@article {Curtine1, author = {M Curtin and T Crisp and P Malliaras and N Padhiar}, title = {The effectiveness of prolotherapy in the management of recalcitrant medial tibial stress syndrome: a pilot study}, volume = {45}, number = {2}, pages = {e1--e1}, year = {2011}, doi = {10.1136/bjsm.2010.081554.8}, publisher = {British Association of Sport and Excercise Medicine}, abstract = {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{\texttimes}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{\textendash}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{\textendash}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 {\textquoteleft}much improved{\textquoteright} 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.}, issn = {0306-3674}, URL = {https://bjsm.bmj.com/content/45/2/e1.67}, eprint = {https://bjsm.bmj.com/content/45/2/e1.67.full.pdf}, journal = {British Journal of Sports Medicine} }