Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity.

Abstract

CONTEXT:

Use of prolotherapy (injection of growth factors or growth factor stimulators).

OBJECTIVE:

Determine the effects of dextrose prolotherapy on knee osteoarthritis with or without anterior cruciate ligament (ACL) laxity.

DESIGN:

Prospective randomized double-blind placebo-controlled trial.

SETTING:

Outpatient physical medicine clinic.

PATIENTS OR OTHER PARTICIPANTS:

Six months or more of pain along with either grade 2 or more joint narrowing or grade 2 or more osteophytic change in any knee compartment. A total of 38 knees were completely void of cartilage radiographically in at least 1 compartment.

INTERVENTION:

Three bimonthly injections of 9 cc of either 10% dextrose and .075% lidocaine in bacteriostatic water (active solution) versus an identical control solution absent 10% dextrose. The dextrose-treated joints then received 3 further bimonthly injections of 10% dextrose in open-label fashion.

MAIN OUTCOME MEASURES:

Visual analogue scale for pain and swelling, frequency of leg buckling, goniometrically measured flexion, radiographic measures of joint narrowing and osteophytosis, and KT1000-measured anterior displacement difference (ADD).

RESULTS:

All knees: Hotelling multivariate analysis of paired observations between 0 and 6 months for pain, swelling, buckling episodes, and knee flexion range revealed significantly more benefit from the dextrose injection (P = .015). By 12 months (6 injections) the dextrose-treated knees improved in pain (44% decrease), swelling complaints (63% decrease), knee buckling frequency (85% decrease), and in flexion range (14 degree increase). Analysis of blinded radiographic readings of 0- and 12-month films revealed stability of all radiographic variables except for 2 variables which improved with statistical significance. (Lateral patellofemoral cartilage thickness [P = .019] and distal femur width in mm [P = .021]. Knees with ACL laxity: 6-month (3 injection) data revealed no significant improvement. However, Hotelling multivariate analysis of paired values at 0 and 12 months for pain, swelling, joint flexion, and joint laxity in the dextrose-treated knees, revealed a statistically significant improvement (P = .021). Individual paired t tests indicated that blinded measurement of goniometric knee flexion range improved by 12.8 degrees (P = .005), and ADD improved by 57% (P = .025). Eight out of 13 dextrose-treated knees with ACL laxity were no longer lax at the conclusion of 1 year.

CONCLUSION:

Prolotherapy injection with 10% dextrose resulted in clinically and statistically significant improvements in knee osteoarthritis. Preliminary blinded radiographic readings (1-year films, with 3-year total follow-up period planned) demonstrated improvement in several measures of osteoarthritis severity. ACL laxity, when present in these osteoarthritic patients, improved.

• Authors: K D Reeves, K Hassanein
• Journal: Alternative therapies in health and medicine (Altern Ther Health Med) Vol. 6 Issue 2 Pg. 68-74, 77-80 (Mar 2000) ISSN: 1078-6791 [Print] United States
• PMID: 10710805 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Growth Substances
• Glucose

Topics

• Anterior Cruciate Ligament (diagnostic imaging, pathology)
• Double-Blind Method
• Female
• Glucose (administration & dosage)
• Growth Substances (therapeutic use)
• Homeopathy (methods)
• Humans
• Injections, Intra-Articular
• Male
• Middle Aged
• Osteoarthritis, Knee (diagnostic imaging, drug therapy)
• Prospective Studies
• Radiography
• Severity of Illness Index
• Treatment Outcome