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J Family Med Prim Care. 2025 Jun;14(6):2180-2186.
doi: 10.4103/jfmpc.jfmpc_1206_24. Epub 2025 Jun 30.

The comparative effects of injecting intra-articular platelet-rich plasma and hypertonic dextrose prolotherapy in osteoarthritis knee - A randomized control trial​


Abstract​

Introduction: Knee osteoarthritis is an age-dependent disease caused by degenerative and healing processes in subchondral tissue of articular and bone cartilage, resulting in changes of its biochemical properties that eventually causes pain, stiffness, and decreased articular function. Therefore, this study aims to compare the effectiveness of platlet-rich plasma (PRP) therapy and 25% hypertonic dextrose (Dextrose) prolotherapy in patients with knee osteoarthritis.

Material and methods: Single-blind randomized control trial was conducted for 18 months. Patients satisfying the inclusion and exclusion criteria were enrolled from the indoor/outdoor facility of the Department of Physical Medicine and Rehabilitation, King George's Medical University (KGMU), Lucknow, India. The informed consent form was duly signed by all the enrolled patients, who were randomly assigned into two groups by the computer-generated system, A total of 85 study participants in this group I (43 patients) received 5 ml Platelet-Rich Plasma (PRP) and Group II (42 patients) received 5 ml of 25% hypertonic dextrose prolotherapy (Dextrose). To compare the effect in terms of reduction of pain, according to the Numeric pain rating scale (NPRS) and Pain/Discomfort, Walking and Activities of Daily Living (ADL) according to the Lequesne Knee Index (LKI) and assessment of each patient was done at specified period, i.e., 0 weeks (Baseline means immediately before intervention), and 6 weeks after the intervention.

Result: Overall, the baseline to 6 weeks change of LKI-Pain in group I (PRP) was significantly more than the group II (DEXTROSE) (P < 0.001). On considering the parameter of LKI-Pain at baseline and 6 weeks for PRP and Dextrose, it was found that in Group I, the mean ± SD reduced more at 6 weeks from 4.81 ± 1.55 to 2.44 ± 1.76 as compared to participants in Group II with 4.83 ± 1.17 at baseline to 6 weeks 3.64 ± 0.98, LKI-Activities of Daily Living (ADL) for group I PRP the Mean ± SD score dropped more from 4.66 ± 1.40 to 2.95 ± 1.35 whereas for group II Dextrose the Mean ± SD score dropped from 4.68 ± 1.40 to 3.65 ± 1.51 at baseline and 6 week respectively and At baseline, the mean LKI-Total score in group I was 12.85 ± 3.59 while in group II the mean score was 13.11 ± 3.15. At 6 weeks, the mean LKI-Total score in group I was 7.63 ± 3.85; in group II the mean score was 10.11 ± 2.93. A significant difference was found in the mean LKI-Total score between the groups at 6 weeks (P = 0.001) and found to be lesser in group I.

Conclusion: It could thus be concluded that on considering the effect of platelet-rich plasma and 25% hypertonic dextrose prolotherapy in patients with knee osteoarthritis, significant improvement was seen in participants administered with both platelet-rich plasma and dextrose with the higher effect being with platelet-rich plasma.

Keywords: Knee osteoarthritis; platelet-rich plasma (PRP); prolotherapy.

Copyright: © 2025 Journal of Family Medicine and Primary Care.

PubMed Disclaimer
 
only 6 weeks duration.

not blinded - looks like people knew what they were getting.

small group size.

did not see report of complications. maybe there were none.



so take home conclusion: dextrose injections can help. 🙂
 
Eur Radiol. 2025 Jul 26.
doi: 10.1007/s00330-025-11867-9. Online ahead of print.

Shear wave elastography to assess healing in lateral epicondylosis: randomized controlled trial with platelet-rich plasma​


Abstract​

Objective: To compare ultrasound and shear wave elastography (SWE) changes in the common extensor tendon over time after platelet-rich plasma (PRP) or corticosteroid (CS) treatment, and to assess for correlations between patient-reported outcomes (PROs) and US/SWE changes of the common extensor tendon.

Materials and methods: A secondary analysis of a prospective double-blinded, randomized controlled trial comparing US and SWE changes after a single treatment of PRP or CS for the treatment of lateral epicondylosis was conducted. Subjects 18-65 years with recalcitrant lateral elbow pain were enrolled between 3/1/2017 and 4/1/2019 and randomized to a treatment group. US/SWE of the common extensor tendon was performed at baseline, 26 weeks, and 52 weeks, and PROs were also recorded. Treatment effects between groups were compared using linear mixed effects models.

Results: Fifty elbows in 47 subjects (mean 48 years ± 8; 25 women) were randomized to two groups-PRP (N = 26) and CS (N = 24). Shear wave speed (SWS) increased with PRP more than with CS at both 26 weeks (2.02 m/s ± 0.61; p = 0.002) and 52 weeks (2.98 m/s ± 0.49; p < 0.01). At 26 weeks, no differences were detected between treatments by conventional US. At 52 weeks, echogenicity and hyperemia improved with PRP relative to CS (p < 0.05). Increased SWS correlated with improvement in all PROs (p < 0.05). For conventional US changes, the only correlation to PROs was that of echogenicity with pain (p = 0.04).

Conclusion: SWS increased more with PRP than CS at 26- and 52-week post-treatment for lateral epicondylosis, and increased SWS correlated with clinical improvement.

Key points: Question Can SWE detect healing changes in the common extensor tendon associated with clinical improvement of lateral epicondylitis in patients treated with PRP or CS injection? Findings Higher common extensor tendon SWSs were associated with clinical improvement and improved more in those treated with PRP than with CS. Clinical relevance statement SWE may be able to quantitatively detect treatment changes in tendons associated with clinical improvement.

Keywords: Elbow tendinopathy; Platelet-rich plasma; Sonoelastography (ultrasonography); Tennis elbow.
 
secondary analysis, extended data.

no control group.

as noted with most studies involving lateral epicondylitis, PRP seems superior to CS when time frames are >3 months.


i havent done a CS injection for lateral epicondylitis in at least 3+ years.
 
lobelsteve said:
Click to expand...

I found their 60 second patient screening quiz.

Gemini_Generated_Image_9vcmfq9vcmfq9vcm.png
 
TIme for Regen Fellowships?

Analysis & Perspective

Call for a Translational Orthobiologics Fellowship in the Era of Regenerative Medicine​

Strader, Shannon DO, MS1; Villaseñor, Andrew DO, MS2; Wyles, Saranya MD, PhD3; Chandan, Priya MD, PhD4; Terzic, Carmen MD, PhD5; Bean, Allison C. MD, PhD6; Master, Zubin PhD7

Author Information
American Journal of Physical Medicine & Rehabilitation 104(9)😛 831-837, September 2025. | DOI: 10.1097/PHM.0000000000002782
AbstractPlain Language Summary
Regenerative medicine is a rapidly advancing field, particularly within the field of physical medicine and rehabilitation. While orthobiologics are currently being used in clinical practice, there remains a need for high-quality clinical trials and translational research to standardize treatments and improve patient outcomes. Education is vital for streamlining development of evidence-based, practical, and effective treatments. In this article, we highlight the need for a 1-yr advanced fellowship in translational orthobiologics aiming to create a standardized core curriculum targeting physicians involved in treating musculoskeletal diseases. The fellowship’s objectives include advancing translational orthobiologics research, ethical considerations, and promoting effective communication regarding orthobiologic therapies. Such a program would serve as a foundation for physicians interested in conducting clinically oriented orthobiologics research for musculoskeletal disorders while improving the development of safe and effective therapeutics related to musculoskeletal disorders.
 
drusso said:
Ignorant.
Click to expand...
yeah right?

make a fellowship to gouge money by using fellows for cheap labor and do research.


then decide that only fellowship trained docs can do regenerative medicine.


then eventually decide that fellowship trained physicians need to take a board exam and recertify every 10 years that rake in oodles more money.



try this instead - have fellowships train regenerative medicine so that all fellowship trained pain docs get trained in them.
 
Even if there was a fellowship there will be naturopaths and APPs that still do them because they've been "trained"
 
bmcmusculoskeletdisord.biomedcentral.com

Non-surgical treatment of anterior cruciate ligament tears with percutaneous bone marrow concentrate and platelet products versus exercise therapy: a randomized-controlled, crossover trial with 2-year follow-up - BMC Musculoskeletal Disorders

Background Anterior cruciate ligament (ACL) reconstruction (ACLR) surgery remains the prevailing standard of care for complete ACL ruptures but is not without risk. The aim of this study was to compare non-surgical, autologous bone marrow concentrate (BMC) with platelet products compared to...
bmcmusculoskeletdisord.biomedcentral.com bmcmusculoskeletdisord.biomedcentral.com

Purpose​

The study compared a non-surgical injection treatment using a person’s own bone marrow concentrate and platelets (BMC + PRP) against standard exercise therapy for treating partial and some complete ACL tears that were not completely pulled apart (“non-retracted”).

How the Study Worked​

  • 51 people with ACL tears were randomly assigned to either:
    • Exercise therapy only, or
    • BMC + platelet injection directly into the ACL under imaging guidance.
  • After 3 months, patients in the exercise group who weren’t improving could switch to the BMC treatment.
  • Patients were followed for 2 years with:
    • Pain and function questionnaires (IKDC, LEFS, SANE, NPS)
    • MRI scans before and after treatment.

Key Findings​

  • At 3 months, patients who received BMC injections improved much more in:
    • Function (LEFS)
    • Overall knee improvement (SANE)
      compared with those who only did exercise therapy.
  • The exercise-only group showed little to no improvement before crossing over.
  • Over 2 years, those who received BMC:
    • Had sustained improvement in knee function and pain.
    • Reported an average of 90% overall improvement.
    • 80–87% were able to return to strenuous or very strenuous activities (like running, skiing, basketball).
  • MRI scans showed visible healing and better ligament structure in the ACL after BMC treatment.
  • No serious side effects occurred.
    A few mild cases (temporary swelling, soreness) resolved on their own.
  • Older injuries (over 12 months old) improved less, suggesting earlier treatment works best.
  • Only 4 patients eventually went on to surgical reconstruction (8%), similar or better than typical surgery failure rates.

What It Means​

  • BMC + platelet injections can help ACL tears heal naturally, improving pain and function without surgery for many patients.
  • This approach may preserve the native ligament, maintaining normal knee movement and proprioception.
  • It’s minimally invasive, has a low complication rate, and could reduce risk of future arthritis compared to surgery.
  • It’s not ideal for everyone, especially for fully torn or retracted ligaments, or for very old injuries.

Bottom Line​

Bone marrow concentrate and platelet therapy offers a safe and effective non-surgical option for select ACL injuries — helping patients regain stability, reduce pain, and return to high-level activity — with lasting results over two years.
 
265 screened. total 50 patients. they did do a power analysis.

they did change the criteria midway through so 34 in injection, 17 in exercise.

injections were not blinded. people knew they were getting injection vs no injeciton.


it appears their exercise regimen was "extensive". patients in the exercise group met (maybe once?) with PT and given 2 sets of take home exercise sheets.

otoh, here is the exercise regimen given to those who got the injection:
For the first month, patients were directed to perform range of motion exercises, light strength training, and balance training while protecting the knee. Afterwards (weeks 5–12), patients participated in resistance training, targeting the hip abductor and hamstring with light squats and leg presses, along with core strengthening using a balance board. If not experiencing pain, straight jogging, single leg exercises, and progression to combo strength/balance exercises were encouraged. Over the next eight weeks (weeks 13–20), patients began guided sport-specific movements and noncutting sports. Finally (weeks 21–52), the Santa Monica Sports Medicine Prevent Injury and Enhance Performance program was recommended and ultimately returned to full sport only with physician clearance.
Click to expand...



all crossed over. so the comparison of duration are between how they were at 2 years after with how they did at 3 months - noone did conservative therapy for 2 years. this would affect whether patients could have improved with just conservative therapy. this is a limitation that the researchers specifically mentioned.




overall, is an injection better than giving a patient an exercise sheet? are people better off 2 years out regardless of outcome? probably yes to both. is it better than surgery? no idea.
 
drusso said:
bmcmusculoskeletdisord.biomedcentral.com

Non-surgical treatment of anterior cruciate ligament tears with percutaneous bone marrow concentrate and platelet products versus exercise therapy: a randomized-controlled, crossover trial with 2-year follow-up - BMC Musculoskeletal Disorders

Background Anterior cruciate ligament (ACL) reconstruction (ACLR) surgery remains the prevailing standard of care for complete ACL ruptures but is not without risk. The aim of this study was to compare non-surgical, autologous bone marrow concentrate (BMC) with platelet products compared to...
bmcmusculoskeletdisord.biomedcentral.com bmcmusculoskeletdisord.biomedcentral.com

Purpose​

The study compared a non-surgical injection treatment using a person’s own bone marrow concentrate and platelets (BMC + PRP) against standard exercise therapy for treating partial and some complete ACL tears that were not completely pulled apart (“non-retracted”).

How the Study Worked​

  • 51 people with ACL tears were randomly assigned to either:
    • Exercise therapy only, or
    • BMC + platelet injection directly into the ACL under imaging guidance.
  • After 3 months, patients in the exercise group who weren’t improving could switch to the BMC treatment.
  • Patients were followed for 2 yearswith:
    • Pain and function questionnaires (IKDC, LEFS, SANE, NPS)
    • MRI scans before and after treatment.

Key Findings​

  • At 3 months, patients who received BMC injections improved much morein:
    • Function (LEFS)
    • Overall knee improvement (SANE)
      compared with those who only did exercise therapy.
  • The exercise-only group showed little to no improvement before crossing over.
  • Over 2 years, those who received BMC:
    • Had sustained improvement in knee function and pain.
    • Reported an average of 90% overall improvement.
    • 80–87% were able to return to strenuous or very strenuous activities (like running, skiing, basketball).
  • MRI scans showed visible healing and better ligament structure in the ACL after BMC treatment.
  • No serious side effects occurred.
    A few mild cases (temporary swelling, soreness) resolved on their own.
  • Older injuries (over 12 months old) improved less, suggesting earlier treatment works best.
  • Only 4 patients eventually went on to surgical reconstruction (8%), similar or better than typical surgery failure rates.

What It Means​

  • BMC + platelet injections can help ACL tears heal naturally, improving pain and function without surgery for many patients.
  • This approach may preserve the native ligament, maintaining normal knee movement and proprioception.
  • It’s minimally invasive, has a low complication rate, and could reduce risk of future arthritis compared to surgery.
  • It’s not ideal for everyone, especially for fully torn or retracted ligaments, or for very old injuries.

Bottom Line​

Bone marrow concentrate and platelet therapy offers a safe and effective non-surgical option for select ACL injuries — helping patients regain stability, reduce pain, and return to high-level activity — with lasting results over two years.
Click to expand...
Targeting ACL/PCL using fluoro with contrast is something I haven't seen before. Pretty cool contrast patterns. Overall promising study that has a lot of confounders and potential for bias. I also wonder what proportion of ACL tears carry this morphology they studied. But I also understand that without a matrix to inject BMAC into, those cells are gonna migrate away wherever they please (probably do anyway). Needs to be compared to surgical correction...
 
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