PATIENTS AND METHODS
All patients were treated at the primary author’s private practice, Caring Medical and Rehabilitation Services in Oak Park, Illinois. A premedical student (H.M.) reviewed in-house medical charts of patients who had completed their last Prolotherapy treatment at least one year ago and had MRI documented meniscal pathology. This criterion was chosen to give adequate time to determine if the positive effects of the Prolotherapy treatments continued once they were finished. H.M. completed phone interviews asking the patients a series of questions with an emphasis on the effect Prolotherapy had on their knee pain, stiffness, and quality of life.
All patients received the Hackett-Hemwall technique of dextrose Prolotherapy to the knee. This included a 15% dextrose, 10% Sarapin and 0.2% lidocaine solution as the base solution. Each patient was given an intraarticular injection of 5-10cc of solution. Twenty-four of 28 knees received 2IU of human growth hormone added to this base solution. Two patients received 3.5cc of Platelet Rich Plasma Prolotherapy (PRPP) injected inside the joint. One patient received only base solution and one patient received manganese as an additive. Injections were also given along the tender points about the knee, including the medial collateral ligament. Patients typically received a total of 30-40cc of solution per treatment visit. Patients were seen every four to six weeks. (See Figure 16.)
All data was analyzed by an independent computer consultant (D.G.), who had no previous knowledge of Prolotherapy. A matched sample paired t-test was used to determine statistically significant improvements in the before and after Prolotherapy measurements for pain and stiffness.
| Figure 16. Typical injection sites for Hackett-Hemwall dextrose Prolotherapy of the knee. Source: Hauser R, et al. A retrospective study on dextrose Prolotherapy for unresolved knee pain. Journal of Prolotherapy. 2009;1:11-21. |
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PATIENT CHARACTERISTICS
Data was tabulated on 28 knees in 24 patients. Of the 24 patients, 71% (17) were male and 29% (7) were female with an average age of 45 years. Eighteen knees had MRI documented meniscal tears of which eight were acute and ten were chronic (over six months since the tear). The medial meniscus was torn in sixteen of the knees and the lateral meniscus in two. According to the radiographic reports, four of the tears were complex, three were vertical, three were horizontal, two were bucket handle, and one was complete. The other five were nondescript meniscal tears. Arthroscopy had been previously performed on ten of the knees. Ten of the knees had MRI documented meniscal degeneration without tears. (See Table 1.)
| Table 1. Patient characteristics prior to Prolotherapy. |
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TREATMENT OUTCOMES
Patients received an average of 6.2 Prolotherapy treatments per knee. The average time since their last Prolotherapy treatment was 18.6 months.
Patients were asked to rate their knee pain, stiffness, and crepitation (crunching sensation) levels on a scale of 0 (none) to 10 (severe crippling). For the 28 knees the average starting pain level was 7.2, stiffness 5.8, and crepitation 4.9 which improved to levels of 1.6, 2.0, and 2.5 respectively, after Prolotherapy. (See Figure 17.) Before Prolotherapy, 17 patients were taking one or more pain medications, but after Prolotherapy only three were taking one pain medication. Patients were also asked to rank their knee range of motion with 0 being normal motion and 10 representing no motion. The average range of motion improved from a level of 4.1 to 1.1 after Prolotherapy. Only 25.9% of the patients had normal motion (0 or 1) before Prolotherapy, but after Prolotherapy this increased to 75%. Before Prolotherapy only four (14.3%) patients had normal walking ability (0% compromised), but this increased to 20 (71.4%) after Prolotherapy. (See Figure 18.) In regard to exercise ability, before Prolotherapy 14.2% of patients could exercise greater than 60 minutes, but after Prolotherapy this increased to 85.7%. (See Figure 19.)
In regard to the question “Did the improvements with Prolotherapy last?” 96.4% of the patients stated they still have lasting pain relief in their knees as a result of the Prolotherapy. Eighty-six percent reported lasting improvement in stiffness, while 100% of the patients noted their improvement in walking ability continues to this day.
To the question “Did Prolotherapy meet your expectations?” 96.4% (27 out of 28) of the patients treated answered “yes.” In regard to the question “Did you end up getting surgery on your knee?” only one patient answered “yes.”
| Figure 17. Pain, stiffness, and crepitation levels before and after Hackett-Hemwall Prolotherapy in 28 patients with unresolved knee pain due to meniscal injuries. |
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| Figure 18. Walking ability before and after Hackett-Hemwall Prolotherapy in 28 patients with unresolved knee pain due to meniscal injuries. |
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| Figure 19. Exercise ability before and after Hackett-Hemwall Prolotherapy in 28 patients with unresolved knee pain due to meniscal injuries. |
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STATISTICAL ANALYSIS
A matched sample paired t-test was used to calculate the difference in responses between the before and after measures for pain and stiffness for the 24 patients (representing 28 knees). Using the paired t-test, the p values for pain and stiffness for the two groups reached statistical significance to the p<.000001 level.
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