Knee osteoarthritis treatments

Marc Darrow MD

Marc Darrow, MD

This article is an outline of our treatments and the research supporting it – I update the information every few weeks to make sure we stay current. Research is important to all of our patients.

Often times we will get a call or an email into the office from people wondering why treatments such as Stem Cell Therapy, Platelet Rich Plasma Therapy (PRP), or Prolotherapy were never offered to them as options in the past. Part of the reason is given in research like that below.

Despite the availability of evidence-based guidelines for conservative treatment of osteoarthritis, management is often confined to the use of painkillers and waiting for eventual total joint replacement. This suggests that many people with osteoarthritis are never made aware of the many different treatments available to them.1

For many of you the research above may be the answer to “Why has my doctor never heard of this?”

Stem Cell Therapy, Platelet Rich Plasma Therapy (PRP), and/or Prolotherapy are injection techniques that do exactly the opposite of surgery. They rebuild and strengthen damaged tissue as opposed to removing them. In our office these treatments are often used in combination.

Prolotherapy is the injection of mild irritants, i.e, Dextrose, PRP is the injection of the patient’s own platelet rich plasma derived from a blood draw. Stem Cell Therapy is an injection of stem cells drawn from the patient’s own bone marrow.

Prolotherapy for knee pain

Prolotherapy works as an irritant using dextrose (a simple sugar) is introduced in the knee. This causes the immune system of the body to accelerate the inflammatory process. More inflammation? The body’s natural healing response is inflammation. Only when complete healing does not occur does inflammation become chronic and problematic.

What this new inflammation does is bring fibroblast and chondrocytes, those cells necessary to rebuild the collagen matrix of the tissue, strengthen and restoring them to pre-injury form in many cases.

There is a long history of medical citations on the effectiveness of Prolotherapy for knee pain, most recently form June 2015 in which University of Wisconsin School of Medicine and Public Health researchers concluded that Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness scores among most participants through a mean follow-up of 2.5 years and may be an appropriate therapy for patients with knee osteoarthritis that did not respond to other conservative treatments.2

Research on effectiveness of Platelet Rich Plasma Therapy (PRP) for knee osteoarthritis

Recently numerous studies have appeared on the effectiveness of PRP in treating knee osteoarthritis:

  • In new research doctors found that in one year or less follow up – patients receiving PRP injections had improved functional outcomes when compared to hyaluronic acid and placebo.3
  • PRP seems to be more effective than hyaluronic acid in younger, active patients with low-grade osteoarthritis.4
  • In the medical journal International Orthopaedics, researchers showed that  PRP enhances and accelerates the tendon healing process. 5
  • Doctors says intra-articular multiple and single platelet-rich plasma (PRP) injections worked better or as well as hyaluronic acid (HA) injections in different stages of osteoarthritis of the knee.6
  • PRP helps regenerate degenerated bone in bone on bone knees.7

Research on effectiveness of Stem Cell Therapy for knee osteoarthritis

“The therapeutic potential of mesenchymal stromal cells (MSCs) is evident by the number of new and ongoing trials targeting an impressive variety of conditions. In bone and cartilage repair, stem cells are expected to replace the damaged tissue.”8

In one study the potential of intra-articular injection of mesenchymal stem cells (MSCs) was evaluated in six osteoarthritic patients. During a one-year follow-up period magnetic resonance images (MRI) at baseline and six months post-stem cell injection displayed an increase in cartilage thickness, extension of the repair tissue over the subchondral bone and a considerable decrease in the size of edematous subchondral patches in three out of six patients. – The results indicated satisfactory effects of intra-articular injection of MSCs in patients with knee osteoarthritis. 9

The Use of Ultrasound

Research in the Journal of Clinical Rheumatology says that “(Ultrasound) Sonographic needle guidance reduced procedural pain and improved the clinical outcomes and cost-effectiveness of intra-articular injections of the osteoarthritic knee.”

The researchers found that ultrasound guided injection over conventional palpation-guided methods resulted in 48% reduction in procedural pain, a 42% reduction in pain scores at outcome, 107% increase in the responder rate and with higher accuracy, less need for procedure, significantly reducing patient cost. 10

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1. Umapathy H, Bennell K, Dickson C, Dobson F, Fransen M, Jones G, Hunter DJ. The Web-Based Osteoarthritis Management Resource My Joint Pain Improves Quality  of Care: A Quasi-Experimental Study. J Med Internet Res. 2015 Jul 7;17(7):e167. doi: 10.2196/jmir.4376.

2. Rabago D, et al. Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes. Complement Ther Med. 2015 Jun;23(3):388-95. doi: 10.1016/j.ctim.2015.04.003. Epub 2015 Apr 8.

3. Kanchanatawan W et al. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2015 Sep 19. [Epub ahead of print]

4. Pourcho AM, Smith J, Wisniewski SJ, Sellon JL. Intraarticular platelet-rich plasma injection in the treatment of knee osteoarthritis: review and recommendations. Am J Phys Med Rehabil. 2014 Nov;93(11 Suppl 3):S108-21. doi: 10.1097/PHM.0000000000000115.

5. (Lyras D, et al.  Immunohistochemical study of angiogenesis after local administration of platelet rich plasma in a patellar tendon defect.  International Orthopaedics 2009;11 February: online.)

6. Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, Nguyen J. Clinical and MRI Outcomes After Platelet-Rich Plasma Treatment for Knee Osteoarthritis. Clin J Sport Med. 2012 Dec 12. [Epub ahead of print]

7. Oryan A, Alidadi S, Moshiri A. Platelet-rich plasma for bone healing and regeneration. Expert Opin Biol Ther. 2015 Nov 11. [Epub ahead of print]

8. Heldring N, Mäger I, Wood M, Le Blanc K, El Andaloussi S. Therapeutic potential of multipotent mesenchymal stromal cells and their extracellular vesicles. Hum Gene Ther. 2015 Jul 8. [Epub ahead of print]

9. Emadedin M, Aghdami N, Taghiyar L, Fazeli R, Moghadasali R, Jahangir S, Farjad R, Baghaban Eslaminejad M. Intra-articular injection of autologous mesenchymal stem cells in six patients with knee osteoarthritis. Arch Iran Med. 2012 Jul;15(7):422-8.

10. Sibbitt WL Jr, Band PA, Kettwich LG, Chavez-Chiang NR, Delea SL, Bankhurst AD. A randomized controlled trial evaluating the cost-effectiveness of sonographic guidance for intra-articular injection of the osteoarthritic knee. J Clin Rheumatol. 2011 Dec;17(8):409-15.

About Marc Darrow MD, JD

Marc Darrow, MD, JD, is one of the leading physicians practicing Stem Cell Therapy, Platelet Rich Plasma Therapy, and Prolotherapy. Email with questions about this article to

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