A New Treatment Option in Osteoarthritis: Prolotherapy Injections Safak Ekinci 1* , Oner Tatar 2 , Serkan Akpancar 3 , Hasan Turgut 4 and Mehmet Murat Seven 5 1 Department of Orthopaedic Surgery, Haydarpasa Gulhane Military Medicine Academy, Istanbul, Turkey 2 Department of Orthopaedic Surgery, Air Force Academy, Kasımpaşa Military Hospital, Istanbul, Turkey 3 Department of Orthopaedic Surgery, Gulhane Military Hospital, Ankara, Turkey 4 Department of Orthopaedic Surgery, Bursa Military Hospital, Bursa, Turkey 5Department of Sports Medicine, Gulhane Military Medicine Academy, Ankara, Turkey * Corresponding author: Safak Ekinci, MD, Department of Orthopaedic Surgery, Agri Military Hospital, Agri, Turkey, Tel: 90 5327339850; Fax: 90 472 215 27 47; E-mail: safakekinci@yahoo.com Rec date: April 06, 2016; Acc date: April 29, 2016; Pub date: May 10, 2016 Copyright: © 2016 Ekinci S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Osteoarthritis is the most common degenerative disorder, and one of the major causes of physical disability in adults. Unfortunately many people experience arthroplasty or other major surgeries, in spite of improvements of the conservative options. There is a need for efficient treatment methods in this group of patients. Prolotherapy is one of the simple and safe injection-based complementary method and it’s efficiency was proved in the musculoskeletal problems. The aim of this article is to present current perspectives of prolotherapy in osteoarthritis. Keywords: Osteoarthritis; Prolotherapy injections; Knee joints; Chondromalacia Patella; Carpometacarpal joints; Metatarsal joints Introduction Prolotherapy is an injection-based complementary method, has successfully used musculosketal problems including tendinopathies and ligament-tendon injuries [1-3]. Because of the successful results of the previous studies, indication range was extended and prolotherapy injections have started to use for joint problems including degenerated intra and extra-articular ligaments, chondral lesions, early and late stages of osteoarthritis [4,5]. Te injection solutions are prepared in combination of distinct concentrations of hypertonic dextrose, erythropoietin (10-25%) and local anesthetic solutions (lidocaine, sensorcaine, xylocaine, etc.) [6-10]. Te optimal concentration and combination remains uncertain [6,7]. Dextrose solutions below the concentration of 10%, stimulate proliferation of cells and tissue but do not efect on histological infammatory reaction; the concentrations greater than 10%, provide osmotic rupture of growth factors and infammatory cells that initiates the wound-healing cascade [11,12]. No animal or clinical study in the literature that compared the efectiveness of distinct concentrations or combinations of prolotherapy solutions [11,13]. Mechanism of action is considered to osmotic rupture of local cells and increase of growth factors in the extracellular matrix. Tis lead to deposition of new collagen and subsequent healing [8,14,15]. Knee osteoarthritis Knee is the most efected joint by osteoarthritis. Various treatment methods are described for the treatment of knee osteoarthritis including shoe modifcation, non-steroidal anti-infammatory medicines, physical rehabilitation, platelet-rich plasma and stem cell therapy. Te symptoms are completely recovered with foregoing treatment modalities in some of the patients, but in majority of the patients symptoms are persisted or exacerbated and ultimately surgical procedures inevitably for this group. Tere is a still need for more efcient treatment methods for patients with osteoarthritis. Prolotherapy injections were recently used in the treatment of knee osteoarthritis. Most of the studies reported benefcial outcomes about prolotherapy injections; especially in the decreasing of pain scores and improvement of knee functions [16-19]. Injection procedures vary according to studies; some authors preferred single intra-articular injection. Others preferred combined intra-articular and extra-articular injections for bony attachments of LCL or other ligaments. Because of the ligament injuries that commonly accompanied to osteoarthritis in the younger ages, and extra-articular degenerated ligaments in the elderly patients, mechanic instability is commonly accompanied to osteoarthritis. Te studies, which preferred combined injections, declared benefcial outcomes in terms of reduction in pain scales, healing of knee ligaments and improving of mechanic stability of knee joint in the osteoarthritic patients with traumatic knee instability. In the studies favorable results of prolotherapy have also shown in terms of improvements of cartilage defects and healing of extra-articular injured ligaments [5,10,20], investigated long-term efcacy of prolotherapy injections in the patients with mild-to-severe knee OA and observed signifcant improvements in the knee functions, pain intensity, and stifness. A randomized controlled study compared the efectiveness of prolotherapy with saline injections, and declared signifcantly better outcomes with prolotherapy injections [16,21] compared the efcacy of erythropoietin prolotherapy, dextrose prolotherapy and pulsed radiofrequency in the treatment of osteoarthritis, and stated that erythropoietin prolotherapy provided better outcomes than dextrose prolotherapy and pulsed radiofrequency. Patellafemoral syndrome (Chondromalacia patella) Chondromalacia patella is common disease of knee, accompanied by chronic pain and dysfunction. Te cartilage of the patella is Arthritis Ekinci et al., J Arthritis 2016, 5:3 http://dx.doi.org/10.4172/2167-7921.1000197 Mini Review Open access J Arthritis ISSN:2167-7921 JAHS, an open access journal Volume 5 • Issue 3 • 1000197