Orselik et al published a randomized treatment comparision of dextrose and PRP for treatment of chondromalacia in 2020. This article showed substantial improvement with injection of either dextose or PRP in those with chondromalacia symptoms This would be considered a positive treatment comparison study although PRP performed somewhat better. This is level B- evidence for dextrose benefit. --> Orscelik A, Akpancar S, Seven MM, Erdem Y, Koca K. The efficacy of platelet rich plasma and prolotherapy in chondromalacia patella treatment. Turk J Sports Med. 2020;55(1):28-37. The link to the ful article is below --> You will be connected with a secure web site, researchgate.net and can click on download to read it.
Heres the high points:
•Design: (Dextrose versus PRP) This was a double-blind randomized design using 3 injections at 3 week intervals of 7 ml of 25% dextrose without mention of lidocaine versus 7 ml of PRP (apparently this was buffy coat type PRP). The intervals were not long enough to allow of a typical healing period of 6-8 weeks and this was a treatment comparision study without a control.
•Candidates: 6 months of pain, failure of 3 months of conservative treatment, with positive MRI findings and grade II to IV OA. These participants qualifed as having chronic pain issues, and had received a resasonable trial of conservative treatment.
•Study size: 75 participants (38 PRP and 37 DPT) This is a moderately good-sized study.
•Bias: A non-treating researcher used computer based random allocation to allocate patients and prepare solutions, covering them with an opaque band. This researcher also did not participate in assessment, so both allocation and randomization appear to have a low risk of bias.
•Measures: VAS pain (0-10), Tegner and Lysholm knee scores at 12 months. WOMAC use as a measure would have been preferred, but the Tegner and Lysholm measures are also commonly used.
•ITT versus Per Protocol Analysis of Data: Per protocol analysis was performed, which allows bias by dropout. 6 in the DPT group did not complete the study to point of last follow-up. This could have acted in favor of the DPT group doing better.
•Other treatments: Progressive exercise and stretching program for 12 weeks and encouraged to continue. These are reasonable.
•Results: PRP participants were worse at baseline and change scores were significantly more for PRP than DPT participants over the year for stiffness, crepitus and range of motion improvement but at 1 year the status of PRP and DPT knees was quite similar across all measures. Both broups improved markedly.
Limitations: Lack of WOMAC use to compare with other studies. Lack of lidocaine use in dextrose may have limited tolerance and led to dropout. Progressive exercise may account for much of differences.
Heres the high points:
•Design: (Dextrose versus PRP) This was a double-blind randomized design using 3 injections at 3 week intervals of 7 ml of 25% dextrose without mention of lidocaine versus 7 ml of PRP (apparently this was buffy coat type PRP). The intervals were not long enough to allow of a typical healing period of 6-8 weeks and this was a treatment comparision study without a control.
•Candidates: 6 months of pain, failure of 3 months of conservative treatment, with positive MRI findings and grade II to IV OA. These participants qualifed as having chronic pain issues, and had received a resasonable trial of conservative treatment.
•Study size: 75 participants (38 PRP and 37 DPT) This is a moderately good-sized study.
•Bias: A non-treating researcher used computer based random allocation to allocate patients and prepare solutions, covering them with an opaque band. This researcher also did not participate in assessment, so both allocation and randomization appear to have a low risk of bias.
•Measures: VAS pain (0-10), Tegner and Lysholm knee scores at 12 months. WOMAC use as a measure would have been preferred, but the Tegner and Lysholm measures are also commonly used.
•ITT versus Per Protocol Analysis of Data: Per protocol analysis was performed, which allows bias by dropout. 6 in the DPT group did not complete the study to point of last follow-up. This could have acted in favor of the DPT group doing better.
•Other treatments: Progressive exercise and stretching program for 12 weeks and encouraged to continue. These are reasonable.
•Results: PRP participants were worse at baseline and change scores were significantly more for PRP than DPT participants over the year for stiffness, crepitus and range of motion improvement but at 1 year the status of PRP and DPT knees was quite similar across all measures. Both broups improved markedly.
Limitations: Lack of WOMAC use to compare with other studies. Lack of lidocaine use in dextrose may have limited tolerance and led to dropout. Progressive exercise may account for much of differences.