Case Report #1 |
OSTEOCHONDRITIS OF THE KNEE IN A 13 YEAR-OLD
In August 2003, J.C., an active 13 year-old baseball player, presented to Caring Medical for evaluation of his bilateral knee pain, diagnosed as osteochondritis dissecans. He was a very active young athlete, playing on soccer and baseball teams in addition to participating in rollerblading, swimming and bicycle riding. He was being followed by an orthopedic surgeon who told J.C. to stop all forms of athletics in order to see if his knees would get better. If they did not improve, he would have to undergo surgery.
At the time of the initial consultation, J.C. had restricted athletics and was using ice and ibuprofen for the pain. The pain was located throughout the knees and increased significantly with activity, especially running. On physical examination, he was found to have several tender points about the knee, as well as some generalized laxity. His X-rays confirmed the diagnosis of osteochondritis dissecans. (See Figures 1 & 2.) J.C. and his parents were explained the process of Prolotherapy but decided to hold off treatment.
| Figure 1. Plain X-r ay of both knees. Osteochondrotic lesions of both medial femoral condules is seen. The appearance of the osteocondritis dissecans shows significant fragmentation on both knees. |
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| Figure 2. MRI’s of both knees prior to Prolotherapy. Because of the patient’s rapid improvement with Prolotherapy there has been no need for follow-up scans. |
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Despite two more months of rest, the knee pain did not abate. J.C. received his first Hackett-Hemwall dextrose Prolotherapy treatment in October 2003. At each visit a total of 30 injections with 40cc of solution was used. A 15% dextrose, 10% Sarapin, and 0.2% lidocaine solution was used. Two IU of human growth hormone was added to the solution and injected intraarticularly as well. He was told to stop the ice and ibuprofen, and encouraged to start cycling. He could also begin light running, as long as it did not elicit pain. When he returned in one month, his pain had decreased by 25%. He was encouraged with the results after only one treatment because he was able to run. After receiving his second Prolotherapy treatment, his pain diminished 75%, and now running and jumping were possible, which included playing basketball. He was doing a lot of sporting activities which included a lot of running with minimal pain. Because of the significant pain relief, he did not come for his third visit until two months later. His last visit was in February 2004. He reported both knees were at least 90% improved. He was able to play baseball at a high intensity level and was basically back to sports 100%. Physical examination revealed full stability in his knees at this time.
After this fourth visit, J.C. was able to play all sports without any knee pain. He was able to fulfill his long term goal of playing baseball in college. J.C. is now twenty years old and has no knee pain whatsoever with sporting activities.
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