THE POSSIBLE HEALING EFFECT OF PROLOTHERAPY IN TREATMENT OF KNEE OSTEOARTHRITIS

Abstract

OA is a group of chronic diseases and mechanical abnormalities that refers to the most prevalent musculoskeletal condition which causes joint pain accompanied by functional limitation and reduced quality of life The most commonly affected peripheral joints are the hips, the knees and the small joints of the hands. It is characterized by localized loss of cartilage and remodeling of the adjacent bone (Philip et al., 2008).

Prolotherapy injection treatment is designed to stimulate healing. It is a fundamental and an effective therapy for the repair of the injured fibrous connective tissue that hold our skeletal infrastructure together, including the ligaments, tendons, muscle fascia, joint capsular tissue and cartilage on the inside of joints (Hackett, 1960).

Prolotherapy treatment commonly consists of several injection sessions delivered either weekly or every 2 to 6 weeks (depending on the concentration of the dextrose used). A core principle is the injection of small volumes of a proliferant solution at multiple painful ligamentous and tendinous insertions, in the adjacent joint spaces, along the course of the inflamed tender nerves as well as their CCIs. The proliferant solution induces inflammation which results in tissue healing, in addition, the dextrose binds to the TRPV1 receptors which inhibits the neurogenic inflammation allowing normal flow of nerve growth factors which are important for tissue repair and healing (Linetsky et al., 2002); (Rabago et al., 2010) and (Adam, 2011).

This study was conducted on 104 pts diagnosed for primary knee OA according to ACR (group I). According to different treatment regimens, group (I) was further sub-divided into two equal sub-groups of 52 pts each, matched with each other for gender and age: Group “Ia” and group “Ib”. Group (II) with 24 knee OA pts matched for gender and age with group (I), served as a control group in this study.

All pts and controls in this study were subjected to detailed history taking and thorough clinical examination. Knee pain was assessed by using the VAS and for the knee function, the WOMAC OA index was used. Laboratory and radiological investigations were done. The later were in the form of plain x-rays in order to determine the grades of the OA and musculoskeletal ultrasound in order to measure the dimensions (length, width and cross section), of the MCLs, the LCLs, the PTs as well as the thickness of the articular cartilage in both medial and lateral articular compartments.

Prolotherapy treatment sessions were given to pts in group (I) while physiotherapy treatment sessions were given to pts in group (II). Short term follow up was done subjectively, for all the pts at the months 2 and 5 by clinical assessment, VAS and WOMAC. Long term follow up was done subjectively and objectively, for all the pts at month 12 by radiological investigations.

6.2 Conclusions

1. Prolotherapy treatment for knee OA is a line of conservative treatment that gives positive, promising results for the pts.

2. Prolotherapy treatment increases the knee OA healing and improves the ligament and tendon repair. Consequently, decreases the chronic pain of the knee, increases the knee stability and improves the knee function.

3. At short term and long term follow up, the pts in group (Ia) and (Ib) showed a statistically high significant improvement compared to the pts in group (II), regarding the clinical symptoms and signs. They reported as well a statistically high significant decrease in the VAS and the WOMAC.

4. The radiological long term follow up for the pts in group (Ia) and (Ib) showed a statistically high significant improvement, compared to baseline and to the pts in group (II), regarding the plain x-ray grades of knee OA.

5. The radiological long term follow up for the pts in group (Ia) and (Ib) showed a statistically high significant decrease in the dimensions of the MCL, the LCL and the PT, as well as a statistically high significant increase in the thickness of the articular cartilage in both medial and lateral compartments, compared to baseline and to the pts in group (II).

6. Combining the NPT technique together with the deep classic one, gave quicker and better clinical improvement, as well as in the VAS and WOMAC rather than applying the deep classic technique alone.