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Background: Prolotherapy may be a good option in the complementary treatment of knee osteoarthritis (OA) patients, specifically for the increase of functionality. Objective: To determine the effectiveness of prolotherapy in OA grade II - III in the functionality and muscular work of knee flexors and extensors. Material and methods: a double-blind randomized controlled clinical trial was conducted. It included patients diagnosed with OA grades II-III. The experimental group was infiltrated in both knees with 6 ml of 25% glucose solution and 0.05% lidocaine; control group with 0.45% saline solution and 0.05% lidocaine. All patients received a comprehensive rehabilitation program. The isokinetic work of the knee flexor and extensor muscles, pain and functionality were measured, prior to infiltration and at 3-month follow-up. To compare the difference in means, the Student's T test was applied, considering P<0.05 as significant. The project was approved by the local ethics and research committee. Results: 37 patients were recruited, 17 in the prolotherapy group. There were no intergroup differences in functionality, isokinetic knee flexor/extensor work, and pain at baseline, or during follow-up up to 12 weeks. Conclusions: In the present study we identify that both prolotherapy and saline infiltration increased functionality, strength, and decreased pain; however, no statistically significant difference was found between the two group.

Introducción: la proloterapia puede ser buena opción en el tratamiento complementario de pacientes con osteoartrosis de rodilla (OA), específicamente para el incremento de la funcionalidad. Objetivo: determinar la efectividad de la proloterapia en OA grado II-III en la funcionalidad y en el trabajo muscular de flexores y extensores de rodilla. Material y métodos: se realizó un ensayo clínico controlado aleatorizado a doble ciego. Incluyó a pacientes con el diagnostico de OA grados II-III. Al grupo experimental se les infiltraron 6 mL de solución glucosada al 25% y lidocaína al 0.05% en ambas rodillas; al grupo control con solución salina al 0.45% y lidocaína al 0.05%. Todos los pacientes recibieron un programa integral de rehabilitación. Se midió el trabajo isocinético de los músculos flexores y extensores de rodilla, dolor y funcionalidad, previa infiltración y a los tres meses de seguimiento. Para comparar la diferencia de medias, se aplicó la prueba de t de Student, considerando p < 0.05 como significativo. El proyecto se aprobó en el comité local de ética e investigación. Resultados: se reclutaron 37 pacientes, 17 en el grupo de proloterapia. No hubo diferencias intergrupo en la funcionalidad, trabajo isocinético de flexores/extensores de rodilla y dolor iniciales, ni durante el seguimiento hasta las 12 semanas. Conclusiones: en el presente estudio identificó que tanto la proloterapia como la infiltración con solución salina incrementaron la funcionalidad, fuerza y disminuyeron el dolor; sin embargo, no se encontró diferencia estadísticamente significativa entre los dos grupos.

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Introduction:Chronic migraine is a socioeconomic and individual burden since it is the largest cause of disability in people under 50 years of age. Although there are several prophylactic drug alternatives, some patients are vulnerable to refractoriness with significant damage to their quality of life. Prolotherapy, a subcutaneous injection of dextrose in peripheral nerves, advocates as a promising tool in the management of this pathology. Case report:A patient with refractory chronic migraine to drug therapy who was submitted to neurofascial prolotherapy. Weekly administration of a 2 ml solution of 1% ropivacaine and 10% glucose in the head peripheral nerves for 6 weeks. Reduced disability and frequency of migraine attacks for a period of 8 weeks after interventions. Conclusion: Prolotherapy proved itself to be a notable technique for reducing the number of days in a month that a patient with refractory chronic migraine to standardized therapy has had headaches. However, placebo group studies are needed to determine the efficacy of the procedure.

Introdução: A enxaqueca crônica representa um fardo socioeconômico e individual, pois é a maior causa de incapacidade em pessoas com menos de 50 anos de idade. Embora existam diversas alternativas de medicamentos profiláticos, alguns pacientes são vulneráveis ​​à refratariedade com prejuízos significativos à sua qualidade de vida. A proloterapia, uma injeção subcutânea de dextrose nos nervos periféricos, é defendida como uma ferramenta promissora no manejo desta patologia. Relato de caso: Paciente com enxaqueca crônica refratária à terapia medicamentosa que foi submetido à proloterapia neurofascial. Administração semanal de 2 ml de solução de ropivacaína a 1% e glicose a 10% nos nervos periféricos da cabeça durante 6 semanas. Redução da incapacidade e frequência de ataques de enxaqueca por um período de 8 semanas após as intervenções. Conclusão: A proloterapia provou ser uma técnica notável para reduzir o número de dias em um mês que um paciente com enxaqueca crônica refratária à terapia padronizada teve dores de cabeça. No entanto, são necessários estudos em grupo placebo para determinar a eficácia do procedimento.

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The objective of this study is to compare the effectiveness of dextrose-prolotherapy with other substances for pain relief in patients with primary knee osteoarthritis. The literature screening was done in January 2021 through Medline (PubMed), EMBASE, and Database of the National Institute of Health based on the following criteria: randomized clinical trials that subjected patients with primary knee osteoarthritis who underwent treatment with dextrose-prolotherapy and other substances for pain relief. Paired reviewers independently identified 3381 articles and included 8 trials that met the eligibility criteria. According to the findings of this review, participants that underwent dextrose-prolotherapy showed improvements between baseline and posterior assessments and when compared to saline injections, but when compared to other substances, the results were not clear. Although dextrose-prolotherapy is a useful treatment method by itself, it is still not possible to clearly affirm that it is superior or inferior to its counterparts. There is an urgent need for further studies to bring more evidence to the field.

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Abstract The objective of this study is to compare the effectiveness of dextrose-prolotherapy with other substances for pain relief in patients with primary knee osteoarthritis. The literature screening was done in January 2021 through Medline (PubMed), EMBASE, and Database of the National Institute of Health based on the following criteria: randomized clinical trials that subjected patients with primary knee osteoarthritis who underwent treatment with dextrose-prolotherapy and other substances for pain relief. Paired reviewers independently identified 3381 articles and included 8 trials that met the eligibility criteria. According to the findings of this review, participants that underwent dextrose-prolotherapy showed improvements between baseline and posterior assessments and when compared to saline injections, but when compared to other substances, the results were not clear. Although dextrose-prolotherapy is a useful treatment method by itself, it is still not possible to clearly affirm that it is superior or inferior to its counterparts. There is an urgent need for further studies to bring more evidence to the field. HIGHLIGHTS Dextrose injections promote deposition of collagen into injured structures through growth factors and inflammatory cells. Dextrose-prolotherapy is a useful treatment method, but it is not superior or inferior to its counterparts.

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RESUMEN La gonartrosis es una entidad muy frecuente y afecta a un grupo numeroso de pacientes en especial a los mayores de 40 años. El tratamiento conservador constituye la primera línea e incluye la proloterapia. El propósito de este estudio es actualizar los conocimientos en relación al uso de la proloterapia en pacientes con gonartrosis. La búsqueda y análisis de la información se realizó en un periodo de 2 meses (primero de febrero de 2020 al 30 de abril de 2020) y se emplearon las siguientes palabras: prolotherapy, regenerative injection therapy and chronic musculoskeletal pain. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 203 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 39 citas seleccionadas para realizar la revisión, de ellas 32 de los últimos cinco años, además se consultó un libro. Se mencionan las concentraciones a emplear tanto intra- como periarticular, indicaciones y mecanismos de acción. Se describen la frecuencia de su aplicación, así como la comparación con otros métodos de tratamiento por vía intraarticular. Se hace referencia a la duración de su efecto y complicaciones. La proloterapia mediante la administración de dextrosa hipertónica intraarticular es un método útil en el tratamiento de pacientes con gonartrosis, su fácil aplicación, disponibilidad y bajo índice de complicaciones lo convierten en un método conservador factible y eficaz.

ABSTRACT Gonarthrosis is a very frequent entity and affects a large group of patients especially above 40 years, conservative treatment is the first line and includes prolotherapy. To update knowledge regarding the use of prolotherapy in patients with gonarthrosis. The information was searched and analyzed over a period of two months (February 1, 2020 to April 30, 2020) and the following words were used: prolotherapy, regenerative injection therapy and chronic musculoskeletal pain. Based on the information obtained, a bibliographic review of a total of 203 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the search manager and reference manager EndNote, 39 selected citations were used to make the review, including 32 of the last five years, also consulted a book. The concentrations to be used both intra and periarticular, indications and mechanisms of action are mentioned. The frequency of its application is described, as well as the comparison with other intra-articular treatment methods. Reference is made to the duration of its effect and complications. Prolotherapy by administering intra-articular hypertonic dextrose is a useful method in the treatment of patients with gonarthrosis, its easy application, availability and low complication rate make it a feasible and effective conservative method.

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Objective: Several intraarticular injections, including dextrose and lidocaine, are reported to reduce pain and dysfunction in temporomandibular dysfunction (TMD) and increase maximal jaw opening; our goal was to determine whether dextrose/lidocaine outperforms sterile water/lidocaine for TMD. Design: Pragmatic randomized controlled trial. Setting: Outpatient clinic. Subjects: Chronic (≥3 months) of moderate-to-severe (≥6/10) jaw or facial pain meeting research-specific TMD criteria. Intervention: Blinded intraarticular dextrose prolotherapy (DPT) (20% dextrose/0.2% lidocaine) versus intraarticular lidocaine (0.2% lidocaine in sterile water) at 0, 1, and 2 months. Participants were then unblinded and offered DPT by request for 9 additional months. Main outcome measures: Primary: Numerical Rating Scale (0-10 points) score for facial pain and jaw dysfunction; percentage achieving ≥50% improvement in pain and dysfunction (0, 3, and 12 months). Secondary: Maximal interincisal opening (MIO; 0 and 3 months). Intention-to-treat analysis was by joint using mixed-model regression. Results: Randomization of 29 participants (25 female, 47 ± 17 years, 43 joints) produced similar groups. Three-month pain and dysfunction improvements were similar, but more DPT-treated joints improved by ≥50% in pain (17/22 vs. 6/21; p = 0.028). The MIO improved in both groups (5.6 ± 5.8 mm vs. 5.1 ± 7.0 mm; p = 0.70). From 3 to 12 months, minimal DPT was received by original DPT and lidocaine recipients, 0.5 ± 0.9 and 0.6 ± 1.5 injections, respectively, with only 2 out of 21 joints in the original lidocaine group receiving more than 1 dextrose injection after 3 months. Twelve-month analysis revealed that joints in the original DPT group improved more in jaw pain (4.8 ± 2.4 points vs. 2.6 ± 2.9 points; p = 0.026) and jaw dysfunction (5.3 ± 2.6 points vs. 2.7 ± 2.3 points; p = 0.013). More DPT than lidocaine-treated joints improved by ≥50% in both pain (19/22 vs. 5/21; p = 0.003) and dysfunction (17/22 vs. 7/21; p = 0.040). There were no adverse events; satisfaction was high. Conclusions: Intraarticular DPT resulted in clinically important and statistically significant improvement in pain and dysfunction at 12 months compared to lidocaine injection (ClinicalTrials.gov identifier NCT01617356).

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BACKGROUND: To evaluate the efficacy and safety of prolotherapy with hypertonic dextrose in patients with knee osteoarthritis. A systematic search was performed in electronic databases including PUBMED, SCIELO, DIALNET and Google Scholar. MAIN BODY: We searched for randomized clinical trials that evaluated therapeutic interventions in patients with knee osteoarthritis. These trials compared the effect of intra-articular and / or extra-articular infiltrations of hypertonic dextrose vs the effect of intra-articular and / or extra-articular infiltrations of other substances or some interventional procedure application, via assessing pain, physical function and secondary effects and / or adverse reactions. Ten randomized clinical trials were included in this systematic review, the total sample size comprised 328 patients treated with hypertonic dextrose (prolotherapy) vs 348 controls treated with other infiltrations such as local anesthetics, hyaluronic acid, ozone, platelet-rich plasma or interventional procedures like radiofrequency. CONCLUSIONS: In terms of pain reduction and function improvement, prolotherapy with hypertonic dextrose was more effective than infiltrations with local anesthetics, as effective as infiltrations with hyaluronic acid, ozone or radiofrequency and less effective than PRP and erythropoietin, with beneficial effect in the short, medium and long term. In addition, no side effects or serious adverse reactions were reported in patients treated with hypertonic dextrose. Although HDP seems to be a promising interventional treatment for knee OA, more studies with better methodological quality and low risk of bias are needed to confirm the efficacy and safety of this intervention.

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Abstract Background: To evaluate the efficacy and safety of prolotherapy with hypertonic dextrose in patients with knee osteoarthritis. A systematic search was performed in electronic databases including PUBMED, SCIELO, DIALNET and Google Scholar. Main body: We searched for randomized clinical trials that evaluated therapeutic interventions in patients with knee osteoarthritis. These trials compared the effect of intra-articular and / or extra-articular infiltrations of hypertonic dextrose vs the effect of intra-articular and / or extra-articular infiltrations of other substances or some interventional procedure application, via assessing pain, physical function and secondary effects and / or adverse reactions. Ten randomized clinical trials were included in this systematic review, the total sample size comprised 328 patients treated with hypertonic dextrose (prolotherapy) vs 348 controls treated with other infiltrations such as local anesthetics, hyaluronic acid, ozone, platelet-rich plasma or interventional procedures like radiofrequency. Conclusions: In terms of pain reduction and function improvement, prolotherapy with hypertonic dextrose was more effective than infiltrations with local anesthetics, as effective as infiltrations with hyaluronic acid, ozone or radiofrequency and less effective than PRP and erythropoietin, with beneficial effect in the short, medium and long term. In addition, no side effects or serious adverse reactions were reported in patients treated with hypertonic dextrose. Although HDP seems to be a promising interventional treatment for knee OA, more studies with better methodological quality and low risk of bias are needed to confirm the efficacy and safety of this intervention.

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