Background: Osteoarthritis (OA) is the most common rheumatologic disease. Knee OA is the most common form of symptomatic OA. It is the fourth most important global cause of disability in women and the eighth most important cause in men1.
Studies found that subcutaneous prolotherapy is an effective treatment for several painful conditions. Some author hypothesizes that subcutaneous prolotherapy injections induce apoptosis of proliferating peptidergic noceffectors and neovessels by reducing vascular endothelial growth factor levels and restoring effective repair processes, with reduction of pain2.
Objectives: To assess the effectiveness of perineural injection therapy as a new modality in management of pain, physical function, ambulation activity, disability and psychological status in moderate and severe knee osteoarthritis.
Methods: In this study; we selected 100 patients with moderate and severe knee osteoarthritis diagnosed clinically and radiologically by plain x-ray. Patients were classified into four equal groups (25 patients in each group). Group I received 6 weekly subcutaneous injections of 0.5–1 ml of buffered dextrose 5% in each chronic constriction injury points and tender points around knee. Group II received therapeutic continuous US three times weekly for 6 weeks using 1-MHz US head, set to an intensity of 1 W/cm2 for 10 min. Group III received combined perineural and US therapy. Group IV received sham US. All patients received 15 min of quadriceps isometric exercise of both knees.
Assessments were performed at baseline, at the end of the treatment and after three and sixth months. using the following measurements: Primary outcome was pain on movement assessed by visual analog scale (VAS). Secondary outcomes consisted of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, 50 meters walking time, Lequesne index, Hospital Anxiety and Depression Scale (HADS).
Results: No baseline differences existed between all groups. The improvement in group IV was non-significant (p>0.05), while there was significant improvement in all other groups (p<0.05) in all primary and secondary outcomes after treatment, 3 and 6 months later. In comparing groups I, II, III the best improvement was in group III then group I then group II after treatment and 3 months later but there was no significant difference between the three groups after 6 months follow up.
Conclusions: Perineural Injection Therapy is an effective new modality in management of pain, physical function, ambulation activity, disability and psychological status in moderate and severe knee osteoarthritis.
References 1. Tuhina Neogi. The Epidemiology and Impact of Pain in Osteoarthritis. Osteoarthritis Cartilage2013;21(9):1145–1153.
2. Lyftogt J. Subcutaneous prolotherapy treatment of refractory knee, shoulder, and lateral elbow pain.Australasian Musculoskeletal Medicine2007;12(2):110–112.
Disclosure of Interest: None declared
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