Disclosures: Jason Kajbaf, DO: Nothing to disclose

Case Description: A 40-year-old male with past medical history of PTSD and two arthroscopic meniscal surgeries (left 2004, right 2008), who presents with chronic left knee pain that began 15 years ago after a military injury. The patient endorses 5/10 sharp left knee pain on the medial aspect and is worse with squatting and pivoting. Physical examination reveals point tenderness of the medial collateral ligament (MCL), and pain with valgus stress testing. Radiographs demonstrated mild to moderate knee osteoarthritis. Given the above findings, the patient’s primary pain generator was suspected to be due to a chronic MCL sprain and was thus offered prolotherapy injections as a treatment option. The patient received 4 monthly 2cc injections that were composed of 1cc 50% hypertonic dextrose and 1cc normal saline to his MCL. The patient endorsed exponentially improving pain relief after each injection, with near resolution after completion of the series.

Setting: VA hospital, outpatient PM&R clinic

Patient: 40-year-old veteran

Assessment/Results: A chronic left MCL sprain with resolution of pain after series of prolotherapy injections.

Discussion: Knee ligament injuries makes up a large proportion of knee injuries, and one review suggested that MCL sprains in particular account for up to 7. 9% of all knee injuries. As evident by the case described above, prolotherapy may provide clinically significant pain relief and serve as a viable treatment option when other conservative measures, such as physical therapy, have failed. However, there are currently no randomized clinical trials looking at the efficacy of prolotherapy for acute or chronic MCL sprains, thus a formal randomized clinic trial should be performed in order to replicate the findings above, and further determine the efficacy of prolotherapy for MCL sprains.

Conclusion: Prolotherapy may prove to be an effective and safe treatment option for chronic MCL sprains, particularly in cases when conservative measures have failed.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/prolotherapy-for-chronic-medial-collateral-ligament-sprain/