Medical Reviews of Prolotherapy for Knee Osteoarthritis

Prolotherapy injections for knee osteoarthritis

In new research, doctors from the University of Wisconsin School of Medicine and Public Health write: Systematic review, including meta-analysis, and randomized controlled trials suggest that Prolotherapy may be associated with symptom improvement in mild to moderate symptomatic knee osteoarthritis and overuse tendinopathy. A growing body of literature suggests that prolotherapy for knee osteoarthritis may be appropriate for the treatment of symptoms associated with knee osteoarthritis in carefully selected patients who did not respond to conservative therapy.1

A team of multi-national researchers publishing in the British Medical Bulletin evaluated ten studies which showed significant improvement in patient scores for pain, function and range of motion, both in the short term and long term. Patient satisfaction was also high in these patients (82%) for Prolotherapy treatment.2

Also from the University of Wisconsin School of Medicine and Public Health, a late 2016 study followed twenty-two participants treated with prolotherapy for symptomatic knee osteoarthritis who were previously enrolled in three randomized and open-label studies. At 52 weeks following enrollment, the patients were interviewed about the overall experience with Prolotherapy.


  • improvement in knee-specific quality of life was found in 18 of 22 patients. Four patients reported limited response.
  • pretreatment counseling enhanced treatment adherence and optimism of the success of the Prolotherapy treatments.
  • patients reported overall positive experience with Prolotherapy.

Most participants reported substantially improved knee-specific effects, resulting in improved quality of life and activities of daily living; four participants reported minimal or no effect. Clear, complete description of procedural rationale may enhance optimism about and adherence to treatment appointments.3

Numerous studies 4,5 have been published to show the effectiveness of Prolotherapy in various knee disorders including Caring Medical research on  Prolotherapy’s effectiveness in regenerating knee cartilage.

In research from June 2015, doctors examined the long-term benefit of Prolotherapy for knee osteoarthritis.

They found that Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness among most participants through an average follow up of 2.5 years.6 This research follows on a study appearing in the Journal of Alternative and Complementary Medicine. Here doctors showed that Prolotherapy provided safe and significant improvement in patients with mild to medium knee osteoarthritis.

In the medical journal Pain Medicine, Prolotherapy results were found after the patients had injections at 4 week intervals – 1st week, 5th week, 9th week, and if needed a 13th and 17th week treatment. This helps emphasize that Prolotherapy is not a one shot-one treatment therapy.7

Research case study | Prolotherapy as alternative to knee surgery

A case report that was published in the medical journal Anesthesiology and Pain Medicine discusses the clinical and radiological outcomes of prolotherapy in a patient whom total knee prosthesis had been planned but surgery couldn’t be performed due to other existing medical conditions.

The patient was a 72 year old woman with severe pain at her knees for over 5 years. Treatment methods include weight loss, decreasing the weight bearing on the joint, stretching exercises, nonsteroid anti-inflammatory and steroid drugs, and physiotherapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was applied to measure the osteoarthritis level of the patient: Pain level; 25 points, stiffness level; 10 points, Physical function loss; 80 points, and total WOMAC 115 points. At radiological evaluation, the patient was diagnosed as grade IV osteoarthritis due to significant osteophyte presence and complete joint space narrowing.

Six sessions of knee prolotherapy protocol was applied to the patient, one session monthly.

Significant improvement was noted at WOMAC scale (Pain level; 5 points, stiffness level; 2 points, Physical function loss; 15 points, and total WOMAC 22 points). Osteoarthritis level of the patient was improved to grade I at radiological evaluation after a year. Our case is the report that presents radiological evidence in addition to clinical findings of improvement of osteoarthritis level.

We are in the opinion that prolotherapy may be preferred more commonly as an efficient method once the importance of ligamentous structures at pathogenesis of osteoarthritis is established.5

1 Rabago D, Nourani B. Prolotherapy for Osteoarthritis and Tendinopathy: a Descriptive Review. 2017 Jun;19(6):34. doi: 10.1007/s11926-017-0659-3. [Pubmed]

2 Hassan F, Trebinjac S, Murrell WD, Maffulli N. The effectiveness of prolotherapy in treating knee osteoarthritis in adults: a systematic review. Br Med Bull. 2017 Mar 4:1-18. [Pubmed]

3 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 Dec;22(12):983-989. Epub 2016 Sep 7. [Pubmed]

4. Hauser R, Phillips HJ, Maddela HS. The Case for Utilizing Prolotherapy as First-Line Treatment for Meniscal Pathology: A Retrospective Study Shows Prolotherapy is Effective in the Treatment of MRI-Documented Meniscal Tears and Degeneration. Journal of Prolotherapy. 2010;2(3):416-437.

5. Dumais R, Benoit C, Dumais A, et al. Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study.Pain Med. 2012 Aug;13(8):990-999. doi: 10.1111/j.1526-4637.2012.01422.x. Epub 2012 Jul 3. [Pubmed]

6. Rabago D, Mundt M, Zgierska A, Grettie J. Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes. Complement Ther Med. 2015 Jun;23(3):388-95. doi: 10.1016/j.ctim.2015.04.003. Epub 2015 Apr 8.

7. Rabago D, Zgierska A, Fortney L, Kijowski R, Mundt M, Ryan M, Grettie J, Patterson JJ.Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up. J Altern Complement Med. 2012 Apr;18(4):408-14.

8. Solmaz I, Deniz S, Cifci OT. Treatment of advanced stage gonarthrosis with prolotherapy: case report. Anesth Pain Med. 2013 Dec 16;4(1):e9171. doi: 10.5812/aapm.9171. eCollection 2014.