Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial

Rabago D, Patterson JJ, Mundt M, et al. · Annals of Family Medicine

Between-group comparison at 52 weeks put the dextrose arm's composite WOMAC change at 15.32 points, a 24% improvement on baseline, against 7.59 on saline (P=.022) and 8.24 on at-home exercise (P=.034), above the WOMAC-based minimal clinically important difference. The separation is present at 9 weeks (13.91 against 6.75, P=.020, and 2.51, P=.001) and holds at 24 weeks. Half the dextrose arm (15 of 30) gained 12 or more WOMAC points, against 30% on saline (10 of 29) and 24% on exercise (8 of 31). No adverse events.

Population

90 adults with >=3 months of painful knee OA

Intervention

Intra- and extra-articular hypertonic dextrose injections at weeks 1, 5, 9 (optional weeks 13, 17)

Comparator

Saline injections or at-home exercise

Limitations

Thirty, 29 and 31 patients per arm at a single site, with no significant baseline difference between them. Blinding covered the injector, the outcome assessor, the principal investigator and the injected participants - syringes were prepared under opaque sleeves by a university pharmacy - and the trial measured whether it held: the injector answered don't know 93% of the time and participants 91% and 93%, the remainder splitting evenly between correct and incorrect (P=.77). The at-home exercise arm could not be blinded. Funded by the National Institutes of Health through the National Center for Complementary and Alternative Medicine.