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Prolotherapy

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Regenerative Medicine
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Abstract

Regenerative medicine, though has recently become an increasingly researched field, has been around for many years, predominantly in the form of prolotherapy. The proposed mechanism of action of prolotherapy is to introduce a local irritant in order to cause cell death, thereby promoting the release of various growth factors. Prolotherapy is most commonly used for chronic musculoskeletal conditions, typically with tendinoses, ligamentous sprains, or articular cartilage damage, as in knee osteoarthritis. Furthermore, prolotherapy injections are commonly thought to be safe procedures with relatively few contraindications and thus pose to be a viable nonsurgical treatment option.

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Suggested Reading

  1. Nih Fact Sheets – Regenerative Medicine. https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=62.

  2. Hackett GS, Hemwall GA, Montgomery GA. Ligament and tendon relaxation treated by prolotherapy. 5. Gustav A. Hemwall: Oak Park; 1993.

    Google Scholar 

  3. Rabago D, Slattengren A, Zgierska A. Prolotherapy in primary care practice. Prim Care. 2010;37:65–80.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical medicine insights: Arthritis Musculoskelet Disord. 2016: 9.

    Google Scholar 

  5. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics Health. With Chartbook on trends in the health of Americans. Hyattsville: National Center for Health Statistics; 2006. DHHS Publication No 2006 1232

    Google Scholar 

  6. United States Bone and Joint Decade. The burden of musculoskeletal diseases in the United States. 1st ed. Rosemont: American Academy of Orthopaedic Surgeons; 2008. p. 42.

    Google Scholar 

  7. Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC). 2017. Retrieved 23 Apr 2018, from https://report.nih.gov/categorical_spending.aspx.

  8. Jenson K, Rabago D, Best T, Patterson J, Vanderby R Jr. Response of knee ligaments to prolotherapy in a rat model. Am J Sports Med. 2008;36(7):1347–57.

    Article  Google Scholar 

  9. Banks AR. The rationale for prolotherapy. J Orthop Med. 1991;13.

    Google Scholar 

  10. Morath O, Kubosch EJ, Taeymans J, Zwingmann J, Konstantinidis L, Südkamp NP, Hirschmüller A. The effect of sclerotherapy and prolotherapy on chronic painful Achilles tendinopathy-a systematic review including meta-analysis. Scandinavian J Med Sci Sports. 2017;28(1):4–15. https://doi.org/10.1111/sms.12898.

    Article  Google Scholar 

  11. Jensen KT, Rabago DP, Best TM, Patterson JJ, Vanderby R. Response of knee ligaments to prolotherapy in a rat injury model. Am J Sports Med. 2008;36(7):1347–57.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Housner JA, Jacobson JA, Misko R. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med. 2009;28(9):1187–92. https://doi.org/10.7863/jum.2009.28.9.1187.

    Article  PubMed  Google Scholar 

  13. Jacobson JA, Rubin J, Yablon CM, Kim SM, Kalume-Brigido M, Parameswaran A. Ultrasound-guided fenestration of tendons about the hip and pelvis. J Ultrasound Med. 2015;34(11):2029–35. https://doi.org/10.7863/ultra.15.01009.

    Article  PubMed  Google Scholar 

  14. Torres F. An assessment on the ultrasound guided dextrose prolotherapy for persistent coccygeal pain: a case series and review of literature. Altern Integr Med. 2014;03(02) https://doi.org/10.4172/2327-5162.1000155.

  15. Miller MR, Mathews RS, Reeves KD. Treatment of painful advanced internal lumbar disc derangement with intradiscal injection of hypertonic dextrose. Pain Phys. 2006;9(2):115–21.

    Google Scholar 

  16. Martins CA, Bertuzzi RT, Tisot RA, et al. Dextrose prolotherapy and corticosteroid injection into rat Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2012;20:1895–900.

    Article  CAS  PubMed  Google Scholar 

  17. Ahn KH, Kim HS, Lee WK, et al. The effect of the prolotherapy on the injured Achilles tendon in a rat model. J Korean Acad Rehabil Med. 2002;26:332–6.

    Google Scholar 

  18. Kim HJ, Jeong TS, Kim WS, et al. Comparison of histological changes in accordance with the level of dextrose-concentration in experimental prolotherapy model. J Korean Acad Rehabil Med. 2003;27:935–40.

    Google Scholar 

  19. Bollen S. Epidemiology of knee injuries: diagnosis and triage. Br J Sports Med. 2000;34(3).

    Google Scholar 

  20. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: part I. Caspain J Int Med. 2011;2(2).

    Google Scholar 

  21. Michael J, Schlüter-Brust K, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int. 2010;107:152–62.

    PubMed  PubMed Central  Google Scholar 

  22. Rabago D, Zgierska A, Fortney L, et al. Hypertonic dextrose injec- tions (prolotherapy) for knee osteoarthritis: results of a single-armed uncontrolled study with 1-year follow-up. J Altern Complement Med. 2012;18(4):408–14.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Rabago D, Patterson JJ, Mundt M, Kifjowski R, Grettie J, Segal NA, Zgierska A. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013;11(3):229–37.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Reeves KD, Hassanein K. Randomized prospective double-blind placebo controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 2000;6(2):68–74. 77-80

    CAS  PubMed  Google Scholar 

  25. Sit RW, Chung VC, Reeves KD, Rabago D, Chan KK, Chan DC, et al. Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic review and meta-analysis. Sci Rep. 2016;6(1).

    Google Scholar 

  26. Jumper’s Knee. 2017. Retrieved 07 Apr 2018, from https://emedicine.medscape.com/article/89569-overview#a8.

  27. Kujala UM, Kvist M, Heinonen O. Osgood-Schlatters disease in adolescent athletes. Am J Sports Med. 1985;13(4):236–41.

    Article  CAS  PubMed  Google Scholar 

  28. Wall EJ. Osgood-Schlatter disease: practical treatment for a self-limiting condition. Phys Sportsmed. 2010;38(4):29–34.

    Article  Google Scholar 

  29. Topol GA, Podesta LA, Reeves KD, Raya MF, Fullerton BD, Yeh H. Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter disease. Pediatrics. 2011;128(5):e1121–8.

    Article  PubMed  Google Scholar 

  30. Maughan K. n.d. Achilles tendinopathy and tendon rupture. Retrieved 07 Apr 2018, from https://www.uptodate.com/contents/achilles-tendinopathy-and-tendon-rupture.

  31. Sanderson LM, Bryant A. Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review. J Foot Ankle Res. 2015;8(1).

    Google Scholar 

  32. Maxwell NK, Ryan M, Taunton J, Gillies JH, Wong A. Sonographically guided intratendinous injection of hyperosmolar dextrose of the Achilles tendon: a pilot study. Am J Roentgenol. 2007;189(4):W215–20.

    Article  Google Scholar 

  33. Ryan M, Wong A, Taunton J. Favourable outcomes after sonographically guided inratendinous injection of hyperosmolar dextrose for chronic insertional and midportion Achilles tendinosis. Am J Roentgenol. 2010;194:1047–53.

    Article  Google Scholar 

  34. Goff J, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011;84(6):676–82.

    PubMed  Google Scholar 

  35. Ryan M, Wong A, Gillies J, Wong J, Taunton J. Sonographically guided intratendinous injections of hyperosmolar dextrose/lidocaine: a pilot study for the treatment of chronic plantar fasciitis. Br J Sports Med. 2009;43:303–6.

    Article  CAS  PubMed  Google Scholar 

  36. Kim E, Lee J. Autologous platelet rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. Phys Med Rehabil Int. 2014;6:152–8.

    Google Scholar 

  37. Van der Windt D, Koes B, De Jong B, Bouter L. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rhem Disease. 1995;54(12):959–64.

    Article  Google Scholar 

  38. Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003;(1):Cd004016.

    Google Scholar 

  39. Seven MM, Ersen O, Akpancar S, Ozkan H, Turkkan S, Yıldız Y, et al. Effectiveness of prolotherapy in the treatment of chronic ro- tator cuff lesions. Orthop Traumatol Surg Res. 2017;103(3):427–33. https://doi.org/10.1016/j.otsr.2017.01.003.

    Article  CAS  PubMed  Google Scholar 

  40. Lebiedziński R, Synder M, Buchcic P, Polguj M, Grzegorzewski A, Sibiński M. A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis. Int Orthop. 2015;39(11):2199–203.

    Article  PubMed  Google Scholar 

  41. Bisset L, Beller E, Jull G, et al. Mobilization with movement and exercise, corticosteroid injection or wait and see. BMJ. 2006;333:939. [PubMed: 17012266]

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rabago D, Lee KS, Ryan M, Chourasia AO, Sesto ME, Zgierska A, et al. Hypertonic dextrose and morrhuate sodium injections (prolotherapy) for lateral epicondylosis (tennis elbow). Am J Phys Med Rehabil. 2013;92(7):587–96. https://doi.org/10.1097/phm.0b013e31827d695f.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clin J Sport Med. 2008;18(3):248–54. https://doi.org/10.1097/jsm.0b013e318170fc87.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Zhang Y, Niu J, Kelly-Hayes M, Chaisson C, Aliabadi P, Felson D. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: the Framingham study. Am J Epidemiol. 2002;156(11):1021–7. https://doi.org/10.1093/aje/kwf141.

    Article  PubMed  Google Scholar 

  45. Kroon F, Rubio R, Schoones J, Kloppenburg M. Intra-articular therapies in the treatment of hand osteoarthritis: a systematic literature review. Osteoarthr Cartil. 2016;24 https://doi.org/10.1016/j.joca.2016.01.952.

  46. Reeves KD, Hassanein K. 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. 2000;6(4):311–20. https://doi.org/10.1089/10755530050120673.

    Article  CAS  PubMed  Google Scholar 

  47. Jahangiri A, Moghaddam FR, Najafi S. 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. 2014;19(5):737–43. https://doi.org/10.1007/s00776-014-0587-2.

    Article  PubMed  Google Scholar 

  48. Feldman, M. D. (2004). Prolotherapy for the treatment of chronic low back pain. California Technology Assessment Forum.

    Google Scholar 

  49. Klein RG, Eek BC, DeLong WB, Mooney V. A randomized double- blind trial of dextrose-glycerine phenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23–33.

    Article  CAS  PubMed  Google Scholar 

  50. Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LJ. A new approach to the treatment of chronic low back pain. Lancet. 1987;2(8551):143–6.

    Article  CAS  PubMed  Google Scholar 

  51. Hooper RA, Yelland M, Fonstad P, Southern D. Prospective case series of litigants and non-litigants with chronic spinal pain treated with dextrose prolotherapy. Int Musculoskelet Med. 2011;33(1):15–20.

    Article  Google Scholar 

  52. Bernard TN Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop. 1987;217:266–80.

    Article  Google Scholar 

  53. Frost S, Wheeler M, Fortin J, Vilensky J. The sacroiliac joint: anatomy, physiology and clinical significance. Pain Physician. 2006;9:61–8.

    Google Scholar 

  54. Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010;16(12):1285–90. https://doi.org/10.1089/acm.2010.0031.

    Article  PubMed  Google Scholar 

  55. Danielle S, C., M. J., Ross, H., Barbara, W., & Sarah, S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthop J. 2014;8(1):326–45. https://doi.org/10.2174/1874325001408010326.

    Article  Google Scholar 

  56. Slade GD. Epidemiology of temporomandibular joint disorders and related painful conditions. Mol Pain. 2014;10(Suppl 1):O16.

    Article  PubMed Central  Google Scholar 

  57. Ebrahim S, Montoya L, Busse JW, Carrasco-Labra A, Guyatt GH. The effectiveness of splint therapy in patients with temporomandibular disorders. J Ame Dental Assoc. 2012;143(8):847–57. https://doi.org/10.14219/jada.archive.2012.0289.

    Article  Google Scholar 

  58. Scrivani SJ, Mehta NR. 2016. Temporomandibular disorders in adults. Retrieved 22 Apr 2018, from https://www.uptodate.com/contents/temporomandibular-disorders-in-adults.

  59. Refai H. Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years’ follow up. Br J Oral Maxillofac Surg. 2017;55(5):465–70. https://doi.org/10.1016/j.bjoms.2016.12.002.

    Article  CAS  PubMed  Google Scholar 

  60. Dagenais S, Ogunseitan O, Haldeman S, et al. Side effects and adverse events related to intraligamentous injection of sclerosing solutions (prolotherapy) for back and neck pain: a survey of practitioners. Arch Phys Med Rehabil. 2006;87:909–13.

    Article  PubMed  Google Scholar 

  61. Rahimzadeh P, Imani F, Faiz SH, Entezary SR, Zamanabadi MN, Alebouyeh MR. The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clin Interv Aging. 2018;13:73–9. https://doi.org/10.2147/cia.s147757.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. Pm&r. 2014;6(2):152–8. https://doi.org/10.1016/j.pmrj.2013.07.003.

    Article  Google Scholar 

  63. Ryan M, Wong A, Rabago D, Lee K, Taunton J. Ultrasound-guided injections of hyperosmolar dextrose for overuse patellar tendinopathy: a pilot study. Br J Sports Med. 2011;45(12):972–7.

    Article  PubMed  Google Scholar 

  64. Labella CR, Hennrikus W, Hewett TE. Anterior cruciate ligament injuries: diagnosis, treatment, and prevention. Pediatrics. 2014;133(5).

    Google Scholar 

  65. Dorman TA. Treatment for spinal pain arising in ligaments–using prolotherapy: a retrospective survey. J Orthop Med. 1991;13:13–9.

    Google Scholar 

  66. Dorman T. Whiplash injuries: treatment with prolotherapy and a new hypothesis. J Orthop Med. 1999;21:13–21.

    Article  Google Scholar 

  67. Iseminger T, Palaikis R. A retrospective study of prolotherapy. San Luis Obispo: Cal State Polytechnic, Biological Sciences Department; honors paper (undergraduate); 1995:15.

    Google Scholar 

  68. Lopez RG, Jung H. Achilles tendinosis: treatment options. Clin Orthop Surg. 2015;7(1):1. https://doi.org/10.4055/cios.2015.7.1.1.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Center for Disease Control and Prevention. National ambulatory medical care survey. 2010. Available at http://www.cdc.gov/nchs/ahcd.htm.

    Google Scholar 

  70. Block J, Berkoff M. Clinical utility of ultrasound guidance for intra-articular knee injections: a review. Clin Interv Aging. 2012:89–95.

    Google Scholar 

  71. Rabago D, van Leuven L, Benes L, Fortney L, Slattengren A, Grettie J, Mundt M. Qualitative assessment of patients receiving prolotherapy for knee osteoarthritis in a multimethod study. J Altern Complement Med. 2016;22:983–9.

    Article  PubMed  PubMed Central  Google Scholar 

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Kajbaf, J. (2023). Prolotherapy. In: Hunter, C.W., Davis, T.T., DePalma, M.J. (eds) Regenerative Medicine . Springer, Cham. https://doi.org/10.1007/978-3-030-75517-1_2

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