Article

Dextrose injection is reported to improve knee osteoarthritis
(KOA)-related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed. OBJECTIVE: To assess biological and clinical effects of intra-articular
hypertonic dextrose injections (prolotherapy) in painful KOA. DESIGN: Case series
with blinded arthroscopic evaluation before and after treatment. SETTING:
Physical medicine and day surgery practice. PARTICIPANTS: Symptomatic KOA for at
least 6 months, arthroscopy-confirmed medial compartment exposed subchondral
bone, and temporary pain relief with intra-articular lidocaine injection.
INTERVENTION: Four to 6 monthly 10-mL intra-articular injections with 12.5%
dextrose. MAIN OUTCOME MEASURES: Visual cartilage growth assessment of 9
standardized medial condyle zones in each of 6 participants by 3 arthroscopy
readers masked to pre-/postinjection status (total 54 zones evaluated per
reader); biopsy of a cartilage growth area posttreatment, evaluated using
hematoxylin and eosin and Safranin-O stains, quantitative polarized light
microscopy, and immunohistologic cartilage typing; self-reported knee specific
quality of life using the Western Ontario McMaster University Osteoarthritis
Index (WOMAC, 0-100 points). RESULTS: Six participants
(1 female and 5 male) with
median age of 71 years, WOMAC composite score of 57.5 points, and a 9-year pain
duration received a median of 6 dextrose injections and follow-up arthroscopy at
7.75 months (range 4.5-9.5 months). In 19 of 54 zone comparisons, all 3 readers
agreed that the posttreatment zone showed cartilage growth compared with the
pretreatment zone. Biopsy specimens showed metabolically active cartilage with
variable cellular organization, fiber parallelism, and cartilage typing patterns
consistent with fibro- and hyaline-like cartilage. Compared with baseline status,
the median WOMAC score improved 13 points (P = .013). Self-limited soreness after
methylene blue instillation was noted. CONCLUSIONS: Positive clinical and
chondrogenic effects were seen after prolotherapy with hypertonic dextrose
injection in participants with symptomatic grade IV KOA, suggesting
disease-modifying effects and the need for confirmation in controlled studies.
Minimally invasive arthroscopy (single-compartment, single-portal) enabled
collection of robust intra-articular data. LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS