Outcomes of hyaluronic acid and dextrose prolotherapy on surgically induced rat osteoarthritis: Single versus combined treatment.

Osteoarthritis (OA) is the most prevalent chronic joint disorder. This study explored therapeutic mechanisms of intra-articular (i.a.) hyaluronic acid (HA), and/or dextrose prolotherapy (DPT) on surgically induced OA. Rats were divided into five groups (n = 12): control, OA, HA, DPT, and DPT + HA groups. OA group revealed increase in serum alkaline phosphatase (ALP) level, knee extension angle diameter, and CD44 immuno-expression, furthermore a decrease in cartilage thickness, chondrocyte density, and glycosaminoglycan and proteoglycan cartilage contents. Radiologically and microscopically, OA caused joint cavity narrowing, articular damage, exposed subchondral bone, and a rough surface. These parameters were modulated in HA, DPT, and DPT + HA groups. There were significant decreased ALP level (404.35, 414.97, and 318.73 U/L) (OA = 425.65 U/L), extension angle (29.25°, 47.93°, and 26.42°) (OA = 52.78°), knee diameter (7.52, 7.04, and 6.92 mm) (OA = 8.87 mm) and CD44-immunopositive chondrocyte percentage (73.27%, 16.33%, and 83.40%) (OA = 87.95%), and increased cartilage thickness (155.24, 186.83, and 230.56 μm) (OA = 115.98 μm), chondrocyte density (2.24, 3.11, and 3.21 cell × 10-3/μm2) (OA = 2.01 cell × 10-3/μm2), and glycosaminoglycan (0.653, 0.837, and 0.886) (OA = 0.485) and proteoglycan cartilage contents (0.588, 0.710, and 0.738) (OA = 0.340). There was no significant difference between HA and DPT groups except for extension angle, chondrocyte density, and glycosaminoglycan and proteoglycan contents were higher in the HA group, and CD44-immunoexpression was higher in the HA group. In conclusion, combination of i.a. HA and DPT has the upper hand in mitigation of OA parameters and is recommended for OA treatment.