The effect of dextrose prolotherapy on patients diagnosed with knee osteoarthritis: A comprehensive systematic review and meta-analysis of interventional studies

Abstract

Background and aims: The primary objective of this systematic review and meta-analysis was to assess the impact of dextrose prolotherapy on individuals diagnosed with knee osteoarthritis (KOA).

Methods: To conduct a thorough investigation, a variety of leading international databases were checked, including PubMed (Medline), Scopus, Web of Sciences, EMBASE (Elsevier), ClinicalTrials.gov, and the Cochrane Library. The search covered a period from January 2000 to the end of June 2023, which facilitated the collection of relevant studies.

Results: The findings of the study revealed that when the studies utilizing the Western Ontario McMaster Universities Index tool (WOMAC) were combined, patients with KOA who received prolotherapy experienced an improvement in function compared with those who received other treatments (SMD: 0.20; 95% Confidence Interval [1]: -0.11, 0.51; p value SMD = 0.221; I ²: 78.49%; p _{heterogeneity} < 0.001). Additionally, there was a decrease in mean pain and stiffness among patients who received prolotherapy compared with those who received other treatments or a placebo [(SMD: -0.95; 95% CI: -1.14, -0.76; p value SMD < 0.001; I ²: 59.35%; p _{heterogeneity} = 0.070) and (SMD: -0.21; 95% CI: -0.32, -0.10; p value SMD < 0.001; I ²: 88.11%; p _{heterogeneity} < 0.001)]. Furthermore, based on the Visual Analog Scale (VAS) score, there was a reduction of 0.81 units out of 10 in mean pain for patients with KOA who received prolotherapy (SMD: -0.81; 95% CI: -5.63, 4.10; p value SMD = 0.693; I ²: 48.54%; p _{heterogeneity} = 0.08).

Conclusion: Drawing from the data analysis performed in this meta-analysis, it is apparent that dextrose prolotherapy exhibits promising effectiveness in reducing joint pain and stiffness, as well as improving functional performance in individuals suffering from KOA. Furthermore, it is recommended that forthcoming studies incorporate follow-up periods to guide decisions concerning the duration of prolotherapy's effects.

Keywords: Dextrose Prolotherapy; Evidence Synthesis; Knee; Osteoarthritis.

Figure 1

Flow diagram for related article numbers which included in meta‐analysis.

Figure 2

Forest plot of the effect of prolotherapy (3–9 mL with 25%–50% dextrose) on the WOMAC score in patients with knee osteoarthritis.

Figure 3

Forest plot of the effect of prolotherapy (3–9 mL with 25 injections to 50% dextrose) on the VAS score in patients with knee osteoarthritis.

Figure 4

Forest plot of the effect of prolotherapy (3–9 mL with 25%–50% dextrose) on the KOOS score in patients with knee osteoarthritis.

Figure 5

Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across and judgments about each risk of bias item for each all‐included study.