CW's story - Bilateral Knee Pain
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Case One: CW is a 72 year-old woman who presented in July 2004, complaining of a five-year history of severe right knee pain. She rated her knee pain on the visual analogue scale (VAS) at a level of 6 on a scale of 0 to 10. She experienced daily pain throughout the whole knee and noted that the severity of the pain was also increasing. Her other symptoms were increased pain upon sitting for long periods of time, difficulty with stairs, and increased pain with walking. She was not exercising. She had no previous history of trauma or knee surgery. Three previous hyaluronic acid treatments provided diminishing relief. She used the oral pain relievers, tramadol hydrochloride and acetaminophen, as needed. X-rays done in 2002 showed osteoarthritis, marked loss of joint space medially, subchondral sclerosis and osteophyte formation. CW was told by an orthopedist that she needed a total knee replacement surgery. She read about Prolotherapy in an alternative medicine newsletter and wanted to try it instead of surgery.
Physical examination showed normal knee alignment. Lachman, anterior drawer, valgus and varus stress tests were all negative. She exhibited joint line tenderness both medially and laterally, but worse medially, as well as quite a bit of crepitus in the knee throughout the range of motion. There was no swelling present in the knee. Her range of motion was 3 to 95 degrees.
Prolotherapy treatments began in July 2004. CW received nine treatments on her right knee through May 2005. She reported an incremental decrease in pain and increased mobility as she was interviewed every four to six weeks during the course of treatment. Her range of motion had improved to full extension and flexion to 110 degrees. Her crepitus was nearly nonexistent. She reported at this time, “I am 97% better. I have no pain (VAS score 0), just mild stiffness that subsides with walking.” She was treated one more time and told to return to the clinic if the pain returned. She no longer needed medications or a total knee replacement.
CW returned to the clinic in May 2006 because she twisted her knee and some of her pain returned. Her physical exam at that time was unchanged from when she was seen in May 2005, except she showed more medial joint line tenderness and tenderness at the pes anserine area. She received four more treatments over the next four months, making incremental improvements in her pain. At this time, the patient was doing great, yet desired to see “how my cartilage was doing.” The X-rays showed a large increase of medial joint space. (See Figure 1.) By this time, the patient had received 14 Prolotherapy treatments to her knee.
Seventeen months after her last Prolotherapy treatment, the patient continues to have full function of the knee with almost no pain (0 to 1 on VAS). She has returned to full activities without pain and is on no pain medications.
Figure 1. Standard weight bearing knee X-rays of C.W. before and after Prolotherapy. The widening of the medial joint space width indicates that cartilage regeneration has taken place.
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