The Hackett Patterson foundation is a leading worldwide group. They defined prolotherapy as a nonsurgical, non-opioid treatment that stimulates the body's natural healing response to repair injured, painful joints, ligaments, and tendons.
They put a hypertonic solution into the affected area to initiate healthy tissue growth to reduce pain, improve mobility, and restore function.
They believe regenerative therapy effectively treats chronic pain for musculoskeletal injuries, arthritis, tendinitis, bursitis, and joint instability.
What do I expect if I introduce dextrose solution into the biological tissue? First, I admit that I use 30 to 40 % dextrose solution, nearly two mOSM/ml. When I was young, I followed an authentic protocol, such as a 5 to 10 percent of dextrose solution.
Thus, the dextrose solution is very hypertonic.
It is the basic biologic mechanism of the dextrose injection. Local administered hypertonic dextrose initiates a fluid extraction from the interstitial space. It would be succeeded by transferring fluid into the interstitial space with dextrose and extracting fluid from cells by the non-penetrating dextrose.
It increases the permeability of capillaries, shrinks cells, and causes interstitial edema. Eventually, it causes a minor abnormal cellular environment.
The provoked cellular environment at tendons and cartilages near bones produces an inflammatory response that "turns on" the healing process. As a result, the new ligaments and tendons become thicker and more robust, containing fibers of varying thicknesses. Furthermore, it inhibits pathologic angiogenesis and neural ingrowth, the leading cause of chronic MSK pain generation.
I assumed two causes of failure in regeneration.
The first one is the retraction of the proximal tendon and gaps between two ends. It has a similar mechanism to the nonunion of a fractured bone.
I believe the healing process of fractured bone and torn tendon are the same. Basic knowledge is that the prerequisites for healing the broken bone are adequate blood supply and mechanical stability. Without proper blood supply and mechanical stability, the interconnecting regeneration process is impossible in the rotator cuff tear.
The dextrose or PRP stimulates the underlying fibroblast. But the fibroblast can not jump to another side without continuity.
The second one is the subacromial and joint fluid. The fluid is a lubricant created to protect surface layers from adhesion or reattachment of two ends.
The lubricants would wash out the regenerating chemicals and interfere with the action of fibroblasts.
The situation is very similar to the meniscus tear. I don't believe the dextrose or even PRP treatment can not heal the torn meniscus.
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They found that a single injection significantly increased tendon diameter and fibroblasts compared to the non-injection side.
The right dextrose injection side is thicker than the non-injected left tendon.
5% and 20% of dextrose injections showed a thicker diameter than saline injection or non-injection side.
Anti-inflammatory drug administration did not affect Achilles diameter and fibroblast count, suggesting a noninflammatory mechanism of proliferation.
What if I infiltrate the dextrose solution into the peri-tendon area. It is a more common situation than an intra-tendinous injection.
They injected 10% glucose solution into the synovium around the middle digit flexor tendon of a healthy rabbit.
At four weeks after the dextrose injection, the cellularity appeared to increase further, and evidence of vascular proliferation was seen along with collagen remodeling.
Eight weeks after the dextrose injection, more angiogenesis and thicker collagen bundles were observed without inflammation.
Twelve weeks after the dextrose injection, they observed vascular proliferation and thicker collagen bundles in the tendon.
How will change in the injured ligament if we put dextrose solution into the injured ligament? It is the typical indication of prolotherapy, and most prolotherapists usually make target dextrose into the torn area.
It was their hope. Dextrose injections would enlarge the cross-sectional area, decrease laxity, and strengthen and stiffen stretch-injured medial collateral ligaments (MCLs). Dextrose prolotherapy will increase collagen fibril diameter and density of stretch-injured MCLs.
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