Can It Be Proven That Prolotherapy Regenerates Knee Cartilage?
It is impossible to do a double-blind study on Prolotherapy because even an injection of sterile water under the skin has a beneficial therapeutic effect. Even if no injection was given on one side, as the control, sticking a needle into a painful area is known to have a beneficial effect (this treatment is called acupuncture). It is very difficult to prove using a traditional scientific model, that Prolotherapy cures chronic pain, sports injuries, and regenerates cartilage tissue. However, that being said, many doctors in the field of Prolotherapy have been publishing studies recently – some are double blind, and others are based on clinical reporting of improvement from patients treated with Prolotherapy.
Research on Prolotherapy: One Prolotherapy doctor validating the treatment of Prolotherapy is K. Dean Reeves, M.D., Physical Medicine and Rehabilitation Specialist, in private practice in Kansas City, Kansas. He has completed three double-blind studies on using 10 percent dextrose versus water injections on finger/thumb arthritis, knee arthritis, and anterior cruciate ligament injured knees. Injections were given every two months of dextrose or water. After three injections, all patients were given the dextrose proliferant for three more injections. In the knee studies, only one intra-articular (inside the joint) injection was given per knee at each session. As of this writing, the x-ray readings at one year had just been completed. In the finger/thumb arthritis study there was a 53 percent improvement in pain, and eight degrees of improvement in flexibility. In the knee arthritis study there was a 44 percent improvement in pain, 63 percent improvement in swelling, and a 14-degree improvement in flexibility.
There was an 85 percent reduction in knee buckling episodes. The loss of cartilage not seen on x-rays by one year and bone spur measurements showed improvement. Of interest was the fact that those without cartilage did nearly as well. In the knee laxity (ACL) study, pain improved 27.5 percent, swelling by 51 percent, and knee buckling episodes by 54 percent. X-ray studies at one year showed improvement in two measures of bone spur and near-significant improvements in thickness of cartilage in the knee. One should remember that this study involved just one knee injection per session and articular cartilage growth was seen. Typically in actual practice, a person with laxity in the knee ligaments may get 20 injections per visit. Dr. Reeves summarized the findings as "...these double-blind studies with objective and measurable endpoints all show that simple injection of arthritic fingers or knees, or knees with ACL laxity, with non-inflammatory levels of osmotic stimulants can bring about favorable responses in pain, flexibility, and x-ray findings." Dr. Reeves has since gone on do additional Prolotherapy studies highlighting it’s improvement in function and pain.
Caring Medical Research on Prolotherapy: At Caring Medical, Dr. Hauser and our team have worked very hard to publish a number of studies on the effectiveness of using Prolotherapy for a wide array of pain complaints. We have published a number of research papers, case studies, and scientific editorials in the Journal of Prolotherapy, including articles on Prolotherapy as an alternative to surgery; Prolotherapy for chronic back pain; cartilage regeneration in knees; PRP Prolotherapy (platelet rich plasma), among them. We also present case studies with before and after X-rays that show first bone-on-bone knees, and then regenerated cartilage. These X-rays were also reviewed by an independent radiologist confirming the growth of cartilage. Our studies published in the Journal of Prolotherapy have been archived here so that they are readily available for you to read and get a better understanding that the results ARE there and they HAVE been documented.
Surgery typically can be avoided
Except in a life threatening situation or impending neurologic injury, surgery, with its many possible complications, should always be a last resort and done only after all conservative treatments have been exhausted. Chronic pain is not a life-threatening situation! It can be very anxiety provoking, life demeaning, and aggravating, but it is not an emergency. Pain should not be an automatic indication that surgery is necessary. Conservative treatments such as vitamins, herbs, massage, physical therapy, chiropractic/osteopathic care, medications, and, of course, Prolotherapy, should precede any surgical intervention. Conservative care is complete only after treatment with Prolotherapy has been tried.
It is not uncommon for patients to tell us that surgery has been recommended to resolve their painful conditions. Reasons for surgery are many, but they may have nothing to do with the actual problem causing the pain!
Trying conservative treatments before undergoing surgery only makes common sense. In more than 95 percent of our patients, we find that the true diagnosis of the cause of chronic pain is different than the diagnosis the patient had previously been given. Rarely will a physician describe a ligament or tendon injury as a cause of chronic pain. Ligaments and tendons often do not appear on X-rays, one of the primary diagnostic instruments of modern medicine. The diagnosis of ligament or tendon weakness cannot be made by a blood test, electrical test, or X-ray. It must be made using a listening ear and a strong thumb (to reproduce the pain on physical examination.)
Even back in early 1981 as new and more effective methods of conservative treatment were being used (including Prolotherapy), the need for surgery was decreasing. Bernard E. Finneson, M.D., pointed out in a survey of surgical cases that "80% should not... have been brought to surgery." It is quite possible that with the widespread use of Prolotherapy this percentage would be even higher.
In more than 95 percent of pain cases, surgery can be avoided by utilizing Prolotherapy. Dr. Hemwall, having treated more than 10,000 pain patients, resorted to surgery for resolving a chronic pain complaint in only one percent of the patients.
Our experience has been similar. In the event that surgery is necessary, the previous Prolotherapy treatment will not hinder the subsequent surgical procedure. Prolotherapy causes normal ligament and tendon tissue to form. The surgeon will observe an area treated with Prolotherapy containing strengthened ligament and tendon tissue.
Surgery to alleviate chronic pain involves the removal of tissue or replacement with prosthetic joints. To alleviate chronic lower back pain, a surgeon may decide to remove a disc or cartilage tissue. The two questions to ask are, "Who put that tissue there? For what purpose?" We believe God placed disc tissue there to stablilize and cushion the lower back, and cartilage tissue in the joints so that bones glide smoothly over one another. What happens when the disc and cartilage tissue are removed? If the disc is removed, the vertebral levels above and below the surgerized segment develop proliferative arthritis. This is due to these segments having to carry more of the force than they were designed to carry in the lower back. If cartilage is removed, the bones no longer glide smoothly over one another. Soon after this, a person notices a crunching of the joint where the cartilage was removed. This crunching sound is arthritis. The end result of surgical procedures that remove cartilage, ligaments, and bone from knees, backs, and necks is often arthritis.
In 1964, John R. Merriman, M.D., compared Prolotherapy versus operative fusion in the treatment of instability of the spine and pelvis and wrote, "The purpose of this article is to evaluate the merit of two methods of treating instability of the spine and pelvis, with which I have been concerned during 40 years as a general and industrial surgeon... The success of either method depends on regeneration of bone cells to provide joint stabilization, elimination of pain and resumption of activity. Ligament and tendon relaxation occurs when the fibro-osseous attachments to bone do not regain their normal tensile strength after sprain and lacerations, and when the attachments are weakened by decalcification from disease, menopause and aging."
Dr. Merriman summarized that conservative physiologic treatment by Prolotherapy after a confirmed diagnosis of ligamental and tendinous relaxation was successful in 80 to 90 percent of more than 15,000 patients treated.
Surgery vs Prolotherapy? Despite the many advances of modern technology, surgery is fraught with many dangers. Dr. Hemwall administered more than four million injections in over 40,000 patient visits without even one permanent injury. In the last 50 years, I do not know of any serious long term consequences from Prolotherapy. The procedure is done in the office, takes less than 20 minutes in most cases, and does not require time off from work. No pre-op type anesthesia is needed, hence no risk of serious complications due to anesthesia. Compare this to a surgical procedure, where general anesthesia is used to knock you out. There you are lying on a table, unconscious. The anesthesia alone leaves you exposed to many possible complications, including cardiac arrest, overmedication, or death. Take a look at a pre-surgical consent form some time - the risk of death is clearly laid out. If you are a healthy person, the risks are low, but common sense dictates: why take any chances when a more conservative treatment is available? Anyone given the option of surgery versus Prolotherapy should try the more conservative option first.
Other reasons to avoid surgery:
- Rehabilitation is much longer after surgery than for more conservative treatments, sometimes requiring many days of hospitalization and months of rehabilitative therapy.
- The cost of surgery is astronomical compared to more conservative treatments. Prolotherapy of the ankle runs a few hundred dollars, as compared to tens of thousands of dollars for ankle surgery and all of the hospitalization and rehabilitation expenses. And that's not even to mention the added cost of Prolotherapy which may still be needed if the surgery doesn't work!
- Surgery is much more traumatic to receive. It puts a great stress on the body and can sometimes cause the patient to feel less confident using the surgerized limb.
- Surgery irreversibly alters the patient's God-given anatomy.
- Surgery can have all kinds of complications which cannot begin to be fully discussed here. One study of arthroscopic ankle arthrodesis (ankle fusion) showed an overall complication rate of 55 percent, including infections and continued pain.
Finally, all the surgery in the world cannot cause the new growth of healthy tendon and ligament tissue; at best, the pain may be alleviated, but for all the expense, risk, and trauma, the underlying cause of pain may never be addressed. Prolotherapy is a safe, simple, inexpensive, effective, and proven cure for chronic pain.