Osteoarthritis of the knee is a degenerative condition where instability of the joint causes the bones to rub on each other resulting in pain and decrease in function.
What causes the instability? Weakened or stretched ligaments and tendons that hold the knee joint in place.
The knee joint is comprised of the thigh bone (femur) and shin bone (tibia), along with the bone beside the shin bone (fibula) and the knee cap (patella). All of these bones are held in place by ligaments and tendons that run along the front, back and sides of the knee. Now, imagine these ligaments and tendons being loose and unstable – with each movement of the knee, there is a greater likelihood for one bone to shift relative to the other. This results in wearing down of the meniscus and eventually degeneration of the joint resulting in osteoarthritis.
Prolotherapy is a regenerative injection therapy that helps to rebuild these weak tendons and ligaments to strengthen the affected joint. Dextrose solution is injected into the bony attachments of ligaments and tendons. This initiates a healing cascade, which increases blood flow, tissue growth factors, and nutrients to the area. The effect is new growth of healthy tendons and ligaments that help to stabilize the joint and thus alleviate pain.
Rabago et al (2013) conducted a randomized controlled trial of adults with at least 3 months of painful knee osteoarthritis to compare the effectiveness of dextrose prolotherapy treatments. The results showed an improvement in pain and function scales after a series of 3-5 monthly prolotherapy treatments. The effects were sustained even after 6months since the last treatment.
Is prolotherapy for everyone? Since prolotherapy is a regenerative treatment that uses the body’s healing abilities, any underlying conditions that impede healing would be a contraindication. Cancer, active infection, acute gout, bleeding disorders and known allergies to the solution are all contraindications.
In appropriate patients, prolotherapy can be an effective and conservative treatment option for those with knee osteoarthritis. Because prolotherapy targets the root cause of the knee instability, it should be considered before long term narcotic therapy or surgical intervention.
Rabago, D., Patterson, J. J., Mundt, M., Kijowski, R., Grettie, J., Segal, N. A., & Zgierska, A. (2013). Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial. The Annals of Family Medicine, 11(3), 229-237. doi:10.1370/afm.1504