Hyperosmolar Dextrose Injection for Recalcitrant Osgood-Schlatter Disease

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Osgood-Schlatter disease symptoms may wax and wane until maturity and affect sport confidence and participation periodically. Chronic sequelae may include anterior knee pain, kneeling discomfort, or sports limitation. Symptom reduction parallels resolution of patellar tendinopathy by MRI/ultrasound, although ossicles may persist radiographically. WHAT THIS STUDY ADDS:Small-needle injection of the patellar tendon enthesis/tibial apophysis with 12.5% dextrose was safe and well tolerated in adolescents with recalcitrant OsgoodSchlatter disease. Dextrose injection resulted in more rapid and frequent achievement of unaltered sport and asymptomatic sport than did usual care. abstract OBJECTIVE: To examine the potential of dextrose injection versus lidocaine injection versus supervised usual care to reduce sport alteration and sport-related symptoms in adolescent athletes with OsgoodSchlatter disease. PATIENTS AND METHODS: Girls aged 9 to 15 and boys aged 10 to 17 were randomly assigned to either therapist-supervised usual care or double-blind injection of 1% lidocaine solution with or without 12.5% dextrose. Injections were administered monthly for 3 months. All subjects were then offered dextrose injections monthly as needed. Unaltered sport (Nirschl Pain Phase Scale Ͻ 4) and asymptomatic sport (Nirschl Pain Phase Scale ϭ 0) were the threshold goals. RESULTS: Sixty-five knees in 54 athletes were treated. Compared with usual care at 3 months, unaltered sport was more common in both dextrose-treated (21 of 21 vs 13 of 22; P ϭ .001) and lidocaine-treated (20 of 22 vs 13 of 22; P ϭ .034) knees, and asymptomatic sport was more frequent in dextrose-treated knees than either lidocaine-treated (14 of 21 vs 5 of 22; P ϭ .006) or usual-care-treated (14 of 21 vs 3 of 22; P Ͻ .001) knees. At 1 year, asymptomatic sport was more common in dextrose-treated knees than knees treated with only lidocaine (32 of 38 vs 6 of 13; P ϭ .024) or only usual care (32 of 38 vs 2 of 14; P Ͻ .0001). CONCLUSIONS: Our results suggest superior symptom-reduction efficacy of injection therapy over usual care in the treatment of OsgoodSchlatter disease in adolescents. A significant component of the effect seems to be associated with the dextrose component of a dextrose/ lidocaine solution. Dextrose injection over the apophysis and patellar tendon origin was safe and well tolerated and resulted in more rapid and frequent achievement of unaltered sport and asymptomatic sport than usual care. Pediatrics 2011;128:e1121-e1128

Tendinosis as the underlying pathology of osgood-schlatter disease: imaging similarities and treatment implications

“…Use of ultrasonographic imaging has been shown to provide reliable and reproducible results in imaging in of the patellar tendon [7] . Similar pathologic findings have been noted in studies of OSD [8,9] . These similarities between OSD with the pathophysiology known as tendinosis suggest new treatment protocols, new aetiology, and possible genetic links for OSD.…”

“…There are numerous sclerosing agents (dextrose, polidocanol, phenol-gylcerine-glucose, and sodium morrhuate) that can be used [25] . The result is a decrease in neovascularization in the area surrounding the tendon, which has been correlated to decreased pain in the tendon [9,12,24] . High volume injections aim to accomplish the same result by injecting high volumes of fluid which interferes with the neovascularization process [12] .…”

“…Conservative treatment is successful in approximately 90% of cases, although it may take 2 years for resolution of symptoms and return to normal activity levels. Topol et al [9] described positive results for treating OSD with injections of 1% lidocaine/12.5% dextrose solution in their randomized control trial. This treatment was investigated following evidence of its efficacy in treating tendinosis [27,28] .…”

Prolotherapy: From Glorious Past to Promising Future

“…At 1 year, 84% of the dextrose-treated knees were pain-free compared with 46% of the lidocaine-treated knees. 14 Ryan et al 15 enrolled 99 patients with chronic Achilles tendon symptoms due to degeneration, who had failed all previous therapies. Ultrasound guidance injection into areas of degeneration (hypoechogenicity or tear) with 0.5 mL or less 25% dextrose in one to three spots at each treatment resulted in improvement in pain with everyday living; improvement from 57% at a mean of 28 weeks into treatment to 81% at a mean of 14 months posttreatment was observed.…”

Synoviology: a new chapter entitled to joints care

“…68 Contemporary injection techniques date from the 1950s when the more commonly used term 'prolotherapy' (from 'proliferant therapy') was adopted based on the observation that ligamentous tissue exhibited larger cross-sectional area after prolotherapy injections in animal models, 68 Hypertonic dextrose is the most commonly used injectant. Injection of painful entheses with hypertonic dextrose has demonstrated clinical benefit 69 and improvement in ultrasound-based tendinopathy findings in several tendinopathies. 70 The processing of whole blood by incubating (typically 24 hours) at 37°C in the presence of medical grade glass beads that had been exposed to CrSO 4 followed by harvesting, filtering the serum, is known as autologous-conditioned serum (ACS).…”