Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study

Dumais, Réjean; Benoit, C.; Dumais, Alexis; Babin, Lise; Bordage, Rachel; Arcos, Claire de; Allard, Jacques; Bélanger, Mathieu

doi:10.1111/j.1526-4637.2012.01422.x

Cited by 54 publications

(61 citation statements)

References 53 publications

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“…We excluded one single-arm trial, due to lack of quantitative pain evaluation in patients with patellar chondro-arthropathy,18 one RCT comparing single injection of dextrose with erythropoietin,19 one RCT targeting nonspecific chronic low back pain without definite radiologic evidence of lumbar spine osteoarthritis,20 and two observational studies analyzing data from a published RCT exploring knee osteoarthritis 21,22. The final meta-analysis included one single-arm follow-up trial23 and five RCTs,7,8,24–26 four of which probed knee osteoarthri tis7,23,24,26 and two of which examined hand osteoarthritis 8,25. Regarding the comparative injection regimens in the five RCTs, one used two serial saline injections followed by one shot of corticosteroids,25 three used sequential administrations of local anesthetics,7,8,24 and one used a crossover design by implementing the dextrose injection at different time points 26…”

Section: Resultsmentioning

confidence: 99%

“…The final meta-analysis included one single-arm follow-up trial23 and five RCTs,7,8,24–26 four of which probed knee osteoarthri tis7,23,24,26 and two of which examined hand osteoarthritis 8,25. Regarding the comparative injection regimens in the five RCTs, one used two serial saline injections followed by one shot of corticosteroids,25 three used sequential administrations of local anesthetics,7,8,24 and one used a crossover design by implementing the dextrose injection at different time points 26…”

Section: Resultsmentioning

confidence: 99%

“…As regards the quality assessment, all the RCTs obtained a maximal 2 points in the aspect of “randomization” in Jadad scale since appropriate randomization methods were mentioned. In the aspect of “blinding”, all the RCTs had appropriate blinding methods (maximal 2 points) except the study by Dumais et al26 which did not mention a blinded design of intervention and evaluation (earning 0 points). In the aspect of “an account of all patients”, the two studies conducted by Reeves and Hassanein,7,8 the one by Rabago et al,24 and the one by Dumais et al26 had descriptions of the outcome of all the patients at the end of the studies (earning 1 point).…”

Section: Resultsmentioning

confidence: 99%

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Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis

Hung

Hsiao

Chang

et al. 2016

JPR

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BackgroundIncreasing evidence has supported the use of dextrose prolotherapy for patients with osteoarthritis. However, the real benefits may be affected by differences in injection protocols, comparative regimens, and evaluation scales.MethodsPubMed and Scopus were searched from the earliest record until February 2016. One single-arm study and five randomized controlled trials were included, comprising 326 participants. We estimated the effect sizes of pain reduction before and after serial dextrose injections and compared the values between dextrose prolotherapy, comparative regimens, and exercise 6 months after the initial injection.ResultsRegarding the treatment arm using dextrose prolotherapy, the effect sizes compared with baseline were 0.65 (95% confidence interval [CI], 0.14–1.17), 0.84 (95% CI, 0.40–1.27), 0.85 (95% CI, 0.60–1.10), and 0.87 (95% CI, 0.53–1.21) after the first, second, third, and fourth or more injections, respectively. The overall effect of dextrose was better than control injections (effect size, 0.36; 95% CI, 0.10–0.63). Dextrose prolotherapy had a superior effect compared with local anesthesia (effect size, 0.38; 95% CI, 0.07–0.70) and exercise (effect size, 0.71; 95% CI, 0.30–1.11). There was an insignificant advantage of dextrose over corticosteroids (effect size, 0.31; 95% CI, –0.18 to 0.80) which was only estimated from one study.ConclusionDextrose injections decreased pain in osteoarthritis patients but did not exhibit a positive dose–response relationship following serial injections. Dextrose prolotherapy was found to provide a better therapeutic effect than exercise, local anesthetics, and probably corticosteroids when patients were retested 6 months following the initial injection.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis

Hung

Hsiao

Chang

et al. 2016

JPR

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“…The remaining research is composed mostly of case series. Table 1 presents a list of studies [17‐47] and levels of evidence.…”

Section: Common Regenerative Methodsmentioning

confidence: 99%

Regenerative Sports Medicine: Past, Present, and Future (Adapted From the PASSOR Legacy Award Presentation; AAPMR; October 2016)

Borg‐Stein

Osoria

Hayano

2018

PM&R

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Regenerative medicine has shown dramatic expanse and evolution in the past decade. Within that milieu, physiatrists are taking an active role in research, clinical care delivery, and education. The purpose of this review is to provide a balance among evidence, theory, experience, clinical trends, and the foreseeable future. We focus on the literature that reports the research with the best methodology in each practice area, recognizing that the level of evidence varies substantially among different treatment modalities and conditions. The following elements are included: an overview of the evolution of currently available regenerative techniques, evidence base for each available modality (prolotherapy, platelet rich plasma, bone marrow aspirate concentrate and stem cells, adipose-derived stem cells, and amniotic tissue products), general principles in the application of these treatments, and discussion and a vision of what lies ahead. We expect that practitioners will use this review to facilitate clinical decision making and to provide a core knowledge base to assist when counseling patients. LEVEL OF EVIDENCE: IV.

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“…Randomized clinical trials [30,31] have compared HDP vs conservative treatments (physiotherapy, exercise program) in individuals with knee OA and have reported greater efficacy of HDP in terms of reducing pain and improving function. When analyzing the effectiveness of HDP in OA knee treatment vs other interventional treatments, HDP appeared to be more effective than local anesthetics [17,19,20].…”

Section: Therapeutic Efficacymentioning

confidence: 99%

Prolotherapy for knee osteoarthritis using hypertonic dextrose vs other interventional treatments: systematic review of clinical trials

et al. 2019

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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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Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study

Abstract: The use of RIT is associated with a marked reduction in symptoms, which was sustained for over 24 weeks.

Cited by 54 publications

References 53 publications

Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis

Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis

Regenerative Sports Medicine: Past, Present, and Future (Adapted From the PASSOR Legacy Award Presentation; AAPMR; October 2016)

Prolotherapy for knee osteoarthritis using hypertonic dextrose vs other interventional treatments: systematic review of clinical trials

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