The effectiveness of PROLOTHERAPY for recalcitrant Medial TIBIAL Stress Syndrome: a prospective consecutive CASE series

• Published in: Journal of foot and ankle research 2021-04, Vol.14 (1), p.32-n/a, Article 32
• Main Authors: Padhiar, Nat, Curtin, Mark, Aweid, Osama, Aweid, Bashaar, Morrissey, Dylan, Chan, Otto, Malliaras, Peter, Crisp, Tom
• Format: Article
• Language: English
• Subjects: Adult; Adverse events; Analysis; Athletic Injuries - therapy; Clinical trials; Dextrose; Exercise; Exercise‐induced leg pain; Female; Glucose; Glucose - administration & dosage; Homeopathy; Humans; Inflammation; Information management; Injection; Legs; Magnetic resonance imaging; Male; Materia medica and therapeutics; Medial Tibial Stress Syndrome - therapy; Military personnel; MTSS; Pain; Pain Measurement; Patients; Periosteum; Physical fitness; Prolotherapy; Prolotherapy - methods; Prospective Studies; Rankings; Sports injuries; Statistical analysis; Stress (Physiology); Surgeons; Surgery; Therapeutics; Tibia; Treatment Outcome; Ultrasonic imaging; Ultrasonography, Interventional - methods; Ultrasound; Young Adult
• ISSN: 1757-1146; 1757-1146
• DOI: 10.1186/s13047-021-00453-z

Background Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6 and 16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degrees of success. In recalcitrant cases, surgery is often the only option. Objective To evaluate whether ultrasound‐guided injection of 15% dextrose for treatment of recalcitrant MTSS decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up the sport. Method The study design was a prospective consecutive case series involving eighteen patients: fifteen male and three female; (mean age = 31.2 years) with recalcitrant MTSS. They were referred from sports injury clinics across the UK, having failed all available conservative treatment. Intervention An ultrasound‐guided sub‐periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of the symptomatic area. Main outcome measures Pain was assessed using a 10‐cm visual analog scale (VAS) at baseline, short‐term, medium‐term (mean 18 weeks), and long‐term (mean 52 weeks) follow‐up. Symptom resolution and return to activity were measured using a Likert scale at medium and long‐term follow‐up. Statistical analyses were performed using SPSS for Mac version 19.0.0 (IBM, New York, NY, US). The Shapiro‐Wilk test was used to evaluate the normality of the distribution of data. Friedman's non‐parametric test was used to compare the within‐patient treatment response over time. Post‐hoc Wilcoxon signed‐rank tests with Bonferroni corrections were performed to determine VAS average pain response to treatment over five paired periods. Results Patients reported a significant (p