Dextrose prolotherapy in knee osteoarthritis: A systematic review and meta-analysis

ObjectiveTo summarize the evidence for dextrose prolotherapy in knee osteoarthritis.Data sourcesThe authors searched PubMed and Embase from inception to September 2020. All publications in the English language were included without demographic limits.Study selectionRandomized clinical trials comparing the effects of any active interventions or placebo versus dextrose prolotherapy in patients with knee osteoarthritis were included.Data extractionPotential articles were screened for eligibility, and data was extracted independently. The risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analysis was performed on clinical trials with similar parameters. The Strength of Recommendation Taxonomy (SORT) was used for evaluating the strength of recommendations.Data synthesisIn total, eleven articles (n = 837 patients) met the search criteria and were included. The risk-of-bias analysis revealed two studies to be of low risk. The overall effectiveness was calculated using a meta-analysis method. Prolotherapy was no different from platelet-rich plasma on the pain subscale at the 6-month time point. Prolotherapy was inferior to platelet-rich plasma at 6 months (MD 0.45, 95% CI 0.06–0.85, p = 0.03) on the stiffness subscale. Prolotherapy was found to be safe with no major adverse effects.ConclusionProlotherapy in knee osteoarthritis confers potential benefits for pain but the studies are at high risk of bias. Based on two well-designed studies, dextrose prolotherapy may be considered in knee osteoarthritis (strength of recommendation B). This treatment is safe and may be considered in patients with limited alternative options (strength of recommendation C).     

Motion analysis as an outcome measure for hip arthroplasty

We review the available literature on the use of motion analysis as an outcome measure following total hip arthroplasty. Several studies have investigated spatio-temporal parameters of gait, kinematics, kinetics and electromyographic outputs following hip arthroplasty. We undertook to review all these studies to evaluate the value of motion analysis as an outcome measure. The search of the literature yielded eight studies. Motion analysis demonstrates functional improvement in patients post-operatively, but the values of the variables measured do not reach the same levels as control subjects. Motion analysis does not show much difference post-operatively between patients operated on by different technique or incision. Furthermore, motion analysis can identify subtle functional limitations which may not be detectable with conventional outcome measures.     

Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review

Background  

Patellofemoral osteoarthritis (PFOA) is a common form of knee OA in middle and older age, but its relation to PF disorders and symptoms earlier in life is unclear. Our aim was to conduct a systematic review to investigate the strength of evidence for an association between anterior knee pain (AKP) in younger adults and subsequent PFOA.