Effects Of Dextrose Prolotherapy Compared with Platelet-Rich Plasma on Knee Osteoarthritis: A Systematic Review and Meta-Analysis
E. Pasqualotto, T. Pasqualotto, L. Lunelli, L.O. Lunelli, F.B. De Sousa, L.F.Z. FunchalObjectives:
To compare the clinical outcomes of dextrose prolotherapy versus platelet-rich plasma (PRP) in adults with knee osteoarthritis.
Methods:
PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) published up to December 2025 comparing dextrose prolotherapy versus PRP in knee osteoarthritis. Risk ratio (RR) was used to evaluate binary outcomes and standardized mean differences (SMDs) or mean differences (MDs) for continuous endpoints, with 95% confidence intervals (CIs). Statistical analyses were conducted using R software, version 4.4.1.
Results:
A total of 5 RCTs involving 305 patients were included. There was a significant difference in favor of the PRP group compared with prolotherapy in pain (SMD 0.98; 95% CI 0.05 to 1.90), physical activity (SMD 0.43; 95% CI 0.08 to 0.79), and WOMAC stiffness (MD 0.45 points; 95% CI 0.06 to 0.85). However, no significant differences were observed between groups for WOMAC total, WOMAC pain, and WOMAC physical activity.
Conclusion:
PRP showed greater improvements in pain, physical activity, and WOMAC stiffness compared with dextrose prolotherapy, while no differences were observed in overall WOMAC scores. These findings suggest that PRP may offer superior symptomatic and functional benefits in knee osteoarthritis, although larger and standardized trials are still needed.