Comparing dextrose prolotherapy with other substances in knee osteoarthritis pain relief: A systematic review

Vitor Santos Cortez, Walter Augusto Moraes, João Victor Taba, Alberto Condi, Milena Oliveira Suzuki, Fernanda Sayuri do Nascimento, Leonardo Zumerkorn Pipek, Vitoria Carneiro de Mattos, Matheus Belloni Torsani, Alberto Meyer, Wu Tu Hsing, Leandro Ryuchi Iuamoto, Vitor Santos Cortez, Walter Augusto Moraes, João Victor Taba, Alberto Condi, Milena Oliveira Suzuki, Fernanda Sayuri do Nascimento, Leonardo Zumerkorn Pipek, Vitoria Carneiro de Mattos, Matheus Belloni Torsani, Alberto Meyer, Wu Tu Hsing, Leandro Ryuchi Iuamoto

Abstract

The objective of this study is to compare the effectiveness of dextrose-prolotherapy with other substances for pain relief in patients with primary knee osteoarthritis. The literature screening was done in January 2021 through Medline (PubMed), EMBASE, and Database of the National Institute of Health based on the following criteria: randomized clinical trials that subjected patients with primary knee osteoarthritis who underwent treatment with dextrose-prolotherapy and other substances for pain relief. Paired reviewers independently identified 3381 articles and included 8 trials that met the eligibility criteria. According to the findings of this review, participants that underwent dextrose-prolotherapy showed improvements between baseline and posterior assessments and when compared to saline injections, but when compared to other substances, the results were not clear. Although dextrose-prolotherapy is a useful treatment method by itself, it is still not possible to clearly affirm that it is superior or inferior to its counterparts. There is an urgent need for further studies to bring more evidence to the field.

Keywords: Dextrose; Knee; Osteoarthritis; Pain; Prolotherapy.

Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

Copyright © 2022 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

Figures

Fig. 1
Fig. 1
Research flow.
Fig. 2
Fig. 2
Graph of risk analysis of general bias in articles.
Fig. 3
Fig. 3
Summary of risk analysis of general articles bias.

References

    1. Losina E., Paltiel A.D., Weinstein A.M., Yelin E., Hunter D.J., Chen S.P., et al. Lifetime medical costs of knee osteoarthritis management in the United States: impact of extending indications for total knee arthroplasty. Arthritis Care Res. 2015;67(2):203–215. (Hoboken)
    1. Cui A., Li H., Wang D., Zhong J., Chen Y., Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2020;29-30 [Internet]Dec 1 [cited 2021 Apr 8]Available from:
    1. The Osteoarthritis Action Alliance (OAAA). Cost of osteoarthritis – osteoarthritis action alliance [Internet]. Available from: . [Accessed 2021 Apr 8th].
    1. Arias-Vázquez P.I., Tovilla-Zárate C.A., Legorreta-Ramírez B.G., Burad Fonz W., Magaña-Ricardez D., González-Castro T.B., et al. Prolotherapy for knee osteoarthritis using hypertonic dextrose vs other interventional treatments: systematic review of clinical trials. Adv Rheumatol. 2019;59(1):39. (London, England)
    1. Hackett G.S. Prolotherapy in whiplash and low back pain. Postgrad Med. 1960;27(June):214–219.
    1. Jensen K.T., Rabago D.P., Best T.M., Patterson J.J., Vanderby R.J. Response of knee ligaments to prolotherapy in a rat injury model. Am J Sports Med. 2008;36(7):1347–1357.
    1. Moher D., Shamseer L., Clarke M., Ghersi D., Liberati A., Petticrew M., et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Rev Esp Nutr Humana Diet. 2016;20(2):148–160.
    1. Tao H., Yang L., Ping A., Quan L., Yang X., Zhang Y., et al. Interpretation of AMSTAR 2: a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions. Chin J Evidenc Based Med. 2018;18(1):101–108.
    1. University of Illinois at Chicago's library of the health sciences at Peoria. What is the PICO Model?[Internet]. Available from: [Accessed 2021 Apr 8th].
    1. Ouzzani M., Hammady H., Fedorowicz Z., et al. Rayyan–a web and mobile app for systematic reviews. Syst Rev. 2016;5(210)
    1. Cochrane Methods Screening and Diagnostic Tests. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy [Internet]. Available from: [Accessed 2021 Apr 8th].
    1. Rabago D., Patterson J.J., Mundt M., Kijowski R., Grettie J., Segal N.A., et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013;11(3):229–237.
    1. Rahimzadeh P., Imani F., Faiz S.H.R., Entezary S.R., Nasiri A.A., Ziaeefard M. Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee. J Res Med Sci. 2014;19(8):696–702.
    1. Rahimzadeh P., Imani F., Faiz S.H.R., Entezary S.R., Zamanabadi M.N., Alebouyeh M.R. The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clin Interv Aging. 2018;13:73–79.
    1. Sert A.T., Sen E.I., Esmaeilzadeh S., Ozcan E. The effects of dextrose prolotherapy in symptomatic knee osteoarthritis: a randomized controlled study. J Altern Complement Med. 2020;26(5):409–417.
    1. Shan Sit R.W.S., Wu R.W.K., Rabago D., Reeves K.D., Chan D.C.C., Yip B.H.K., et al. Efficacy of intra-articular hypertonic dextrose (Prolotherapy) for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2020;18(3):235–242.
    1. Rezasoltani Z., Azizi S., Najafi S., Sanati E., Dadarkhah A., Abdorrazaghi F. Physical therapy, intra-articular dextrose prolotherapy, botulinum neurotoxin, and hyaluronic acid for knee osteoarthritis: randomized clinical trial. Int J Rehabil Res. 2020;43(3):219–227. [Internet]
    1. Hosseini B., Taheri M., Ardekani R.P., Moradi S., Mofrad M.K. Periarticular hypertonic dextrose vs intraarticular hyaluronic acid injections: a comparison of two minimally invasive techniques in the treatment of symptomatic knee osteoarthritis. Open Access Rheumatol Res Rev. 2019;11:269–274. Hypertonic dextrose vs intraarticular hyaluronic acid injections: A comparison of two minimally invasive techniques in the treatment of symptomatic knee osteoarthritis. [Internet]
    1. Pishgahi A., Abolhasan R., Shakouri S.K., Zangbar M.S.S., Dareshiri S., Kiyakalayeh S.R., et al. Effect of dextrose prolotherapy, platelet rich plasma and autologous conditioned serum on knee osteoarthritis: a randomized clinical trial. Iran J Allergy Asthma Immunol. 2020;19(3):243–252. [Internet]Available from: U2 - L2007309864.
    1. Vaishya R., Pariyo G.B., Agarwal A.K., Vijay V. Non-operative management of osteoarthritis of the knee joint. J Clin Orthop Traum. 2016;7(3):170–176. [Internet]
    1. Copsey B., Thompson J.Y., Vadher K., Ali U., Dutton S.J., Fitzpatrick R., et al. Problems persist in reporting of methods and results for the WOMAC measure in hip and knee osteoarthritis trials. Qual life Res an Int J Qual life Asp Treat Care Rehabil. 2019;28(2):335–343.
    1. Delgado D.A., Lambert B.S., Boutris N., McCulloch P.C., Robbins A.B., Moreno M.R., et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2(3):e088.
    1. Boonstra A.M., Schiphorst H.R., Reneman M.F., Posthumus J.B., Stewart R.E. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res. 2008;31(2):165–169. Boonstra, Anne M.; Schiphorst Preuper, Henrica R.; Reneman, Michiel F.; Posthumus, Jitze B.; Stewart, Roy E.
    1. Ware J.E.J. SF-36 health survey update. Spine. 2000;25(24):3130–3139. (Phila Pa 1976)
    1. Rejeski W.J., Ettinger W.H.J., Shumaker S., Heuser M.D., James P., Monu J., et al. The evaluation of pain in patients with knee osteoarthritis: the knee pain scale. J Rheumatol. 1995;22(6):1124–1129.
    1. Fransen M., Edmonds J. Reliability and validity of the EuroQol in patients with osteoarthritis of the knee. Rheumatology. 1999;38(9):807–813. [Internet]
    1. Roos E.M., Lohmander L.S. The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64.
    1. Bendich I., Rubenstein W.J., Cole B.J., Ma C.B., Feeley B.T., Lansdown D.A. What is the appropriate price for platelet-rich plasma injections for knee osteoarthritis? A Cost-effectiveness analysis based on evidence from level i randomized controlled trials. Arthrosc J Arthrosc Relat Surg. 2020;36(7):1983–1991. e1.
    1. Fu X.N., Li H.W., Du N., Liang X., He S.H., Guo K.J., et al. Erythropoietin enhances meniscal regeneration and prevents osteoarthritis formation in mice. Am J Transl Res. 2020;12(10):6464–6477.
    1. Pelfort X., Torres-Claramunt R., Sánchez-Soler J.F., Hinarejos P., Leal-Blanquet J., Valverde D., et al. Pressure algometry is a useful tool to quantify pain in the medial part of the knee: an intra- and inter-reliability study in healthy subjects. Orthop Traumatol Surg Res. 2015;101(5):559–563.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner