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Proliferative injection therapy for osteoarthritis: a systematic review

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Abstract

Purpose

To systematically analyse randomised controlled trials (RCTs) about efficacy and safety of proliferative injection therapy (prolotherapy) for treatment of osteoarthritis (OA).

Methods

CENTRAL, Embase and MEDLINE were searched. Two reviewers independently conducted screening and data extraction. RCTs were assessed with the Cochrane risk of bias tool. Type of treatment, study design, dosing, efficacy outcomes and safety outcomes were analysed. The protocol was registered in PROSPERO (CRD42016035258).

Results

Seven RCTs were included, with 393 participants aged 40-75 years and mean OA pain duration from three months to eight years. Follow-up was 12 weeks to 12 months. Studies analysed OA of the knee joint (n = 5), first carpometacarpal joint (n = 1) and finger joints (n = 1). Various types of prolotherapy were used; dextrose was the most commonly used irritant agent. All studies concluded that prolotherapy was effective treatment for OA. No serious adverse events were reported. The studies had considerable methodological limitations.

Discussion

Limited evidence from low-quality studies indicates a beneficial effect of prolotherapy for OA management. The number of participants in these studies was too small to provide reliable evidence.

Conclusions

Current data from trials about prolotherapy for OA should be considered preliminary, and future high-quality trials on this topic are warranted.

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Acknowledgements

We are very grateful to Ms. Parisa Mansoori for helping us with translation of one manuscript.

Author contributions

M.K., M.J., A.J.K. and S.D. screened the bibliographic records. M.K. and M.J. extracted data. M.K. and S.D. assessed risk of bias. L.P. resolved disagreements between authors. M.K. wrote the first version of the manuscript with the help of M.J. All authors contributed to the final version of the systematic review. All authors approved final version of the systematic review.

Author information

Authors and Affiliations

  1. Department of Orthopedics, University Hospital Split, Split, Croatia

    Mišo Krstičević

  2. Department of Dermatovenerology, General Hospital Zadar, Zadar, Croatia

    Milka Jerić

  3. Department of Anesthesiology and Intensive Care Medicine, University Hospital Split, Split, Croatia

    Svjetlana Došenović

  4. Laboratory for Pain Research, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia

    Svjetlana Došenović, Antonia Jeličić Kadić & Livia Puljak

  5. Department of Pediatrics, University Hospital Split, Split, Croatia

    Antonia Jeličić Kadić

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  1. Mišo Krstičević
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  2. Milka Jerić
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  3. Svjetlana Došenović
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  4. Antonia Jeličić Kadić
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Corresponding author

Correspondence to Livia Puljak.

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Role of funding source

The authors did not receive any extramural funding for this study apart from the institutional support of the University of Split School of Medicine and its library services for obtaining manuscripts.

Conflict of interest

The systematic review authors have no conflicts of interest to declare. Conflicts of interest in the included studies were analysed and reported in the manuscript. The majority of the included studies did not report whether there was a conflict of interest or source of funding.

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Krstičević, M., Jerić, M., Došenović, S. et al. Proliferative injection therapy for osteoarthritis: a systematic review. International Orthopaedics (SICOT) 41, 671–679 (2017). https://doi.org/10.1007/s00264-017-3422-5

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