Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis

Zahra Rezasoltani, Mehrdad Taheri, Morteza Kazempour Mofrad, Seyed Amir Mohajerani, Zahra Rezasoltani, Mehrdad Taheri, Morteza Kazempour Mofrad, Seyed Amir Mohajerani

Abstract

Background: Osteoarthritis (OA) is a degenerative disease that can lead to painful and dysfunctional joints. Prolotherapy involves using injections to produce functional restoration of the soft tissues of the joint. Intra-articular injections are controversial because of the introduction of needles into the articular capsule.

Objectives: To compare the effect of periarticular versus intra-articular prolotherapy on pain and disability in patients with knee OA.

Study design: Randomized double-blind controlled clinical trial.

Setting: Single center, university hospital (Imam Hossein Hospital, Tehran, Iran).

Methods: A total of 104 patients with chronic knee OA were enrolled. In the intra-articular group, 8 mL of 10% dextrose and 2 mL of 2% lidocaine were injected. Injections were repeated at 1 and 2 weeks after the first injection. In the periarticular group, 5 mL of 20% dextrose and 5 mL of 1% lidocaine were injected subcutaneously at 4 points in the periarticular area. Pain and disability, as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), were recorded at each follow-up visit at 1, 2, 3, 4, and 5 months post-injection.

Results: The visual analog scale score was significantly lower in the periarticular compared with the intra-articular group at the 2-, 3-, 4-, and 5-month visits but not at 1 month. Morning stiffness and difficulty in rising from sitting were improved in both groups and were not signifi-cantly different in the peri- and intra-articular groups. Pain, joint locking, and limitation scores were all improved in both groups. Difficulty in walking on flat surfaces or climbing stairs, and sitting and standing pain, were all improved in both groups from 1 to 5 months after treatment.

Limitations: WOMAC scores are subjective and could be a limitation of the study.

Conclusion: Periarticular prolotherapy has comparable effects on pain and disability due to knee OA to intra-articular injections, while avoiding risks of complications.

Keywords: acupuncture; knee; osteoarthritis; periarticular; prolotherapy.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Points of periarticular injection around the knee (blue dots) and articular nerves of the left knee (red lines). Notes: (A) Acupuncture points of periarticular injections for knee osteoarthritis in terms of the anteroposterior (B) and lateral (C) view.
Figure 2
Figure 2
Pain score (VAS) in the periarticular and intra-articular injection groups. Abbreviation: VAS, visual analog scale.
Figure 3
Figure 3
Comparison of rising stiffness duration and awakening stiffness duration in the periarticular and intra-articular injection groups. Notes: Y-axes shown in probability, as measured by Mann–Whitney U test.
Figure 4
Figure 4
Comparison of the pain period and joint locking and limitation in the periarticular and intra-articular injection groups. Notes: Y-axes shown in probability, as measured by Mann–Whitney U test.
Figure 5
Figure 5
Comparison of difficulty in walking, stair climbing, ordinary activity problems, and lying pain in the periarticular and intra-articular injection groups. Notes: Y-axes shown in probability, as measured by Mann–Whitney U test.
Figure 6
Figure 6
Comparison of walking on smooth surface, going up and down stairs, sitting pain, and standing pain in the periarticular and intra-articular injection groups. Notes: Y-axes shown in probability, as measured by Mann–Whitney U test.

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Source: PubMed

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