Disclosures: Vinny Francio, MD: Nothing to disclose

Objective: To review the literature regarding the clinical uses of prolotherapy for musculoskeletal pain due to osteoarthritis (OA) and sports-related injuries.

Design: Descriptive narrative review of 40 peer-reviewed publications from 1997-2019.

Setting: N/A

Participants: N/A

Interventions: N/A

Main Outcome Measures: N/A

Results: Prolotherapy appears most efficacious when treating knee OA, rotator cuff tendinopathy, and sacroiliac pain. A RCT with supraspinatus pathology revealed that pain with overhead activities was significantly reduced at the 3-month follow-up in the prolotherapy group and at the 6-month follow-up for both the prolotherapy and corticosteroid groups. In another RCT, prolotherapy treatment improved pain and ROM when compared to placebo or lidocaine for rotator cuff tendinopathy. A 2018 study showed a 15-point improvement in Oswestry Disability Index within two SI joint injections, indicating a 92% sensitivity and 80% specificity in determining which patients would likely improve. Regarding symptomatic ACL laxity, a 2013 trial concluded that prolotherapy resulted in significant improvement in stability, pain, swelling, and ROM. A 2019 study revealed that WOMAC knee scores and functional testing improved after prolotherapy, including walking speed and a 4×10 m walk test. A 2016 prospective trial followed patients up to 18 months after prolotherapy for knee OA. Post-injection pain scores were reduced by 83% and 90% at 3 and 6 months, respectively. At 18 months, WOMAC index function scores improved 61%, indicating positive long-term outcomes. Prolotherapy injections produce stimulatory chondrogenic effects visualized directly under arthroscopy. Conversely, knee corticosteroid injections reduce pain up to 6 months and produce time and dose-dependent chondrotoxic effects.

Conclusions: Current guidelines suggest moderate evidence supporting prolotherapy use in knee and shoulder pathology, with studies suggesting long-term improvements in function, pain, and ROM. Although these results are optimistic, higher quality studies including RCTs are needed to determine the impact on quality of life in order to give stronger warrant for the usage of prolotherapy for these conditions.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/prolotherapy-for-the-treatment-of-osteoarthritis-and-sports-related-injuries/