PATIENTS AND METHODS
The five patients were treated at the primary author’s private practice, Caring Medical and Rehabilitation Services in Oak Park, Illinois.
The patients received 3.5-4cc of platelet rich plasma Prolotherapy (PRPP) injected inside the joint. Twenty cc’s of patient’s blood was drawn at the time of treatment. The blood sample, mixed with anticoagulant citrate dextrose solution A (ACD-A), was placed into centrifuge to separate the platelet rich plasma from the platelet poor plasma. The platelet concentrate system used in this study was Harvest Technologies SmartPReP. Patients were asked to let pain be their guide as far as activity levels after the PRPP.
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 tears. 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 return to sports.
CASE REPORT #1
A 21-year-old runner athlete sustained a medial meniscal tear during wrestling. MRI revealed an oblique tear of the posterior horn of the medial meniscus. Because the patient failed physiotherapy and other conservative care the orthopedic surgeon recommended a partial menisectomy. The patient’s parents were prolotherapy patients and hoped that prolotherapy would offer a non-surgical option for their son as well.
The patient was complaining of pain with all activities except walking. He had popping in the knee and locking when trying to go from flexion to extension. Physical examination revealed medial joint laxity as well as a positive anterior drawer sign. The patient received one session of 3.5cc of Platelet Rich Plasma Prolotherapy to the inside of the knee. The anterior cruciate ligament and medial collateral ligament were treated with Hackett-Hemwall prolotherapy using a 15% dextrose, 10% Sarapin® and 0.2% procaine solution as previously described.
Prior to prolotherapy the patient reported pain and stiffness levels of 5 (on a scale of 0 to 10) which decreased to 0 and 1, respectively. Prior to prolotherapy, he was completely incapacitated related to sports and after prolotherapy he was back to running and exercising longer than 60 minutes. When he was questioned 15 months after the PRP prolotherapy session, he said prolotherapy had met his expectations.
CASE REPORT #2
A 39-year-old squash player sustained a right knee injury while playing squash about one year prior to the visit. An MRI revealed a horizontal flap tear in the body of the lateral meniscus and the patient had a trial of physiotherapy without success. The patient did not want to get an arthroscopy which was suggested and sought out prolotherapy after an internet search.
The patient complained of pain when running and was unable to play sports. He had crepitation in the knee but no locking. He complained of a deep ache within the knee. Physical examination revealed slight medial ligament laxity but no heat or swelling.
He received two sessions of PRP prolotherapy to his knee, each with 3.5 cc of solution. He also received Hackett-Hemwall prolotherapy to his medial collateral ligament. The patient stated his pain and stiffness levels went from a 6 to a 1 after the prolotherapy. He reported that prior to prolotherapy he was completely incapacitated from running or playing squash but now, 17 months removed from his PRP prolotherapy, has no limitations.
CASE REPORT #3
A 50-year-old chiropractor sustained medial and lateral meniscal tears after falling in a bicycling accident two years prior. He had tried previous conservative therapy without success in relieving his severe left knee pain. He was completely disabled as far as his previous activities of running and cycling. He did not want to get arthroscopy because of a poor response to an arthroscopy on his right knee several years before.
Beside pain with any type of activity other than walking, he had popping and crepitation in the knee but no locking. He had pain deep within the knee as well as both laterally and medially. He had some generalized laxity of his knee throughout on physical examination.
He received a total of four sessions of PRP prolotherapy to his knee over a one year period of time. His general laxity was also treated with Hackett-Hemwall prolotherapy. The primary reason for such a long time span is that each treatment gave him so much improvement he thought it was his last as he increased his physical activity, only to have some of the pain return. He was contacted twenty-four months after his last PRP prolotherapy session.
Before the prolotherapy he had a pain and stiffness level of 8 and 7 respectively, both of which decreased to a 1 after prolotherapy. He was unable to exercise before prolotherapy but after the PRP prolotherapy he is able to do unlimited cycling and is able to run, but has chosen not to run because of his right knee (the one that had arthroscopy). He also said that PRP prolotherapy met his expectations.
CASE REPORT #4
A 52-year-old athlete presented after sustaining an MRI-documented horizontal tear of the posterior horn of the lateral meniscus and oblique tear involving the postern horn of the medial meniscus after falling during running. He had a past history of partial lateral meniscectomy 20 years prior. His symptoms included diffuse knee pain and a feeling of his knee giving way. He also had occasional locking of the knee.
On physical examination he had medial joint laxity as well as significant crepitation especially on the medial aspect of the knee. He received a single PRP prolotherapy treatment to his knee. At that time he also received Hackett-Hemwall prolotherapy for his medial knee instability. His pain level before prolotherapy was a 7 and stiffness also a 7 but fourteen months post PRP treatment his pain level is 0 and stiffness is 1. He was unable to exercise at all before Prolotherapy but after treatment he can cycle for two hours and has no limitations with most weight lifting, all swimming and all cycling. He cannot run currently because of an Achilles injury that he is thinking about getting treated with prolotherapy.
CASE REPORT #5
A 46-year-old male with a history of three right knee surgeries and two on the left—including partial meniscectomies on both knees—presented for a prolotherapy evaluation because of presumed recurrent meniscal tears on both knees. The patient’s main sport is soccer, but had a recent skiing injury causing bilateral knee swelling and pain for one month prior to the first visit. The patient saw an orthopedist who ordered an MRI which showed the medial meniscal tears.
The patient was adamant about not wanting another knee surgery. He was on nonsteroidal anti-inflammatory medication, which was stopped once PRPP was begun. The complaints in both knees (the right was worse than the left) were swelling, popping and snapping and inability to run at all without significant pain. He felt both knees were unstable. The patient was completely disabled in regard to sports because of the injuries.
On physical examination, there was some slight knee swelling bilaterally as well as evidence of medial knee joint instability bilaterally. Both knees started out with a pain level of 7 and stiffness level of 6, but the patient felt the right knee was significantly more unstable. Both knees were treated intraarticularly with platelet rich plasma prolotherapy, as well as with Hackett- Hemwall prolotherapy on the medial knee for the instability. His right knee required five PRPP treatments and his left four treatments total.
Upon follow-up fifteen months after his last prolotherapy treatment, he stated his right knee pain was still a 0 while stiffness was at 1. His left knee pain and stiffness was at a 0. He stated that over the past year he has been playing soccer without any limitations.
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