What is Dextrose Prolotherapy?

What is Dextrose Prolotherapy?

Dextrose prolotherapy is an injection-based treatment in which a hyperosmolar dextrose (glucose) solution is injected into ligaments, tendons, joints, or adjacent soft tissues with the intent to stimulate a local inflammatory response and promote tissue repair in chronic musculoskeletal conditions.

The mechanism of action, which has been proposed for decades, is that it causes the induction of a mild, controlled inflammatory reaction, which is hypothesized to trigger healing and regeneration of connective tissue through the recruitment of growth factors and modulation of the inflammatory process. [1–2]

 
Expanding Understanding of the Mechanism

More recently, the exact mechanism of why dextrose-based solutions are beneficial has gone under deeper investigation around the world. To say that the whole story has been fully elucidated would not be an accurate statement.

Different mechanisms are being proposed and discussed, which add more understanding to our current inflammatory model of understanding. One of the hypotheses that has been proposed is that dextrose injections can actually enhance cartilage growth through aggrecan synthesis and expression in musculoskeletal tissues, particularly chondrocytes. [7]

This particular mechanism of action would fit well with some of the case reports across the literature, which suggest that osteoarthritic patients can actually achieve an increase in joint space following treatment. [8] Additionally, it would fit very well with a case study that performed arthroscopies (camera is placed into the joint) following treatment to assess for cartilage re-growth. [9]

 
Research, Dosing, and Common Uses

We are committed to keeping you up to date on the latest prolotherapy research as we elucidate this treatment mechanism of action in real-time.

Despite the push to further understand the MOA, Dextrose prolotherapy is commonly used for:

Chronic tendinopathies
Ligament injuries
Osteoarthritis
Other various musculoskeletal conditions

Concentrations of dextrose used in clinical studies typically range from 10% to 25%, with higher concentrations often used for intra-articular structures, and lower concentrations for extra-articular structures.

The injection protocol and frequency vary, but treatments are usually administered at intervals of 2–6 weeks over several sessions. Individuals typically average 4–6 treatments, with some above this number and some below. [3–6]

 
Otten Medical’s Biotensegrity-Based Approach

At Otten Medical, we have dedicated significant time to sampling various practices in their use of dextrose prolotherapy. What we have found is that achieving good patient outcomes is largely dependent on the method that is used.

Since this is a proliferant solution and the goal with this specific regenerative treatment is to use a biotensegrity-based approach (addressing the joint as a whole), it is important that the physician uses a sufficient amount of concentrated solution and adresses a sufficient number of connective tissue structures.

For instance, if we are specifically trying to address an MCL sprain in the knee, we take the approach that it’s unlikely the MCL was sprained in isolation. If the MCL has been sprained, using a biotensegrity-based approach tells us that it’s likely there are other connective tissue structures that have been weakened in the process.

So even if other structures are non-painful, restoring biotensegrity, and therefore good biomechanics of the joint, may be dependent on addressing these structures also.

 
The Broader Perspective Makes a Difference

This is why we strongly consider supporting role structures as well as downstream and upstream joints.

In addition to this, reversing the degenerative cascade to a regenerative one typically takes a little persistence. Therefore, we employ this perspective in each case.

These overall differences in philosophy typically make treatment much more successful in our experience. And these differences can often give that case which “has tried it all” the elusive answers that they’ve been looking for.

Article written and composed by:

Dr. Drew Otten NMD

Founder and Medical Director of Otten Medical PLLC

REFERENCES

1.     Distel, L. M., & Best, T. M. (2011). Prolotherapy: A clinical review of its role in treating chronic musculoskeletal pain. PM&R: The Journal of Injury, Function, and Rehabilitation, 3(6 Suppl 1), S78–S81. https://doi.org/10.1016/j.pmrj.2011.04.003 

2.     Jensen, K. T., Rabago, D. P., Best, T. M., Patterson, J. J., & Vanderby, R. (2008). Early inflammatory response of knee ligaments to prolotherapy in a rat model. Journal of Orthopaedic Research, 26(6), 816–823. https://doi.org/10.1002/jor.20600 

3.     Ciftci, Y. G. D., Tuncay, F., Kocak, F. A., & Okcu, M. (2023). Is low-dose dextrose prolotherapy as effective as high-dose dextrose prolotherapy in the treatment of lateral epicondylitis? A double-blind, ultrasound guided, randomized controlled study. Archives of Physical Medicine and Rehabilitation, 104(2), 179–187.  https://doi.org/10.1016/j.apmr.2022.09.017 

4.     Teymouri, A., Birang, N., Fakheri, M., & Nasiri, A. (2025). Comparison of the efficacy of ultrasound-guided dextrose 25% hypertonic prolotherapy and intra-articular normal saline injection on pain, functional limitation, and range of motion in patients with knee osteoarthritis: A randomized controlled trial. BMC Musculoskeletal Disorders, 26(1), 313. https://doi.org/10.1186/s12891-025-08580-5 

5.     A comparative analysis of prolotherapy efficacy in patients with knee osteoarthritis across varied dextrose concentrations. (n.d.). https://pubmed.ncbi.nlm.nih.gov/37540383/ 

6.     Open Medical Publishing. (n.d.). A comprehensive update of prolotherapy in the management of osteoarthritis of the knee. Orthopedic Reviews. https://orthopedicreviews.openmedicalpublishing.org/article/33921-a-comprehensive-update-of-prolotherapy-in-the-management-of-osteoarthritis-of-the-knee 

7.     Wu, T. J., Fong, Y. C., Lin, C. Y., Huang, Y. L., & Tang, C. H. (2018). Glucose enhances aggrecan expression in chondrocytes via the PKCα/p38-miR-141-3p signaling pathway. Journal of Cellular Physiology, 233(9), 6878–6887. https://doi.org/10.1002/jcp.2645 

8.     Caring Medical. (2024, September 21). Prolotherapy knee cartilage regeneration: Standard clinical x-ray studies document cartilage regeneration in five degenerated knees. https://caringmedical.com/about/prolotherapy-results/cartilage-regeneration-knees/ 

9.     Rabago, D., Mundt, M., Zgierska, A., Grettie, J., & Kijowski, R. (2016). Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Results of a single-arm uncontrolled study with 1-year follow-up. PM&R, 8(7), 652–662. https://pubmed.ncbi.nlm.nih.gov/27058744/