Prolotherapy for knee injuries

Doug,
I am familiar with the use of prolotherapy for chronic back pain as one of the researchers where I work is conducting a study. His results have been good to this point. To my knowledge there is some literature (1 or 2 studies)on its use for knee osteoarthritis with fairly good results, but you must read between the lines. Some of the patients had ACL laxity that improved after a year of treatment, but remember the laxity was likely secondary to arthritic changes and not acute trauma like yours. They did not have controls in the study and the measurement of ACL laxity is not an exact science. All the patients were chronic and generally older and less active. Thus you must be careful not to generalize the findings.

My opinion would be based your current knee function and symptoms:
1) Is your knee unstable? Has the ACL laxity been given a grade?
2) Are you in constant pain?
3) Do you have a lot of swelling?
4) Does your knee buckle with activity?
5) Have you had a MRI and or scope?
6) Have you done conventional rehab?

Traditionally, prolotherapy was designated for chronic (>6 months) conditions but this is not an absolute. There exist some limited ability to heal a partially torn ACL and I would be in favor of letting this "natural" healing , if any, take place before seeking alternatives. The bottom line is, however, that you don't have a lot to lose by trying it except money if your insurance doesn't pick it up, many don't. The biggest risk is the injection itself as the injected fluid amounts to sugar water (sometimes a pain med is added, xylocaine). The possibility exist of interference with the natural healing process although this is purely speculation. Incidently, I have had a partially torn ACL for almost 15 years with no significant problems. I still have laxity with a manual or machine examine but I do not have instability with activity or pain. I do train my legs regularly and I am highly active with running, motorcycles, skiing etc.. A daily dose of glucosamine and chrondroitin helps my paranoia of trashing my cartilage. Once again, don't generalize from my story and if I became symptomatic I would consider prolotherapy as an option after a scope as I could be relatively sure that I have reached a plateau in healing.

One other note, your meniscal tear is a wild card in this depending on the degree of injury. Let me know if your interested and I will try to dig up the journal article for you.

Good Luck, Keith.

Hey Doug,

Here is the abstract from one article pertaining to the knee, the University library does not carry this journal for full text. A big national library should have it or you could contact the author for a reprint if interested.
It is concerning that you are experiencing some instability while having a meniscal tear. Did they tell you what kind of tear, radial, bucket handle etc..? Can it be sutured or repaired? The combination of ACL laxity and a meniscal tear leaves you prone to develop problems down the road. The limited healing properties of the meniscus is further diminished with an unstable knee as the faulty biomechanics can cause further damage. Some rehab with a good sports therapist wouldn't hurt and don't forget to train the hamstrings as they are the muscles that can check the anterior displacement of the tibia which is the main stress for the ACL. Some therapists and trainers will measure the ratio of your hamstring strength to your ****s to see if there is a deficiency. Going conservative at first is what I would do, and what I did, as I was offered ACL reconstruction an opted out. I, however, had an isolated partial ACL tear with no other pathology. I would however be vigilant on how the knee is doing as arthritic changes are not amenable to many therapies. Try to strengthen your knee as much as possible especially if you are continuing to experience "buckling" or locking of the knee in 6 months or so you may want to consider revisting your orthopedic surgeon.


Good luck and keep us posted on your progress, Keith

Key: **** = ****riceps, sorry for the profanity :)



Altern Ther Health Med 2000 Mar;6(2):68-74, 77-80

Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity.

Reeves KD, Hassanein K.

Bethany Medical Center, Kansas City, Kan., USA.

CONTEXT: Use of prolotherapy (injection of growth factors or growth factor stimulators). OBJECTIVE: Determine the effects of dextrose prolotherapy on knee osteoarthritis with or without anterior cruciate ligament (ACL) laxity. DESIGN: Prospective randomized double-blind placebo-controlled trial. SETTING: Outpatient physical medicine clinic. PATIENTS OR OTHER PARTICIPANTS: Six months or more of pain along with either grade 2 or more joint narrowing or grade 2 or more osteophytic change in any knee compartment. A total of 38 knees were completely void of cartilage radiographically in at least 1 compartment. INTERVENTION: Three bimonthly injections of 9 cc of either 10% dextrose and .075% lidocaine in bacteriostatic water (active solution) versus an identical control solution absent 10% dextrose. The dextrose-treated joints then received 3 further bimonthly injections of 10% dextrose in open-label fashion. MAIN OUTCOME MEASURES: Visual analogue scale for pain and swelling, frequency of leg buckling, goniometrically measured flexion, radiographic measures of joint narrowing and osteophytosis, and KT1000-measured anterior displacement difference (ADD). RESULTS: All knees: Hotelling multivariate analysis of paired observations between 0 and 6 months for pain, swelling, buckling episodes, and knee flexion range revealed significantly more benefit from the dextrose injection (P = .015). By 12 months (6 injections) the dextrose-treated knees improved in pain (44% decrease), swelling complaints (63% decrease), knee buckling frequency (85% decrease), and in flexion range (14 degree increase). Analysis of blinded radiographic readings of 0- and 12-month films revealed stability of all radiographic variables except for 2 variables which improved with statistical significance. (Lateral patellofemoral cartilage thickness [P = .019] and distal femur width in mm [P = .021]. Knees with ACL laxity: 6-month (3 injection) data revealed no significant improvement. However, Hotelling multivariate analysis of paired values at 0 and 12 months for pain, swelling, joint flexion, and joint laxity in the dextrose-treated knees, revealed a statistically significant improvement (P = .021). Individual paired t tests indicated that blinded measurement of goniometric knee flexion range improved by 12.8 degrees (P = .005), and ADD improved by 57% (P = .025). Eight out of 13 dextrose-treated knees with ACL laxity were no longer lax at the conclusion of 1 year. CONCLUSION: Prolotherapy injection with 10% dextrose resulted in clinically and statistically significant improvements in knee osteoarthritis. Preliminary blinded radiographic readings (1-year films, with 3-year total follow-up period planned) demonstrated improvement in several measures of osteoarthritis severity. ACL laxity, when present in these osteoarthritic patients, improved.