PM&R News   •   August 2018

Prolotherapy is a regenerative injection therapy that introduces small amounts of irritant solution to the site of painful/degenerated tendon insertions, joints, and ligaments to promote growth of normal cells and tissue. The irritant solution most commonly used is hypertonic dextrose – yes, you read correctly – sugar water. Let’s start from the basics of how this works. Hypertonic dextrose solu­tions act by dehydrating cells at the injection site, leading to local tissue trauma, and initiating a local inflammatory cascade. Specifically, the elevation in dextrose around fibroblasts and chondrocytes results in a rise in cytokines responsible for signaling growth or breakdown of human tissue. The release of growth factors and collagen deposition is triggered leading to the proliferation and strengthening of new connective tissue. The increase in tensile strength of joint stabilizing structures, such as ligaments tendons, joint capsules, menisci, and labral tissue is the major goal of therapy which ultimately leads to a reduction of pain and dysfunction.

When should it be considered? Dextrose prolotherapy is most effective and should be considered in the treatment of tendinopathy and osteoarthritis. Although the clinical research is somewhat limited, dextrose prolotherapy has been most extensively studied in the treatment of knee osteoarthritis with a level A recommendation. Superior outcomes have also been seen in patients with sacroiliac pain when compared with steroid injection (B). Finger/thumb osteoarthritis, Osgood-schlatter, TMJ, Achilles tendinopathy, lateral epicondylosis, plantar fasciosis, and rotator cuff tendinopathy are also currently a level B and recommendation.

In clinical practice, dextrose prolotherapy is usually done in a series of 2-5 treatments, each 3-4 weeks apart. Treatments may be extended if the patient continues to improve. The concentration used for the injection ranges from 12.5-25% dextrose typically diluted with a local anesthetic. The only major side effect reported has been injection site pain. Prolotherapy is a low risk, low cost regenerative treatment that has demonstrated beneficial outcomes across a range of musculoskeletal conditions.

Author: Malia Cali, MD