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The effectiveness of prolotherapy in the management of recalcitrant medial tibial stress syndrome: a pilot study
  1. M Curtin,
  2. T Crisp,
  3. P Malliaras,
  4. N Padhiar
  1. Centre for Sport & Exercise Medicine, Queen Mary, University of London, London, UK


Objective To study the effectiveness of dextrose prolotherapy in the treatment of recalcitrant medial tibial stress syndrome (MTSS).

Design A prospective case-series.

Setting A London private hospital.

Participants Seven patients: five male and two female; (mean age=36 years+4 months) referred to a specialist tertiary referral centre having failed existing care pathways for MTSS.

Intervention Subjects received a subperiosteal injection containing 15% dextrose solution via a BD spinal needle 22GA 3.5 IN (0.7×90 mm) under ultrasound guidance. Typically a 1 ml volume of the dextrose solution was injected per centimetre of symptomatic area of the tibia using a 20 ml syringe, giving set and three-way tap.

Study period 11/2009–7/2010

Main outcome measures Subjects completed a visual analogue scale (VAS) for average pain (where 10=severe pain and 0=no pain). Scores recorded at baseline, 1, 2 and 4 weeks postinjection and again during telephone follow-up (mean 18 weeks, range 13–36 weeks). Subjects were also reviewed at least once in a follow-up appointment where they also completed a symptom diary. At final telephone follow-up they completed a six-point Likert global improvement scale, and a five-point activity scale.

Results All subjects reported a marked improvement in their symptoms. There was a significant decrease in mean average pain measured by VAS scores at 4 weeks (p <0.05) and 18 weeks (p<0.05) compared to baseline. The median VAS average pain score improvement per subject was 4/10. The median change in activity value at 18 week postinjection follow-up was a score of 4.0 representing a return to a desired level of sport but not to preinjury level. The median Likert global improvement score at 18 weeks postinjection follow-up was 2.0 which represented ‘much improved’ on a six-point scale. There were no adverse events.

Conclusions Dextrose prolotherapy injection resulted in tangible symptom improvement in seven patients with painful recalcitrant MTSS. Controlled trials of this intervention are warranted.

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