Dextrose Prolotherapy for Muscle, Tendon and Ligament Injury or Pathology: A Systematic Review

Main Article Content

Sholahuddin Rhatomy
Evlin Margaretha
Rizki Rahmadian


Background: Prolotherapy with dextrose has recently gained attention as a potential treatment for muscle, ligament or tendon pathology/injury.

Questions/Purpose: This review aimed to: 1) evaluate the main outcome of dextrose prolotherapy treatment for muscle, ligament or tendon pathology/injury; 2) determine the concentrations of dextrose and protocol of injection; and 3) assess complications or adverse effects after dextrose prolotherapy.

Methods: Four electronic databases were searched for related published articles. Articles that met the following criteria were included in this review: 1) articles on peer-reviewed level 1 to 4 studies; 2) articles published in English; 3) articles on dextrose prolotherapy study for tendon or ligament or muscle injury/pathology; and 5) articles that describe dose of dextrose. Published articles that met this inclusion criteria were included in this systematic review.

Results: Twenty four studies fulfilled inclusion criteria,consisting of seventeen clinical studies, four animal studies and three invitro studies. Eleven studies reported there were improvement of functional outcome after dextrose prolotherapy. Three Studies reported improvement of patient satisfaction after dextroprolotherapy in supraspinatus tear, Achilles tendinopathy. And patellar tendinopathy, meniscus tear and anterior tibiofibular ligament tear. Three studies reported there are increasing of neovascularization in Achilles tendinopathy and patellar tendinopathy in animal studies, increasing of inflammatory response in animal studies and in vitro studies and increasing of cell proliferation and collagen production. Nine studies (52%) use dextrose 25% concentration. A few adverse effects were reported and  minor effect, such as discomfort  Minor soreness, extreme pain, skin burns 2nd grade, hypotension, Deep Vein Thrombosis (DVT) ( patient has history DVT).

Conclusions: Dextrose Prolotherapy is a potentially effective treatment for patients with muscle, tendon or ligament tear or pathology. Efficacy in long term follow-up, as single therapy or first-line therapy cannot be determined from the current literature.

Dextrose, prolotherapy, muscle, tendon, ligament.

Article Details

How to Cite
Rhatomy, S., Margaretha, E., & Rahmadian, R. (2020). Dextrose Prolotherapy for Muscle, Tendon and Ligament Injury or Pathology: A Systematic Review. Annual Research & Review in Biology, 35(10), 43-62.
Systematic Review Article


Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Heal Organ. 2003;81:646–656.

Hootman JM, Macera CA, Ainsworth BE, Addy CL, Martin M, Blair SN. Epidemiology of musculoskeletal injuries among sedentary and physically active adults. Med Sci Sport Exerc. 2002;34:838–44.

Shah R, Sinclair A. Utilization of prolotherapy for facilitation of ligament and tendon healing. Athl Ther Today. 2010;15(11):25–7.

Yelland MJ, Mar C. Del, Pirozzo S, Schoene ML. Prolotherapy injections for chronic low back pain: A systematic review. Spine (Phila Pa 1976). 2004;29(19):2126–33.

Hauser RA, Lackner JB, Steilen-matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139–59.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ. 2009;339(7716):332–6.

Longo UG, Rizzello G, Loppini M, Locher J, Buchmann S, Maffulli N, et al. Multidirectional instability of the shoulder: A systematic review. Arthrosc - J Arthrosc Relat Surg. 2015;31(12):2431–43.

Bertrand H, Reeves KD, Bennett J, Bicknell S, Cheng A, Statistics PD. Dextrose prolotherapy versus control injections in painful rotator cuff tendinopathy. Arch Phys Med Rehabil. 2016;97:17-25.

Seven MM, Ersen O, Akpancar S, Ozkan H, Turkkan S, Yıldız Y, et al. Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions. Orthop Traumatol Surg Res [Internet]. 2017;103(3):427–33. Available:

George J, Li SC, Jaafar ZHM. Comparative effectiveness of ultrasound-guided intratendinous prolotherapy injection with conventional treatment to treat focal supraspinatus tendinosis. Sci. 2018;1–6.

Lin C, Huang C, Huang S. Effects of hypertonic dextrose injection on chronic supraspinatus tendinopathy of the shoulder: Randomized effects placebo-controlled trial. Eur J Phys Rehabil Med. 2018;55(4):480–7.

Cole B, Lam P, Hackett L, Murrell GAC. Ultrasound-guided injections for supraspinatus tendinopathy: Corticosteroid versus glucose prolotherapy – a randomized controlled clinical trial. Shoulder Elb. 2017;1–9.

Lee D, Kwack K, Rah UW, Yoon S. Prolotherapy for refractory rotator cuff disease: Retrospective case-control study of one year follow-up. Arch Phys Med Rehabil. 2015;96(11):2027–32.

Buchanan BK, Deluca JP, Lammlein KP. Case report technical innovation case report: Ultrasound-guided prolotherapy injection for insertional Achilles calcific tendinosis. Case Rep Orthop. 2016;1– 5.

Lyftogt J, Zealand N. Prolotherapy and Achilles tendinopathy: A prospective pilot study of an old treatment. Australas Musculoskelet Med. 2005;10(1):16–9.

Maxwell NJ, Ryan MB, Taunton JE, Gillies JH, Wong AD, Nj M, et al. Intratendinous injection of hyperosmolar dextrose to treat chronic tendinosis of the Achilles tendon: A pilot study. AJR. 2007;189(10):215– 20.

Ryan M, Wong A, Taunton J. Favorable outcomes after sonographically guided intratendinous injection of hyperosmolar dextrose for chronic insertional and midportion Achilles tendinosis. AJR. 2010;194(4):1047–53.

Yelland MJ, Sweeting KR, Lyftogt JA, Ng SK, Scuffham PA, Evans KA. Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: A randomised trial. Br J Sport Med. 2011;45(5):421–8.

Fullerton BD. High-resolution ultrasound and magnetic resonance imaging to document tissue repair after prolotherapy: A report of 3 cases. Arch Phys Med Rehabil. 2008;89:377–85.

Pei-Chun Hsieh, Hong-Jen Chiou, Hsin-Kai Wang, Yi-Chen Lai, Yung-Hui Lin M. Ultrasound-guided prolotherapy for acromial enthesopathy and acromioclavicular joint arthropathy: A single-arm prospective study. J Ultrasound Med. 2018;1–8.

Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM R. 2014;6(2):152–8.

Ryan M, Wong A, Rabago D, Lee K, Taunton J. Ultrasound-guided injections of hyperosmolar dextrose for overuse patellar tendinopathy: A pilot study. Br J Sports Med. 2011;45(12):972–7.

Reeves KD, Hassanein KM. Long term effects of dextrose ligament laxity. Altern Ther. 2003;9(3):58–62.

Jensen KT, Rabago DP, Best TM, Patterson JJ, Jr RV. Response of knee ligaments to prolotherapy in a rat injury model. Am J Sports Med. 2008;36(7): 1347–57.

Martins CAQ, Bertuzzi RT, Tisot RA, Michelin AF, Stroher A, Burigo M. Dextrose prolotherapy and corticosteroid injection into rat Achilles tendon. Knee Surg Sport Traumatol Arthrosc. 2012;20:1895–900.

Ekwueme EC, Mohiuddin M, Yarborough JA, Brolinson PG, Docheva D, Fernandes HAM, et al. Prolotherapy induces an inflammatory response in human tenocytes in vitro. Clin Orthop Relat Res. 2017;475(8):2117–27.

Freeman JW, Empson YM, Ekwueme EC, Paynter DM, Brolinson PG. Effect of prolotherapy on cellular proliferation. Transl Res. 2011;158(0298):132–9.

Chan O, Havard B, Morton S, Pritchard M, Maffulli N, Crisp T, et al. Outcomes of prolotherapy for intra-tendinous Achilles tears: A case series. Muscles Ligaments Tendons J. 2017;7(1):78–87.

Jensen KT, Rabago DP, Best TM, Patterson JJ, Jr RV. Early inflammatory response of knee ligaments to prolotherapy in a rat model. J Orthop Res. 2008;26(6):816–23.

Tsai S, Hsu Y, Lee M, Huang H, Huang C, Tung Y. Effects of dextrose prolotherapy on contusion-induced muscle injuries in mice. Int J Med Sci. 2018;15(11):1251–9.

Güran Ş, Çoban ZD, Karasimav Ö, Demirhan S, Karaağaç N, Örsçelik A. Dextrose solution used for prolotherapy decreases cell viability and increases gene expressions of angiogenic and apopitotic factors. Gulhane Med J. 2018;60:42–6.

Catapano M, Zhang K, Mittal N, Sangha H, Onishi K, Sa D. De. Effectiveness of dextrose prolotherapy for rotator cuff tendinopathy: A systematic review. PMR. 2020;12:288–300.

Hassan F, Trebinjac S, Murrell WD. The effectiveness of prolotherapy in treating knee osteoarthritis in adults a systematic review. Br Med Bull. 2017;122(1):91–108.

Wooley JR, Newcomb RL, SAD, Ogunseitan O, Haldeman S. Side effects and adverse events related to intraligamentous injection of sclerosing solutions (Prolotherapy) for back and neck pain: A survey of practitioners. Arch Phys Med Rehabil. 2006;87(7):909–13.