Case Descriptions

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. 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.

Case Two: JP is a 60 year-old female who was first seen in October 2005 complaining of a three year history of bilateral knee pain. She rated her right knee pain as 6 and her left knee as a 5 on the VAS. The pain in both knees occurred primarily in the medial area. Rising from a chair, taking the stairs, and simply walking caused pain. The patient tried using heat, ice, aspirin and ibuprofen to alleviate the pain. She tried to avoid allowing the pain to limit her activities, but she was now down to walking once or twice a week instead of daily. She could only stand for short periods of time now. She also noted that getting up from a low couch or stool was now “very difficult.” She felt the strength in her legs was rapidly diminishing. X-rays done in April 2005 by her primary care physician showed moderately severe osteoarthritic degenerative changes bilaterally, greatest in the medial compartments. She told her massage therapist about the X-ray and she recommended a Prolotherapy evaluation.

Physical examination revealed full extension, but only 90 degrees of flexion. Tenderness with palpation at the medial joint line bilaterally was also noted. The patient was unsteady with a one-legged stand on either leg. Moderate clicking was noted in both knees. There was no evidence of swelling or joint instability.

JP steadily improved with Prolotherapy treatments. When seen in September 2006, after eight Prolotherapy treatments on her right knee and six on her left, she reported an 85% reduction in pain in the right knee and 70% in the left. She now had some pain free days. She noticed the clicking in both knees was markedly less and was now able to climb stairs without any complaints. Her walking was uninhibited as long as it was slow without much pain. She felt she had poor balance if she walked fast. JP did great, but felt some stiffness with long periods of sitting, thus she came in for one more visit in May 2007. This was her eleventh Prolotherapy on her right knee and ninth on her left knee. Her walking was now completely pain free. Physical examination at that time showed that her bilateral knee flexion had increased to 100 degrees and the clicking had completely resolved. She requested repeat X-rays after that visit and they showed a significant improvement of the joint space width in both knees both medially and laterally. (See Figure 2.) Specifically the X-rays on both knees showed a joint space now present medially.

When phoned six months after her last visit in 2007, she noted that both knee joints were gliding smoothly and were “not making any noises” according to the patient. She had no pain with walking or stairs. She was on no pain medications and felt she had absolutely no limitations in regard to her knees.

Case Three: JL is a 42 year-old female who came in with a ten year history of bilateral knee subluxations and diffuse knee pains. Her goal was to decrease pain with the hope of being able to play competitive tennis again. She complained of her knees “giving out,” along with having bilateral medial knee weakness, joint stiffness, and recurring edema with most leg exercises. The patient reported that the pain was making tennis playing impossible. She was being followed by an orthopedic physician because of her severe bilateral chondromalacia. He prescribed piroxicam 20mg daily and ordered her to discontinue tennis and lower extremity weight training for a minimum of eight weeks. He also ordered 10 weeks of physical therapy, which was of no help to the patient in reducing her pain. She rated her pain as a seven on the left knee and six on the right knee (VAS) 0 to 10. Physical exam revealed significant crepitation in knees bilaterally. The patellas were tracking laterally with excessive movement. Lachman, anterior drawer, valgus and varus stress tests were all negative. She had full knee extension, but flexion was limited to 90 degrees bilaterally. She found out about Prolotherapy through an internet search.

The knees were treated with Prolotherapy on her first visit in October, 2006 and she returned for treatment every four to six weeks. As she felt better, she began to increase her tennis and exercise levels with slight discomfort coming only after competitive tennis, especially playing consecutive days. She reported after the seventh visit that she was having no recurrences of her knees “giving out” and her knee pain was improved 80%. She rated it a 3 bilaterally on VAS. After the ninth visit, she reported a 90% improvement in knee strength, and a 75% improvement in crepitus. She noted some pain-free days. On physical examination she had almost no clicking in the knee. JL received a total of 11 Prolotherapy treatments when seen in September 2007. Her patellar gliding was normal with normal patellar tracking. Her range of motion was now full. At this time her chiropractor ordered X-rays of her knees. Comparison X-rays of September 2006 versus September 2007 showed a significant increase in joint space in the lateral compartments, with improvement of patellar alignment. (See Figure 3.)

While JL made tremendous strides with Prolotherapy, unfortunately in the spring of 2008, because of her tremendous training schedule, to make an elite traveling tennis team, she developed new injuries and had to give up her spot on the team.