Proliferative injection therapy for osteoarthritis: a systematic review
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To systematically analyse randomised controlled trials (RCTs) about efficacy and safety of proliferative injection therapy (prolotherapy) for treatment of osteoarthritis (OA).
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).
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.
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.
Current data from trials about prolotherapy for OA should be considered preliminary, and future high-quality trials on this topic are warranted.
KeywordsOsteoarthritis Proliferative injection therapy Prolotherapy Dextrose Pain
We are very grateful to Ms. Parisa Mansoori for helping us with translation of one manuscript.
M.K., M.J., A.J.K. and S.D. screened the bibliographic records. M.K. and M.J. extracted data. M.K. and S.D. assessed risk of bias. L.P. resolved disagreements between authors. M.K. wrote the first version of the manuscript with the help of M.J. All authors contributed to the final version of the systematic review. All authors approved final version of the systematic review.
Compliance with ethical standards
Role of funding source
The authors did not receive any extramural funding for this study apart from the institutional support of the University of Split School of Medicine and its library services for obtaining manuscripts.
Conflict of interest
The systematic review authors have no conflicts of interest to declare. Conflicts of interest in the included studies were analysed and reported in the manuscript. The majority of the included studies did not report whether there was a conflict of interest or source of funding.
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