Effectiveness of different concentrations of dextrose prolotherapy in osteoarthritis knee: A double-blind randomised comparative study

Background: Intra-articular dextrose prolotherapy (DPT) is reported to improve the outcomes in the treatment of the osteoarthritis (OA) knee. Outcomes may be variable as per the concentration of the agent, scales for evaluation, patients' perception and severity of the disease. Methods: This was a double-arm double-blind randomised prospective study. As per computer-generated randomisation, participants were divided into two Groups A and B and subjected to four intra-articular injections either of 12.5% or 25% dextrose, respectively, at 0, 3rd, 6th and 9th week. Outcomes are measured by two scales, i.e., Visual Analogue Scale (VAS) at all subsequent visits, 12th and 20th week, and knee injury osteoarthritis outcome score (KOOS) (five subscales) at baseline and 20th week (at 95% confidence interval, and P < 0.05 significant). A common exercise regimen was given to both groups. Results: A total of 78 patients were enrolled, out of which only 50 participants (25 in each group) completed the study. Both the treatment arms were age- and sex-matched with a female preponderance of 64% and males 36%. Following treatment, the VAS score of both the groups showed parallel improvement in the first three visits, but Group B was found to be statistically significant for 9th week (P = 0.024) onwards (P = 0.0071 at 12th and P = 0.013 at 20th week). The KOOS score also improved in both groups but the Group B had a superior effect compared with Group A in all the subscales (P < 0.05). Conclusion: Intra-articular DPT improves the symptomatic picture of patients with OA knee in a concentration-dependent manner. It also showed a dose-response relationship following serial injections on VAS. DPT is found to be cost-effective, safe and beneficial therapy for OA knee.