Prolotherapy: an effective adjunctive therapy for knee osteoarthritis.

The Journal of the American Osteopathic Association February 2013 | Vol 113 | No. 2 122 rigor documented positive clinical outcomes from the 1930s to the early 2000s.9 Our group has conducted an openlabel trial10 and a blinded randomized controlled trial11,12 (Clinical Trial number NCT00085722) assessing prolotherapy for patients with knee OA. In the open-label trial, we compared pain and disability in participants receiving prolotherapy to their baseline levels;10 in the randomized controlled trial, we compared the effects of prolotherapy with blinded saline control or at-home exercise therapy.11,12 Outcomes in both studies were assessed by the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100-point scale) at 52 weeks. Participants in the open-label study10 reported improvement in overall WOMAC scores at as early as 4 weeks progressing through 52 weeks (mean [standard deviation (SD)] point improvement, 15.9 [2.5]; P<.001). Interestingly, while participants reported less severe baseline knee OA in uninjected contralateral knees compared with injected knees, they reported small but statistically significant improvements in pain severity and frequency (P<.001) and severity alone (43%; P=.001) at 52 weeks as well, suggesting a compensatory mechanism associated with prolotherapy.10 In the randomized controlled trial,11,12 WOMAC scores among prolotherapy recipients improved more at 52 weeks than did scores among saline control and athome exercise participants (mean [SD] score change, 15.3 [3.5] vs 7.6 [3.4] and 8.2 [3.3], respectively; P<.05). In both studies,10-12 the improvement in WOMAC scores exceeded the minimal clinically important difference for the WOMAC of Prolotherapy: An Effective Adjunctive Therapy for Knee Osteoarthritis