Healing effects of prolotherapy in treatment of knee osteoarthritis healing effects of prolotherapy in treatment of knee osteoarthritis
Tóm tắt
Pelotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a two-arm controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis (OA). A total of 104 adults with at least 6 months of painful primary knee OA were treated with dextrose prolotherapy (group I). They were divided into two subgroups: Ia and Ib. Subgroup Ia was treated with both techniques of prolotherapy (Hackett technique – classic, traditional prolotherapy – and Lyftgot technique – neural prolotherapy), whereas subgroup Ib was treated with the Hackett technique only. Extra-articular and intra-articular injections were administered at 1, 2, and 3 months, with as needed additional treatments at months 4 and 5. A total of 24 adults with at least 6 months of painful primary knee OA were treated with physiotherapy (group II). Outcome measures included the following: clinical assessment; visual analogue scale (VAS), 10; Western Ontario McMaster University Osteoarthritis Index (WOMAC), 96 points; plain radiographs; and musculoskeletal ultrasound. Postprocedure hot packs were applied, and at-home massage and exercises were taught. 128 Patients enrolled in the study were matched with each other for sex, age, disease durations, and BMI. Subgroups Ia and Ib reported a significant improvement as regards the clinical assessment, VAS, WOMAC, and radiological assessment at 12 months, compared with their baseline at month 0 and compared with group II (P ≤ 0.001). At 12 months, the mean ± SD of VAS was 0.32 ± 0.27 for subgroup Ia, 0.44 ± 0.5 for subgroup Ib, and 9.9 ± 1.65 for group II, and the mean ± SD of WOMAC was 11.32 ± 10.3 for subgroup Ia, 18.5 ± 10.25 for subgroup Ib, and 79.5 ± 22.63 for group II. Postprocedure application of hot packs, massage, and paracetamol resulted in diminution of injection-related pain. There were no adverse events. Prolotherapy resulted in clinically sustained improvement of pain, function, and radiological assessment, which means that the healing effects of prolotherapy is better than that of physiotherapy. The combination of the two prolotherapy techniques results in quicker and better improvement for patients in terms of the clinical assessment, VAS, and WOMAC.
Tài liệu tham khảo
Rabago D, Zgierska A, Fortney L et al. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-armed uncontrolled study with 1-year follow-up. J Altern Complement Med 2012; 18:408–414.
Rabago D, JJ Patterson, Marlon Mundt et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med 2013; 11:229–237.
Hackett G. Joint stabilization through induced ligament sclerosis. Ohio State Med J 1953; 49:877–884.
Felson DT. The sources of pain in knee osteoarthritis. Curr Opin Rheumatol 2005; 17:624–628.
AD Weglein. Neural prolotherapy. J Prolother 2011; 3:639–643.
Hauser R. Standard clinical X-ray studies document cartilage regeneration in five degenerated knees after prolotherapy. J Prolother 2009; 1:22–28.
Hauser Ross A, JJ Cukla. Standard clinical X-ray studies document cartilage regeneration in five degenerated knees after prolotherapy. J Prolother 2009; 1:22–28.
Reeves KD, Hassanein KM. Long-term effects of dextrose prolotherapy for anterior cruciate ligament laxity: a prospective and consecutive patient study. Altern Ther Health Med 2003; 9:58–62.
Lyftogt J. Subcutaneous prolotherapy treatment of refractory knee, shoulder and lateral elbow pain. Aust Musculoskeletal Med 2007; 12:110–112.
Altman RD. Criteria for classification of clinical osteoarthritis. J Rheumatol Suppl 1991; 27:10–12.
Banks A. A rationale for prolotherapy. J Orthop Med 1991; 13:54–59.
Rabago D, Jensen K, Patterson JJ, Best T, Vanderby R. Response of knee ligaments to prolotherapy in a rat injury model. Am J Sports Med 2008; 36:1347–1357.
H Ross, I Schaefer. Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function. Clin Med Insights Arthritis Musculoskeletal Disord 2014; 7:13–20.
L Shamir, SM Ling, WW Scott, A Bos, N Orlov, et al. Knee x-ray image analysis method for automated detection of osteoarthritis. IEEE Trans Biomed Eng 2009; 56:407–415.
Solmaz I, Deniz S, Cifci OT. Treatment of advanced stage gonarthrosis with prolotherapy: case report. Anesth Pain Med 2013; 4:e9171.
Reeves KD, Hassanein K): Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 2000; 6 :68–74. 77–80
Veronesi B, Oortgiesen M. Neurogenic inflammation and particulate matter (PM) air pollutants. Neurotoxicology 2001; 22:795 – 810.
Gould D et al. Visual analogue scale (VAS). J Clin Nurs 2001; 10:697–706.
Bellamy N, Bell M, Goldsmith C et al. Evaluation of WOMAC 20, 50, 70 response criteria in patients treated with hylan G-F 20 for knee osteoarthritis. Ann Rheum Dis 2005; 64:881–885.
Aneja A, Karas SG, Weinhold PS, Afshari HM, Dahners LE. Suture plication, thermal shrinkage, and sclerosing agents: effects on rat patellar tendon length and biomechanical strength. Am J Sports Med 2005; 33 :1729–1734.