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

Abstract

Abstract 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 /μm 2 ) (OA = 2.01 cell × 10–3/μm 2 ), 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.