. The P group received an injection of dextrose solution into the ligaments of painful joints once weekly for three weeks. Visual analog scale (VAS), Duruoz Hand Index (DHI) scale, hand dynamometer for grip strength, and pinch meter for lateral pinch were used for baseline and post-treatment follow-up assessments. RESULTS: Overall, 42 patients were included. The VAS scores significantly decreased in both PW and P groups (p=0.024 and p=0.014). Baseline and third-month post-treatment VAS scores did not significantly differ (p=0.581). The DHI scores improved significantly in both groups (p<0.001 and p<0.001), being higher in the P than in the PW group (p=0.042). Right- and left-hand grip strength increased significantly in PW and P groups (p<0.001, p=0.001; p=0.013, p=0.002, respectively). CONCLUSIONS: Both treatment methods were effective regarding pain and grip strength; however, P improved the hand functions more significantly.

Hypertonic glucose in the treatment of low back pain: A randomized clinical trial.

BACKGROUND: Chronic low back pain (LBP) is defined as pain lasting longer than 3 months and is one of the conditions with the most significant social impact. Treatment is complex and includes proliferative agents used in prolotherapy. The mechanism is not known, but osmotic agents (hypertonic solutions of dextrose or glucose) cause cellular rupture and an inflammatory response that releases cytokines and growth factors that lead to scarring and reinnervation. METHODS: Patients with chronic LBP (>12 weeks) who were non-traumatic and unresponsive to at least 1 month of physical therapy were selected. All patients were followed up at a return visit at 1, 3, and 6 months for pain assessment using validated pain questionnaires and scales. RESULTS: Nineteen patients were included in the conservative group and 19 in the glucose group, with the majority being women (57.9%). The patients were between 47 and 59 years of age (39.5%), mixed race (76.33%), married or in a committed relationship (73.7%), and had completed the study for 5.2 years. Overall mean body mass index was 27.3 ± 4.4 kg/m 2 and was higher in the conservative group (28.0 ± 4.7 kg/m 2 ). The groups showed differences in Visual Analog Scale scores, with median and amplitude values close to each other between the time points evaluated and increasing values in the glucose group, which had significantly higher values for this scale at the third evaluation ( P = .031). When comparing the Rolland-Morris scale scores between the groups, there was a significant difference only in the 3-m assessment ( P = .021). In the follow-up assessment, both groups showed significant improvement between T0 and the other assessment time points ( P < .05) in all evaluations. CONCLUSION: Both groups significantly improved on the evaluated scales during follow-up. Overall, no effects were attributable to the glucose components or the prolotherapy protocol.

Ameliorative Effects of Prolotherapy on Histomorphology of Tibial Articular Cartilage of Chemically Induced Osteoarthritic Knee Joint in a Rat Model.

OBJECTIVE: To determine the ameliorative effects of prolotherapy on monosodium iodoacetate (MIA) induced and histomorphological changes in the articular cartilage of tibial condyles at rat knee joint. STUDY DESIGN: An experimental study. Place and Duration of the Study: Department of Anatomy, Army Medical College Rawalpindi, NUMS, Rawalpindi, from August to November 2021. METHODOLOGY: Thirty adult male Sprague Dawley rats were divided into three groups, each having 10 rats. Group A was control. Group B was injected with single dose of 1mg MIA intraarticularly in the right knee to induce osteoarthritic changes. Group C was injected with single dose of 1mg MIA intraarticularly, in right knee was followed by 0.1ml Prolotherapy (3ml of 25% dextrose, 2ml of 2% xylocaine, 1ml of injection neurobion, and 1ml of injection methecobal) as intra articular injection at week 2, 6 and 10 in right knee. Rats were sacrificed after one month of the last dose of Prolotherapy. Articular cartilage was collected for gross and histological examination and compared among the groups. RESULTS: Articular cartilage belonging to control group A was normal. While group B showed statistically significant deterioration in gross appearance (p = 0.001**), reduction in number of chondrocytes (p = 0.005*) and thickness of articular cartilage (p = 0.001**) in comparison to group A. In group C due to prolotherapy statistically significant improvement in gross appearance (p = 0.034*), increase in number of chondrocytes (p = 0.003*), and thickness of articular cartilage (p = 0.001**) was observed as compared to group B. CONCLUSION: Prolotherapy significantly ameliorates histomorphology of tibial articular cartilage against MIA induced osteoarthritic changes in rat knee joint. KEY WORDS: Articular cartilage, Knee joint, Monosodium iodoacetate, Osteoarthritis, Prolotherapy.

A comparative analysis of prolotherapy efficacy in patients with knee osteoarthritis across varied dextrose concentrations.

OBJECTIVE: To compare the effectiveness of prolotherapy with dextrose concentrations of 5%, 10%, and 20% in patients diagnosed with knee osteoarthritis. METHODS: This study was planned as a prospective, randomized controlled interventional trial. Prolotherapy at 5% dextrose concentration in group 1, 10% in group 2, and 20% in group 3 was applied to the knee intra-articularly and periarticularly at 0, 3, and 6 weeks, and a home exercise program was given. Group 4 received a home exercise program. All groups received hotpack therapy at weeks 0, 3, and 6. Outcome measures included the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee range of motion, timed up and go test, and Short Form-36. RESULTS: A total of 128 patients were divided into 4 groups. At the 6th and 12th weeks, VAS scores were significantly lower in groups 2 and 3 than in group 4 (p < 0.05). At the 12th week, the WOMAC pain score was significantly lower in group 3 than in group 4, and WOMAC physical function and WOMAC total scores were significantly lower in groups 1, 2, and 3 than in group 4 (p < 0.05). Week 6 active and passive knee flexion and week 12 passive knee flexion were significantly higher in group 3 than in group 4 (p < 0.05). CONCLUSIONS: Although no significant difference was observed among the dextrose prolotherapy groups, higher dextrose concentrations demonstrated a greater improvement compared to the control group. Therefore, the use of 20% dextrose is recommended due to its significant superiority. Long-term follow-up and placebo-controlled studies are needed. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT05537077, registration date: 09.03.2022, retrospectively registered. Key Points • The utilization of dextrose prolotherapy has gained popularity in the management of osteoarthritis, aiming to harness its regenerative and proliferative properties. However, the comparative efficacy of various concentrations of dextrose prolotherapy in treating knee osteoarthritis remains unexplored in the literature. This study aimed to address this gap by comparing different concentrations of dextrose prolotherapy in the treatment of knee osteoarthritis. The findings revealed no statistically significant difference among the various concentrations of dextrose prolotherapy for knee osteoarthritis treatment.

Comparing the effectiveness of prolotherapy and percutaneous dry needling in the treatment of lateral epicondylitis: a retrospective cohort study.

OBJECTIVE: Lateral epicondylitis (LE) can result in a functional loss in patients because of pain and has recently become more prevalent. This study compared the effects of minimally invasive prolotherapy (PRO) and percutaneous dry needling (PDN) on LE treatment. PATIENTS AND METHODS: Patients were divided into three groups; Group 1 included patients undergoing PDN, Group 2 included those undergoing PRO, and Group 3 included those undergoing PDN+PRO. All these treatments were administered three times and at a 3-week interval in each patient. Data on the visual analog scale (VAS) and patient-rated tennis elbow evaluation (PRTEE) scale scores of the patients were collected at weeks 0, 3, and 6 and month 6 and retrospectively analyzed. RESULTS: The VAS and PRTEE scores decreased in all groups. The decrease in Group 3 was higher than that in the other groups (p<0.001). Upon evaluating within-group differences in VAS and PRTEE scores, the scores at week 3, week 6, and month 6 gradually decreased compared with the baseline in all groups (p<0.001). CONCLUSIONS: PDN and PRO are minimally invasive and can successfully treat LE. A combination of PDN+PRO provides better results than PDN or PRO alone. As the materials we used in these treatments are relatively inexpensive and readily available, we believe our study will help reduce the national healthcare costs allocated for the treatment of LE.

The level of ratio between matrix metalloproteinase-1 (MMP-1) and tissue inhibitor matrix metalloproteinase-1 (TIMP-1) after prolotherapy intervention and the functional outcome in patient with frozen shoulder: A randomized controlled trial.

OBJECTIVE: To determine the effect of prolotherapy on functional outcome changes, along with ratio of matrix metalloproteinase-1 (MMP-1)/tissue inhibitor matrix metalloproteinase-1 (TIMP-1) as an indicator of tissue repair in the glenohumeral joint in frozen shoulder patients. DESIGN: Single-blinded randomized controlled trial. SUBJECTS/PATIENTS: Participants with frozen shoulder. METHODS: The prolotherapy group is the study group, and the normal saline (NS) group is the control group. Each group was given injections at weeks 0, 2, 4, and 6. Level of biomarker levels was measured at week 6 and week 12 after there. Functional outcomes were measured at weeks 0, 6, and 12. RESULTS: A significant difference in week 6 and week 12 was demonstrated in the ratio of MMP-1/TIMP-1 level between the prolotherapy group and the normal saline group (P value = .002). Both groups performed well regarding the Numerical Rating Scale score and functional outcome. Compared to the normal saline group, prolotherapy changed the mean range of motion in flexion and internal rotation. CONCLUSION: Prolotherapy is considered to play a role in repairing cartilage based on biomarker assessment, particularly the ratio of MMP-1/TIMP-1-prolotherapy effectiveness in improving functional outcome and Numerical Rating Scale score.

Effect of dextrose prolotherapy on internal derangement of the temporomandibular joint.

OBJECTIVE: This study aimed to evaluate the effect of dextrose prolotherapy in treating internal derangement of the temporomandibular joint. PATIENTS AND METHODS: A total of 20 patients with temporomandibular joint internal derangement were enrolled in the study. The diagnosis of internal derangement was confirmed by magnetic resonance imaging (MRI). The posterior and anterior disc attachment, as well as the most tender part of the masseter muscle, were injected with 12.5% dextrose. Pain, maximum mouth opening, clicking, and deviation were assessed immediately before treatment, as well as at 2-, 4-, and 12- weeks post-treatment. RESULTS: There was a significant improvement in the four clinical variables at the three-time intervals. Pain at two weeks was reduced by 60% (6 vs. 3.75) and by 200% (6 vs. 1.9) at 4 weeks. The maximum mouth opening was increased by 6.4 mm at 2 weeks and 7.85 mm at 4 weeks. The percentage of patients with clicking decreased from 70%, preoperatively- to 50% at 2 weeks, 15% at 4 weeks, and 5% at 12 weeks. The ratio of patients with deviation was decreased from 80% preoperatively to 35% at 2 weeks, 15% at 4 weeks, and 5% at 12 weeks. CONCLUSIONS: Prolotherapy is a safe and effective treatment for alleviating the symptoms of internal derangement of the temporomandibular joint.

Effects of platelet-rich plasma and prolotherapy on supraspinatus tendinopathy: a double blind randomized clinical trial.

BACKGROUND: Supraspinatus tendinopathy is a significant cause of pain and function loss. It has been suggested that platelet-rich plasma (PRP) and prolotherapy are effective treatments for this condition. This study was done to assess and compare the effects of PRP and prolotherapy on shoulder function and pain. The secondary aim was to evaluate the effect of the treatment on shoulder range of motion, supraspinatus tendon thickness, patient satisfaction, and adverse effects. METHODS: This was a randomized, double-blind clinical trial. The study included 64 patients over the age of 18 who had supraspinatus tendinopathy and had not responded to at least three months of conventional treatment. Patients were assigned to either receive 2 mL of PRP (N.=32) or prolotherapy (N.=32). The Shoulder Pain and Disability Index (SPADI) and the Numerical Rating Scale (NRS) were the primary outcomes. Secondary outcomes included shoulder range of motion (ROM), supraspinatus tendon thickness, and adverse effects, which were measured at baseline, 3, 6, and 6 months after injection. At six months, patient satisfaction was assessed. RESULTS: Repeated measures ANOVA showed there was a statistically significant effect of time on total SPADI scores (F [2.75, 151.11], = 2.85, P=0.040) and the NRS (F [2.69, 147.86], = 4.32, P=0.008) within each group. There were no other significant changes over time or between groups. Significantly more patients in the PRP group experienced increased pain lasting less than two weeks after injection (χ2=11.94, P=0.030). CONCLUSIONS: PRP and prolotherapy resulted in improved shoulder function and pain for patients with chronic supraspinatus tendinopathy who did not response to conventional treatment.

Effectiveness of Hypertonic Dextrose Injection (Prolotherapy) in Plantar Fasciopathy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To systematically review the effectiveness of hypertonic dextrose prolotherapy (DPT) in plantar fasciopathy (PF) compared with other non-surgical treatments. DATA SOURCES: PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Allied and Complementary Medicine Database, Global Health, Ovid Nursing Database, Dimensions, and WHO ICTRP were searched from inception to April 30th, 2022. STUDY SELECTION: Two independent reviewers selected randomized controlled trials (RCTs) that evaluated the effectiveness of DPT in PF compared with non-surgical treatments. Outcomes included pain intensity, foot and ankle function, and plantar fascia thickness. DATA EXTRACTION: Two independent reviewers conducted data extraction. Risk of bias (RoB) assessment was conducted using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was assessed with Grading of Recommendation Assessment, Development, and Evaluation (GRADE). DATA SYNTHESIS: Eight RCTs (n=469) met the inclusion criteria. Pooled results favored the use of DPT versus normal saline (NS) injections in reducing pain (weighted mean difference [WMD] -41.72; 95% confidence interval [CI] -62.36 to -21.08; P<.01; low certainty evidence) and improving function [WMD -39.04; 95% CI -55.24 to -22.85; P<.01; low certainty evidence] in the medium term. Pooled results also showed corticosteroid (CS) injections was superior to DPT in reducing pain in the short term [standardized mean difference 0.77; 95% CI 0.40 to 1.14; P<.01; moderate certainty evidence]. Overall RoB varied from "some concerns" to "high". The overall certainty of evidence presented ranges from very low to moderate based on the assessment with the GRADE approach. CONCLUSION: Low certainty evidence demonstrated that DPT was superior to NS injections in reducing pain and improving function in the medium term, but moderate certainty evidence showed that it was inferior to CS in reducing pain in the short term. Further high-quality RCTs with standard protocol, longer-term follow-up, and adequate sample size are needed to confirm its role in clinical practice.

Efficacy of Prolotherapy for Osteoarthritis: A Systematic Review.

OBJECTIVE: Current treatments for osteoarthritis do not resolve the underlying cause. Dextrose prolotherapy is an alternative method that has been proposed for treatment of osteoarthritis, due to its ability to aid tissue regeneration, improve clinical manifestations, and repair damaged tissue structures, which are pathological conditions in osteoarthritis. The aim of this systematic review was to evaluate the efficacy of dextrose prolotherapy compared with other interventions in the management of osteoarthritis. METHODS: Electronic databases PubMed, Google Scholar, Cochrane, and BioMed Central were searched from inception to October 2021. Search terms included [(prolotherapy) OR (prolotherapies) OR (dextrose prolotherapy)] AND [(osteoarthritis) OR (osteoarthritides) OR (knee osteoarthritis) OR (hip osteoarthritis) OR (hand osteoarthritis) OR (shoulder osteoarthritis)]. Randomized controlled trials that compared the use of dextrose prolotherapy with other interventions (injection, placebo, therapy, or conservative treatment) in the treatment of osteoarthritis were included. Potential articles were screened for eligibility, and data were extracted by all authors. Risk of bias was assessed using the Cochrane Risk of Bias tool. Study population, methods, and results data were extracted and tabulated by 3 authors. RESULTS: 12 studies reported that DPT was as effective or even more effective in improving functional outcomes compared with other interventions whilst others found that HA, PRP, EP, and ACS were more effective. 14 studies assessed the effectiveness of DPT and ten of them reported that DPT was more effective in reducing pain compared with other interventions. CONCLUSION: Dextrose prolotherapy in osteoarthritis confers potential benefits for pain and functional outcomes, but this systematic review found that the studies to date are at high risk of bias.