Changes In Levels Of Cartilage Oligomeric Proteinase And Urinary C-Terminal Telopeptide Of Type Ii Collagen In Subjects With Knee Osteoarthritis After Dextrose Prolotherapy: A Randomized Controlled Trial

Objective: To assess the effects of dextrose prolo-therapy in patients with knee osteoarthritis on the levels of serum cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen,and on the Western Ontario McMaster Universities Index and numerical rating scale score for pain. Methods: A randomized controlled trial, in which participants were randomly allocated into 2 groups, receiving injections of either hyaluronic acid or dex-trose prolotherapy. The hyaluronic acid group receiv-ed 5 injections, 1 each on weeks 1, 2, 3, 4 and 5, and the dextrose prolotherapy group received 3 injec-tions, 1 each on weeks 1, 5 and 9. Serum cartilage oligomeric proteinase, urinary C-terminal telopeptide of type II collagen, Western Ontario McMaster Univer-sities Index score, and numerical rating scale score for pain were measured at baseline and 3 weeks after the last injection. Comparative analysis was conduct- ed using Wilcoxon test within groups and analysis of covariance (ANCOVA) test between groups. Results: A total of 47 participants (21 allocated to hyaluronic acid, 26 allocated to dextrose proloth- erapy) completed the protocol. Both interventions result­ed in significant improvements in numerical ra- ting scale scores for pain, total Western Ontario Mc-Master Universities Index scores, and its subscales score. However, the dextrose prolotherapy outperfor-med hyaluronic acid in numerical rating scale score for pain and level of urinary C-terminal telopeptide of type II collagen, with score changes differences of 0.93 (p=0.042) and 0.34 (p=0.048), respective-ly. No significant changes in level of serum cartilage oligomeric proteinase were found in either group. Conclusion: Dextrose prolotherapy is an alternative injection therapy for knee osteoarthritis, which was found to be associated with a significant reduction in urinary C-terminal telopeptide of type II collagen compared with hyaluronic acid injection. Neither in-jection method resulted in reduced serum cartilageoligomeric proteinase.