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Dextrose injection effective for Osgood-Schlatter disease

Clinical Question:
Can injection with hyperosmolar dextrose decrease sports-related symptoms in young athletes with Osgood-Schlatter disease?

Bottom Line:
An injection of a solution of 12.5% dextrose and 1% lidocaine is an effective treatment of Osgood-Schlatter disease (OSD) symptoms in young athletes. The mechanism of action is not clear, but it likely involves local healing prompted by the increased availability of glucose rather than the scarring-down that occurs with prolotherapy using higher concentrations. (LOE = 1b-)

Reference:
Topol GA, Podesta LA, Reeves KD, Raya MF, Fullerton BD, Yeh HW. Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter disease. Pediatrics 2011;128(5):e1121-e1128.  [PMID:21969284]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Self-funded or unfunded

Allocation:
Uncertain

Setting:
Outpatient (any)

Synopsis:
These researchers enrolled 51 boys aged 10 years to 17 years and 4 girls aged 9 years to 15 years identified through a screening of teams of jumping or kicking sports in a city in Argentina. All the patients had a diagnosis of OSD, characterized as pain during sport activity, pain over the tibial tuberosity during a single leg squat, and the lack of patellofemoral crepitus and patellar tenderness. Before enrollment, all the athletes underwent 2 months of stretching and strengthening. If the pain during activity remained, the children were randomized (concealed allocation unknown) into 1 of 3 groups. One group received usual care (continued strengthening and stretching). Children in the other 2 groups received an injection with either lidocaine 1% or lidocaine 1% mixed with dextrose 12.5%. After identifying the tender point, 1/2 mL lidocaine or lidocaine/dextrose solution was administered via a 27-gauge needle to a depth of less than 1.25 cm. Three to 4 injections at 1-cm intervals were administered over and above the tibial tuberosity, with additional injections administered 5 minutes later, either medial or lateral, until all pain was relieved (hence the lidocaine in both groups). This procedure was repeated monthly for 2 more months, regardless of the degree of pain at these times. One month after the third injection, the majority of children in both injection groups had full return to their sports (100% and 91%) as compared with 60% of children treated with usual care (P < .05 for both comparisons). At 1 year, 32 of 38 (84%) dextrose-treated knees were pain-free as compared with 6 of 13 lidocaine-treated knees and 2 of 14 usual care knees (P < .05 for both comparisons).

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