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11.02.2017 | Review Article

Proliferative injection therapy for osteoarthritis: a systematic review

verfasst von: Mišo Krstičević, Milka Jerić, Svjetlana Došenović, Antonia Jeličić Kadić, Livia Puljak

Erschienen in: International Orthopaedics | Ausgabe 4/2017

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Abstract

Purpose

To systematically analyse randomised controlled trials (RCTs) about efficacy and safety of proliferative injection therapy (prolotherapy) for treatment of osteoarthritis (OA).

Methods

CENTRAL, Embase and MEDLINE were searched. Two reviewers independently conducted screening and data extraction. RCTs were assessed with the Cochrane risk of bias tool. Type of treatment, study design, dosing, efficacy outcomes and safety outcomes were analysed. The protocol was registered in PROSPERO (CRD42016035258).

Results

Seven RCTs were included, with 393 participants aged 40-75 years and mean OA pain duration from three months to eight years. Follow-up was 12 weeks to 12 months. Studies analysed OA of the knee joint (n = 5), first carpometacarpal joint (n = 1) and finger joints (n = 1). Various types of prolotherapy were used; dextrose was the most commonly used irritant agent. All studies concluded that prolotherapy was effective treatment for OA. No serious adverse events were reported. The studies had considerable methodological limitations.

Discussion

Limited evidence from low-quality studies indicates a beneficial effect of prolotherapy for OA management. The number of participants in these studies was too small to provide reliable evidence.

Conclusions

Current data from trials about prolotherapy for OA should be considered preliminary, and future high-quality trials on this topic are warranted.
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Literatur
1.
Zurück zum Zitat Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73(7):1323–1330. doi:10.1136/annrheumdis-2013-204763 CrossRefPubMed Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73(7):1323–1330. doi:10.​1136/​annrheumdis-2013-204763 CrossRefPubMed
2.
Zurück zum Zitat Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 64(4):465–474. doi:10.1002/acr.21596 CrossRef Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 64(4):465–474. doi:10.​1002/​acr.​21596 CrossRef
4.
Zurück zum Zitat De Filippis L, Gulli S, Caliri A, Romano C, Munao F, Trimarchi G, La Torre D, Fichera C, Pappalardo A, Triolo G, Gallo M, Valentini G, Bagnato G (2004) Epidemiology and risk factors in osteoarthritis: literature review data from “OASIS” study. Reumatismo 56(3):169–184. doi:10.4081/reumatismo.2004.169 PubMed De Filippis L, Gulli S, Caliri A, Romano C, Munao F, Trimarchi G, La Torre D, Fichera C, Pappalardo A, Triolo G, Gallo M, Valentini G, Bagnato G (2004) Epidemiology and risk factors in osteoarthritis: literature review data from “OASIS” study. Reumatismo 56(3):169–184. doi:10.​4081/​reumatismo.​2004.​169 PubMed
6.
Zurück zum Zitat Samson DJ, Grant MD, Ratko TA, Bonnell CJ, Ziegler KM, Aronson N (2007) Treatment of primary and secondary osteoarthritis of the knee. Evid Rep Technol Assess 157:1–157 Samson DJ, Grant MD, Ratko TA, Bonnell CJ, Ziegler KM, Aronson N (2007) Treatment of primary and secondary osteoarthritis of the knee. Evid Rep Technol Assess 157:1–157
8.
Zurück zum Zitat Tucker JD, Ericksen JJ, Goetz LL, Elmore LW (2014) Should clinical studies involving “regenerative injection therapy,” strive to incorporate a triad of outcome measures instead of only including clinical outcome measures? Osteoarthr Cartil 22(6):715–717. doi:10.1016/j.joca.2014.04.005 CrossRefPubMed Tucker JD, Ericksen JJ, Goetz LL, Elmore LW (2014) Should clinical studies involving “regenerative injection therapy,” strive to incorporate a triad of outcome measures instead of only including clinical outcome measures? Osteoarthr Cartil 22(6):715–717. doi:10.​1016/​j.​joca.​2014.​04.​005 CrossRefPubMed
9.
Zurück zum Zitat Trzeciak T, Richter M, Suchorska W, Augustyniak E, Lach M, Kaczmarek M, Kaczmarczyk J (2016) Application of cell and biomaterial-based tissue engineering methods in the treatment of cartilage, menisci and ligament injuries. Int Orthop 40(3):615–624. doi:10.1007/s00264-015-3099-6 CrossRefPubMed Trzeciak T, Richter M, Suchorska W, Augustyniak E, Lach M, Kaczmarek M, Kaczmarczyk J (2016) Application of cell and biomaterial-based tissue engineering methods in the treatment of cartilage, menisci and ligament injuries. Int Orthop 40(3):615–624. doi:10.​1007/​s00264-015-3099-6 CrossRefPubMed
15.
Zurück zum Zitat Covey CJ, Sineath MH Jr, Penta JF, Leggit JC (2015) Prolotherapy: can it help your patient? J Fam Pract 64(12):763–768PubMed Covey CJ, Sineath MH Jr, Penta JF, Leggit JC (2015) Prolotherapy: can it help your patient? J Fam Pract 64(12):763–768PubMed
16.
Zurück zum Zitat Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH (2010) A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med 16(12):1285–1290. doi:10.1089/acm.2010.0031 CrossRefPubMed Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH (2010) A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med 16(12):1285–1290. doi:10.​1089/​acm.​2010.​0031 CrossRefPubMed
20.
Zurück zum Zitat Rahimzadeh P, Imani F, Faiz SHR, Entezary SR, Nasiri AA, Ziaeefard M (2014) Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee. J Res Med Sci 8:696–702 Rahimzadeh P, Imani F, Faiz SHR, Entezary SR, Nasiri AA, Ziaeefard M (2014) Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee. J Res Med Sci 8:696–702
21.
Zurück zum Zitat Jahangiri A, Moghaddam FR, Najafi S (2014) Hypertonic dextrose versus corticosteroid local injection for the treatment of osteoarthritis in the first carpometacarpal joint: a double-blind randomized clinical trial. J Orthop Sci 5:737–743. doi:10.1007/s00776-014-0587-2 CrossRef Jahangiri A, Moghaddam FR, Najafi S (2014) Hypertonic dextrose versus corticosteroid local injection for the treatment of osteoarthritis in the first carpometacarpal joint: a double-blind randomized clinical trial. J Orthop Sci 5:737–743. doi:10.​1007/​s00776-014-0587-2 CrossRef
23.
Zurück zum Zitat Reeves KD, Hassanein K (2000) Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med (2):68–74, 77–80 Reeves KD, Hassanein K (2000) Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med (2):68–74, 77–80
24.
Zurück zum Zitat Reeves KD, Hassanein K (2000) Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy. J Altern Complement Med 6(4):311–320. doi:10.1089/10755530050120673 CrossRefPubMed Reeves KD, Hassanein K (2000) Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy. J Altern Complement Med 6(4):311–320. doi:10.​1089/​1075553005012067​3 CrossRefPubMed
25.
Zurück zum Zitat Dumais R, Benoit C, Dumais A, Babin L, Bordage R, Arcos C, Allard J, Bélanger M (2012) Effect of regenerative injection therapy on function and pain in patients with knee osteoarthritis: a randomized crossover study. Pain Med 8:990–999. doi:10.1111/j.1526-4637.2012.01422.x CrossRef Dumais R, Benoit C, Dumais A, Babin L, Bordage R, Arcos C, Allard J, Bélanger M (2012) Effect of regenerative injection therapy on function and pain in patients with knee osteoarthritis: a randomized crossover study. Pain Med 8:990–999. doi:10.​1111/​j.​1526-4637.​2012.​01422.​x CrossRef
26.
Zurück zum Zitat Hashemi M, Jalili P, Mennati S, Koosha A, Rohanifar R, Madadi F, Razavi SS, Taheri F (2015) The effects of prolotherapy with hypertonic dextrose versus prolozone (intraarticular ozone) in patients with knee osteoarthritis. Anesth Pain Med (5). doi:10.5812/aapm.27585 Hashemi M, Jalili P, Mennati S, Koosha A, Rohanifar R, Madadi F, Razavi SS, Taheri F (2015) The effects of prolotherapy with hypertonic dextrose versus prolozone (intraarticular ozone) in patients with knee osteoarthritis. Anesth Pain Med (5). doi:10.​5812/​aapm.​27585
27.
Zurück zum Zitat Hashemi SM, Madadi F, Razavi S, Nikooseresht M, Kiyabi FH, Nasiripour S (2012) Intra-articular hyaluronic acid injections vs. dextrose prolotherapy in the treatment of osteoarthritic knee pain. Tehran Univ Med J (2):119–125 Hashemi SM, Madadi F, Razavi S, Nikooseresht M, Kiyabi FH, Nasiripour S (2012) Intra-articular hyaluronic acid injections vs. dextrose prolotherapy in the treatment of osteoarthritic knee pain. Tehran Univ Med J (2):119–125
28.
Zurück zum Zitat Sit RW, Chung VC, Reeves KD, Rabago D, Chan KK, Chan DC, Wu X, Ho RS, Wong SY (2016) Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic review and meta-analysis. Sci Rep 6:25247. doi:10.1038/srep25247 CrossRefPubMedPubMedCentral Sit RW, Chung VC, Reeves KD, Rabago D, Chan KK, Chan DC, Wu X, Ho RS, Wong SY (2016) Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic review and meta-analysis. Sci Rep 6:25247. doi:10.​1038/​srep25247 CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Handoll HHG, Langhorne P (2015) In defence of reviews of small trials: underpinning the generation of evidence to inform practice. Cochrane Database Syst Rev 11, ED000106. doi:10.1002/14651858.ED000106 Handoll HHG, Langhorne P (2015) In defence of reviews of small trials: underpinning the generation of evidence to inform practice. Cochrane Database Syst Rev 11, ED000106. doi:10.​1002/​14651858.​ED000106
35.
Zurück zum Zitat Berenfeld A, Bessing WD, Bisplinghoff U, Bittner G, Matthiesen HO, Tilscher H, Ramm S, Ebeling L, Schmitz H (1991) [Gonalgia: treatment with therapeutic local anesthesia. Results of a controlled comparative study versus diclofenac]. Fortschritte der Medizin (35):724–728 Berenfeld A, Bessing WD, Bisplinghoff U, Bittner G, Matthiesen HO, Tilscher H, Ramm S, Ebeling L, Schmitz H (1991) [Gonalgia: treatment with therapeutic local anesthesia. Results of a controlled comparative study versus diclofenac]. Fortschritte der Medizin (35):724–728
37.
Zurück zum Zitat Gu ZY, Wu HL, Wu QL, Cao ZQ, Zhang YX (1998) The effect of intra-articular irrigation injection therapy on osteoarthrosis of the temporomandibular joint. Chin J Dent Med 3:44–48 Gu ZY, Wu HL, Wu QL, Cao ZQ, Zhang YX (1998) The effect of intra-articular irrigation injection therapy on osteoarthrosis of the temporomandibular joint. Chin J Dent Med 3:44–48
41.
Zurück zum Zitat Rabago D, Patterson JJ, Mundt M, Zgierska A, Fortney L, Grettie J, Kijowski R (2014) Dextrose and morrhuate sodium injections (Prolotherapy) for knee osteoarthritis: a prospective open-label trial. J Altern Complement Med 5:383–391. doi:10.1089/acm.2013.0225 CrossRef Rabago D, Patterson JJ, Mundt M, Zgierska A, Fortney L, Grettie J, Kijowski R (2014) Dextrose and morrhuate sodium injections (Prolotherapy) for knee osteoarthritis: a prospective open-label trial. J Altern Complement Med 5:383–391. doi:10.​1089/​acm.​2013.​0225 CrossRef
42.
Zurück zum Zitat Rabago DP, Miller DJ, Zgierska AE, Mundt M, Kijowski RX, Jessica B, Patterson JJ (2011) Dextrose prolotherapy for knee osteoarthritis: results of a randomized controlled trial. Osteoarthr Cartil S142–s143. doi:10.1016/S1063-4584(11)60335-X Rabago DP, Miller DJ, Zgierska AE, Mundt M, Kijowski RX, Jessica B, Patterson JJ (2011) Dextrose prolotherapy for knee osteoarthritis: results of a randomized controlled trial. Osteoarthr Cartil S142–s143. doi:10.​1016/​S1063-4584(11)60335-X
43.
Zurück zum Zitat Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, Zgierska A (2013) Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med 3:229–237. doi:10.1370/afm.1504 CrossRef Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, Zgierska A (2013) Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med 3:229–237. doi:10.​1370/​afm.​1504 CrossRef
44.
Zurück zum Zitat Rabago D, Kijowski R, Woods M, Patterson JJ, Mundt M, Zgierska A, Grettie J, Lyftogt J, Fortney L (2013) Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis. Arch Phys Med Rehabil 11:2075–2082. doi:10.1016/j.apmr.2013.06.025 CrossRef Rabago D, Kijowski R, Woods M, Patterson JJ, Mundt M, Zgierska A, Grettie J, Lyftogt J, Fortney L (2013) Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis. Arch Phys Med Rehabil 11:2075–2082. doi:10.​1016/​j.​apmr.​2013.​06.​025 CrossRef
Metadaten
Titel
Proliferative injection therapy for osteoarthritis: a systematic review
verfasst von
Mišo Krstičević
Milka Jerić
Svjetlana Došenović
Antonia Jeličić Kadić
Livia Puljak
Publikationsdatum
11.02.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 4/2017
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-017-3422-5

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