Prolotherapy knee osteoarthritis injections

Shin Splints medial tibial stress syndromeDanielle R. Steilen-Matias, MMS, PA-C

In this article, we will update new information and discuss Prolotherapy knee osteoarthritis injections. The knee is the most common joint treated with Prolotherapy at Caring Medical. We use a comprehensive Prolotherapy approach that stimulates the natural repair of connective tissue.

This article highlights:

Degenerative knee disease begins with knee instability

When you understand osteoarthritis, you immediately understand that you cannot treat the knee as individual components, you have to treat it as a whole. This means to help repair a meniscus, you must strengthen the ligaments. To heal cartilage damage, you must treat the ligaments. To prevent recurrence of Baker’s Cyst, you must treat the ligaments. To prevent continued knee degeneration from the destructive forces of osteoarthritis, you must treat the ligaments.

The benefits is holistic approach to treating the knee can be clearly seen in the simple definition of knee osteoarthritis:

Osteoarthritis is a slow, progressive, degenerative disease that destroys articular cartilage, causes destructive changes to the knee’s lubricating and protective synovial membrane, damages and causes the death of subchondral bone, causes weakness, damage, and laxity in the knee’s supporting ligaments and tendons, destroys and causes the death of the meniscus, and in general causes the degeneration of ligaments and menisci and causes destructive hypertrophy (enlargement or swelling) of the knee joint capsule.

The link box below contains various articles on Prolotherapy, stem cell, and Platelet Rich Plasma treatments for knee ligaments

Medial Collateral Ligament Knee Injury  Your doctor or MRI tells you that you have a partial tear of the medial collateral ligament (MCL)  of the knee. What are your treatment options?

ACL reconstruction surgery alternatives and treatment options  Is ACL reconstruction surgical repair the right option for every athlete? In this article Ross Hauser, MD reviews the latest medical research that can help the patient / athlete understand their ACL pre and post surgery challenges and how treatments that include Prolotherapy, PRP and stem cells may offer surgical options options and accelerated recovery.

After ACL Reconstruction | Complications and knee instability In this article we will discuss problems of knee instability following anterior cruciate ligament reconstruction and review various non-surgical treatment suggestions including Prolotherapy.

Posterior Cruciate Ligament (PCL) Injury and Treatments Isolated PCL injuries are already under scrutiny. Untreated knee instability from an undiagnosed PCL tear can lead to meniscal tears and osteochondral injuries which are relatively prevalent in isolated acute PCL injury of the knee.

LCL | Lateral Collateral Ligament Injury of the Knee While we look at the LCL’s involvement in knee stabilization, no ligament or stabilizing structure in the knee should ever be considered an “island unto itself.” Each stabilizer interacts with other stabilizes to provide the highly active knee with support.

Posterolateral corner injuries of the knee The knee is a complex joint of many parts. The posterolateral corner (PLC) of the knee is one such complex area. However a complex area can be described simply: (postero) back (lateral) outside – the back and outer side of the knee. It can also be treated in many cases more simply than with aggressive reconstructive surgery.

Research on the benefits of Prolotherapy for knee osteoarthritis

Knee Osteoarthritis

In more difficult cases we may introduce Platelet Rich Plasma and for cases where warranted Stem Cells and/or a combination of therapy. If we get to a situation where we decide to use stem cell therapy, we augment this treatment with Prolotherapy, PRP, and sometimes a combination treatment using bone marrow stem cells and fat derived stem cells.

In October 2017, a team of researchers from Shahid Beheshti University of Medical Sciences, Tehran, Iran published their findings in the Middle East Journal of Family Medicine in which they found significant pain relief after Prolotherapy injections in patients suffering from knee osteoarthritis.

Here are the bullet points of the research:

The study was a single-blind clinical trial. (The patients did not know they were getting Prolotherapy).

According to the results, it can be concluded that the mechanism of the effect of Dextrose Prolotherapy is direct effects, osmotic (growth in the number of cells) and inflammatory growth. Dextrose injection with a concentration of less than 10% still directly promotes cell and tissue proliferation without inflammatory reaction and a high concentration of 10% results in an extracellular osmotic gradient at the injection site resulting in loss of intracellular and lyse cellular cells (a breakdown of damaged cells) and the beneficial invasion of growth factors and inflammatory cells that start the wound healing cascade in that particular area.1

In research from June 2017, doctors publishing in the British Medical Bulletin reviewed  and evaluated Prolotherapy findings and determined Prolotherapy treatments for patients with knee osteoarthritis showed significant improvement in scores for pain, function and range of motion, both in the short term and long term. Patient satisfaction was also high in these patients (82%). 2

Recent independent research published in the doctors writing in the journal Therapeutic advances in musculoskeletal disease, says that Prolotherapy treatments in female patients with knee osteoarthritis resulted in significant improvement in pain, function, and range-of-motion scores.3

Doctors took 24 female patients with an average age of 58 (the youngest being 46 the oldest 70) and gave them three monthly Prolotherapy injections.

At the end of week 24 of the study, knee range of motion increased, pain severity in rest and activity decreased. Improvements of all parameters were considerable until week 8, and were maintained throughout the study period.

Prolotherapy in grade IV knee osteoarthritis

In 2016 the Universities of Wisconsin, Kansas, and Michigan team with doctors from Argentina is publishing combined research on the positive clinical and chondrogenic (cartilage growing) effects of Prolotherapy in participants with symptomatic grade IV knee osteoarthritis.11

Dextrose injection is reported to improve knee osteoarthritis −related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed.  This study assessed biological and clinical effects of intra-articular hypertonic dextrose injections (prolotherapy) in painful knee osteoarthritis.

The study design was case series with blinded arthroscopic evaluation before and after treatment.

Study Participants
Symptomatic knee osteoarthritis for at least 6 months, arthroscopy-confirmed medial compartment exposed subchondral bone (a bone on bone situation), and temporary pain relief with intra-articular lidocaine injection.

Four to 6 monthly 10-mL intra-articular injections with 12.5% dextrose.


Positive clinical and chondrogenic (cartilage growth) effects were seen after prolotherapy with hypertonic dextrose injection in participants with symptomatic grade IV Knee Osteoarthritis, suggesting disease-modifying effects and the need for confirmation in controlled studies. Minimally invasive arthroscopy (single-compartment, single-portal) enabled collection of robust intra-articular data.10

Caring Medical Research – Prolotherapy for Knee Pain

In published research in the Journal of Prolotherapy, Ross Hauser MD investigated the outcomes of patients receiving Prolotherapy treatment for unresolved, difficult to treat knee pain at a charity clinic in  Illinois.

Quality of Life changes after Prolotherapy treatment for knee osteoarthritis

In the same study, we asked the patients a simple yes or no question:

Long-term results

The patients in this study were treated four to six years prior to the publishing of this paper.

Prolotherapy used on patients who had a duration of five years of unresolved knee pain was shown in this observational study to improve their quality of life.

Patients reported:

Therefore, Prolotherapy appears to be a viable treatment option for people suffering with unresolved knee pain.11

Treating the whole knee

In the previously cited study above about female patients in the journal Therapeutic advances in musculoskeletal disease, researchers also noted:

Doctors writing in the Journal of pain research have published research supporting what we have known here for decades. To most effectively treat knee osteoarthritis with Prolotherapy, Platelet Rich Plasma, or Stem Cells, you must treat the whole knee and not simply the cartilage degeneration.

In this study, doctors from the University of Tehran compared results in patients who received Prolotherapy with dextrose periarticular injections around the knee joint with patients who received Prolotherapy intra-articular injections. In other words, one group received injections around the knee joint, another group received injections directly into the knee joint.

Knee function and mobility improvements

The researchers found periarticular Prolotherapy showed healing effects in many aspects of knee function that were better than with intra-articular prolotherapy. This healing effect was observed particularly in active movements, including walking on flat surfaces, and ascending and descending stairs.

Simply, Prolotherapy for knee osteoarthritis is not a single or few injections, it is many injections.

Would you like to ask a question about Prolotherapy for knee osteoarthritis? Get help and information from our Caring Medical Staff

1. Ghasemi M, Behnaz F, Sajjadi MM, Zandi R, Hashemi M. The effect of Hypertonic Dextrose injection on the control of pain associated with knee osteoarthritis. MIDDLE EAST JOURNAL OF FAMILY MEDICINE.;7(10):193.

Hassan F, Trebinjac S, Murrell WD, Maffulli N. The effectiveness of prolotherapy in treating knee osteoarthritis in adults: a systematic review. Br Med Bull. 2017 Mar 4:1-18.

3. Eslamian F, Amouzandeh B. Therapeutic effects of prolotherapy with intra-articular dextrose injection in patients with moderate knee osteoarthritis: a single-arm study with 6 months follow up. Ther Adv Musculoskelet Dis. 2015 Apr;7(2):35-44.

4 Rabago D, Nourani B. Prolotherapy for Osteoarthritis and Tendinopathy: a Descriptive Review. 2017 Jun;19(6):34. doi: 10.1007/s11926-017-0659-3.

5 Sit RW, Chung VCh, Reeves KD, Rabago D, Chan KK, Chan DC, Wu X, Ho RS, Wong SY. Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and meta-analysis. Sci Rep. 2016 May 5;6:25247

6. Rabago D, Kijowski R, Woods M, Patterson JJ, Mundt M, Zgierska A, Grettie J, Lyftogt J, Fortney L. Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis. Archives of physical medicine and rehabilitation. 2013 Nov 30;94(11):2075-82.

7. Hauser R. The regeneration of articular cartilage with prolotherapy. Journal of Prolotherapy. 2009;1(1):39-44.

8. Topol GA, Podesta LA, Reeves KD, Giraldo MM, Johnson LL, Grasso R, Jamín A, Clark T, Rabago D. Chondrogenic Effect of Intra-articular Hypertonic-Dextrose (Prolotherapy) in Severe Knee Osteoarthritis. PM R. 2016 Apr 4. pii:S1934-1482(16)30054-5.

9 Sit RW, Chung VC, Reeves KD, Rabago D, Chan KK, Chan DC, Wu X, Ho RS, Wong SY. Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic review and meta-analysis. Scientific reports. 2016;6.

10. Rabago D, van Leuven L, Benes L, Fortney L, Slattengren A, Grettie J, Mundt M. Qualitative Assessment of Patients Receiving Prolotherapy for Knee Osteoarthritis in a Multimethod Study. Journal of alternative and complementary medicine (New York, NY). 2016 Dec;22(12):983.

11.  Hauser RA, Hauser MA.  A Retrospective Study on Dextrose Prolotherapy for Unresolved Knee Pain at an Outpatient Charity Clinic in Rural Illinois. Journal of Prolotherapy. 2009;1:11-21.

12 Rezasoltani Z, Taheri M, Mofrad MK, Mohajerani SA. Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis. Journal of Pain Research. 2017;10:1179-1187.

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