Prolotherapy for Knee Osteoarthritis: A Descriptive Review

Knee osteoarthritis (KOA) is a common chronic disease of high patient and societal impact. The etiology is multifactorial; pain sources include both intra- and extra-articular tissues. A number of alternative therapies have been assessed for KOA. Patients are often refractory to best-practice conservative management, and the development of new therapy has been called for by national health services groups. Prolotherapy is an outpatient therapy for chronic musculoskeletal pain including KOA. Protocols include injection at attachments of soft-tissue supportive structures such as ligaments and tendons, and within intra-articular spaces. Although the understanding of mechanism is not well understood, a small but growing body of literature suggests that prolotherapy may be appropriate therapy for carefully selected patients refractory to conventional treatment. This article summarizes evidence from basic and clinical science for use of prolotherapy among patients with KOA.