DISCUSSION: PRINCIPLE FINDINGS
The results of this pilot, retrospective, uncontrolled study show that Prolotherapy helps decrease pain and stiffness and improve the quality of life in patients with meniscal tears and degeneration. This includes tears in all three meniscal zones, as well complete and complex meniscal tears. The Hackett-Hemwall dextrose Prolotherapy, including those with human growth hormone or platelet rich plasma added to the intraarticular injection, improved pain and stiffness to a statistically significant level. From the patient’s point of view there were noticeable improvements in crepitation and range of motion of their knees. Ninety-six percent (27 out of 28 knees) improved to the point that the patients felt that Prolotherapy met their expectations and no surgery for meniscal pathology was needed. Major improvements in other quality of life issues, including walking ability, exercise ability, and decreased medication usage was also reported with Prolotherapy.
One patient underwent a total knee replacement in February 2010. In reviewing this patient’s chart, his initial MRI revealed “a degenerative tear involving the anterior horn and body of the lateral meniscus which extends in a longitudinal fashion to the apex and superior surface.” The patient’s dates of Prolotherapy treatment were 10/18/06, 2/5/07, 3/19/07 and 7/26/07. At the third visit he said his overall improvement was 70% and at his last visit his overall improvement was 80%. He was not seen after 7/26/07. While this patient ended up needing a total knee replacement in February 2010, our review found that the patient did not comply with the recommended Prolotherapy treatment course, to be received every four to six weeks until his pain resolved or he was satisfied with the improvements. It is not known why this patient did not continue to follow-up and receive more Prolotherapy after the July 2007 visit, if his pain returned, as reported.
While this study cannot be compared to a clinical trial in which an intervention is investigated under controlled conditions, clearly the findings are extremely positive. The level of improvement with pain and stiffness met a highly statistically significant level and more importantly the Prolotherapy met the expectations of the patient in 27 of 28 knees to the point that surgery was not required. The marked decrease in pain and stiffness was accompanied by similar improvements in walking and exercise ability, suggestive that the Prolotherapy was indeed repairing the meniscus tear. Another plausible explanation for the extremely high success rate of this study is that the treatment given was Hackett-Hemwall Prolotherapy. In this type of Prolotherapy, not only are the meniscal injuries treated, but also any joint instability, ligament weakness or tear, as well as any tendinopathy.
In regard to the patients with degeneration of the menisci, Prolotherapy strengthened the menisci to the point that they could function properly under load. As previously mentioned, various types of tears were treated and showed improvement with Prolotherapy, including the tears of the white zone (with little or no blood supply). One reason to do this study was to determine if a certain type of meniscal tear did not respond to Prolotherapy. But in this pilot study, all type of tears (including vertical, horizontal, complex and oblique) and locations (lateral, medial, posterior, and anterior) responded. In the future, MRI documentation of meniscal repair with Prolotherapy would confirm these conclusions.
CONCLUSIONS
The Hackett-Hemwall technique of dextrose Prolotherapy used on patients with MRI documented meniscal pathology including tears and degeneration, interviewed an average of 18 months after their last Prolotherapy treatment, was shown in this retrospective pilot study to improve patients’ quality of life. Most patients reported statistically significantly less pain and stiffness and major improvements in range of motion, crepitation of the knee, medication usage, walking ability, and exercise ability. The improvements with Prolotherapy met the expectations of the patients in over 96% of the knees to the point where surgery was not needed. Prolotherapy improved knee pain and function regardless of the type or location of the meniscal tear or degeneration. The improvements were so overwhelmingly positive that Hackett-Hemwall Prolotherapy should be considered as a first-line treatment for pain and disability caused by meniscal tears and degeneration. If these results are confirmed by further studies under more controlled circumstances, with larger patient populations, and with MRI confirmation, surely Hackett-Hemwall Prolotherapy will become a first-line treatment for meniscal tears and degeneration.
 |
 |
