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Table 1 Characteristics of included studies

From: Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review

Reference Title Objective Study design Population characteristics Intervention/s Outcome measures Exclusion criteria
Prolotherapy injection for Achilles tendinopathy
 Lyftogt [30] Prolotherapy and Achilles tendinopathy: A prospective pilot study of an old treatment. To assess the clinical effectiveness of prolotherapy in the treatment of AT in a general medical/sports medicine setting with three-month follow-up; and a postulated positive relationship between initial VAS scores and number of treatments. Prospective case series. Location: New Zealand. Intervention: Pain results were monitored with individual prolotherapy recovergrams which were compiled in a study recovergram. A satisfaction survey was also performed. Insertional AT.
Sex: 4 female, 12 male. 1 mL subcutaneous prolotherapy, dextrose 20 %/lignocaine 0.1 %; at weekly intervals where possible.
Mean age: 48.0.
 Lyftogt [31] Subcutaneous prolotherapy for Achilles tendinopathy: The best solution? Reporting on treatment of chronic midportion AT with subcutaneous prolotherapy. Prospective case series. Location: New Zealand. Intervention: Follow up was conducted by an independent party with a standard questionnaire assessing VAS pain scores and overall satisfaction. Not defined.
Sex: 59 female, 85 male. 1 mL subcutaneous prolotherapy, three different dextrose/local anaesthetic regimens; at weekly intervals where possible.
Mean age: 48.0.
 Maxwell et al. [32] Sonographically guided intratendinous injection of hyperosmolar dextrose to treat chronic tendinosis of the Achilles tendon: a pilot study. Reporting on treatment of chronic AT with injections of hyperosmolar dextrose under sonographic guidance, to induce an inflammatory reaction and initiate a wound-healing cascade and subsequent collagen synthesis. Prospective case series. Location: Canada. Intervention: Improvement in VAS1, VAS2 and VAS3; satisfaction rating, as well as sonographic measurements of tendon thickness, size of hypoechoic region and intratendinous tear size. Acute Achilles tendonitis or symptoms associated with acute trauma, surgery or interventional procedures in 3 months prior to trial.
Sex: 11 female, 25 male. ≤2 mL prolotherapy, dextrose 25 %/lignocaine 1 %; every 6 weeks until either the symptoms resolved or no improvement.
Mean age: 54.0.
 Ryan et al. [33] Favourable outcomes after sonographically guided intratendinous injection of hyperosmolar dextrose for chronic insertional and midportion Achilles tendinosis. To report on changes in the short-term sonographic appearance at two year follow-up for pain outcomes in a large population with chronic AT who underwent sonographically guided injections of hyperosmolar dextrose. Prospective Case series. Location: Canada. Intervention: Improvement in VAS1, VAS2 and VAS3; as well as sonographic measurements of tendon thickness, size of hypoechoic region and intratendinous tear size. Not defined.
Sex: 41 female, 58 male. ≤2 mL prolotherapy, dextrose 25 %/lignocaine 1 %; every 6 weeks until either the symptoms resolved or no improvement.
Mean age: 54.0.
 Yelland et al. [34] Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial. To compare the effectiveness of eccentric loading exercises (ELE); based on Alfredson protocol, with prolotherapy used alone and in combination for painful AT. Single-blinded randomised controlled trial. Location: Australia. Intervention: Improvement in VISA-A, pain stiffness and limitation of activity scores, satisfaction rating and treatment costs. Previous steroid or prolotherapy or surgery to affected tendon, previous completion of >50 % of the Achilles ELE protocol, and allergies or medical conditions that may limit completion of treatments.
Sex: not defined, 43 total participants. ≤5 mL dextrose 20 %/ lignocaine 0.1 %/ ropivacaine 0.1 % for 4–12 treatments (n = 15); vs Comparator a): Combination of prolotherapy plus ELE (n = 14); vs Comparator b): ELE (n = 14).
Mean age: 46.7.
Prolotherapy injection for Plantar fasciopathy
 Kim et al. [35] Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. To determine the efficacy of autologous PRP compared with prolotherapy in participants with chronic recalcitrant plantar PF. Single-blinded randomised controlled trial. Location: Korea. Intervention: Pain, disability and activity limitation subscales, measured by means of the FFI. Local steroid injections within 6 months or nonsteroidal anti-inflammatory drugs within 1 week prior to randomisation, active bilateral PF, or previous surgery for PF.
Number: 10 female, 11 male. 2 mL dextrose 15 %/lignocaine 1.25 % (n = 11); vs Comparator: 2 mL of autologous PRP (n = 10). Two injections into the plantar fascia at interval of 2 weeks.
Mean age: 37.0.
 Ryan [36] Sonographically guided intratendinous injections of hyperosmplar dextrose/lignocaine: a pilot study for the treatment of chronic plantar fasciitis. To report on the effectiveness of sonographically guided injections of hyperosmolar dextrose at reducing the pain associated with chronic PF. Prospective case series. Location: Canada. Intervention: VAS1, VAS2 and VAS3, foot function index (FFI) were recorded at baseline and at final treatment consultation (post-test). Acute plantar foot pain or symptoms associated with acute trauma. Surgery or interventional procedures within previous 6-months.
Number: 17 female, 3 male. ≤2 mL dextrose 25 %/ lignocaine 1 %; injected sonographic guidance; 6-week intervals.
Mean age: 51.2.
Prolotherapy injection for Osgood-Schlatter Disease
 Topol [37] Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter disease. To examine prolotheapy versus lignocaine injection versus supervised usual care to reduce sport alteration and sport-related symptoms in adolescent athletes with OSD. Double-blinded randomised controlled trial. Location: Argentina, USA. Intervention: The Nirschl pain phase scale (NPPS) was used to assess Unaltered sport (NPPS <4) and asymptomatic sport (NPPS = 0) were the threshold goals. Not defined.
Sex: 3 female, 51 male. ≥2 mL dextrose 12.5 %/lignocaine 1 % solution (n = 21); vs Comparator a):≥2 mL lignocaine 1 % solution (n = 22); vs Comparator b): Supervised standard therapy (n = 22).
Mean age: 13.3.
  1. AT Achilles tendinopathy, VAS visual analogue scale, VAS1 pain during rest, VAS2 pain during normal daily activity, VAS3 pain during or after sporting activity, ELE eccentric loading exercises, VISA-A Victorian institute of sports assessment-Achilles, PRP platelet-rich plasma, PF plantar fasciopathy, OSD Osgood-Schlatter disease