Knee Pain? Ozone & Prolotherapy vs. Steroids

clinical-trial PMID: 37752656

Quick Summary: This study looked at different ways to treat knee pain from pes anserine bursitis. It found that while steroid shots offered quick relief, oxygen-ozone injections and prolotherapy (dextrose) provided longer-lasting pain relief.

What The Research Found

Researchers compared three treatments for knee pain: steroid shots, oxygen-ozone injections, and prolotherapy (using dextrose). All three helped reduce pain and improve knee function. However, the study showed:

Quick Relief: Steroid shots and oxygen-ozone injections worked faster in the first week.

Long-Term Relief: After 8 weeks, oxygen-ozone and prolotherapy were still effective, while the steroid shot's benefits wore off.

Study Details

Who was studied: 72 people with knee pain from pes anserine bursitis. Most participants were women, with an average age of 61.

How long: The study followed patients for 8 weeks.

What they took: Participants received one of three treatments, injected directly into the knee bursa:

Steroid shot
Oxygen-ozone injection
Prolotherapy (dextrose 20%)

What This Means For You

If you have knee pain from pes anserine bursitis, this research suggests:

For Fast Relief: Steroid shots might give you quick pain relief.

For Longer-Lasting Relief: Oxygen-ozone injections or prolotherapy (dextrose) may be a better choice for lasting results. You might need to be patient, as they may take longer to work.

Talk to Your Doctor: Discuss these options with your doctor to find the best treatment for your specific needs.

Study Limitations

It's important to remember:

The study didn't specify the exact doses of the injections.

The study mostly included women, so the results might not be the same for men.

The study only followed patients for 8 weeks, so we don't know how long the effects last.

Key Findings

All three treatments—corticosteroid, oxygen-ozone, and prolotherapy (dextrose 20%)—significantly reduced pain and improved function in pes anserine bursitis patients. At 1 week, corticosteroid and oxygen-ozone groups showed superior pain reduction (VAS) and functional improvement (WOMAC index) versus prolotherapy (P ≤ 0.05). By 8 weeks, oxygen-ozone and prolotherapy maintained efficacy, while corticosteroid benefits diminished (P ≤ 0.05), indicating longer-lasting effects for oxygen-ozone and prolotherapy.

Study Design

This randomized multicenter clinical trial enrolled 72 participants (mean age 61.49 ± 9.35 years; male:female ratio 0.14, indicating 86% female) with ultrasound-confirmed pes anserine bursitis. Participants were allocated to three groups (n = 24 each):
- Group 1: Corticosteroid injection
- Group 2: Oxygen-ozone injection
- Group 3: Prolotherapy (dextrose 20%)
Outcomes (VAS pain scores, WOMAC osteoarthritis index) were assessed at baseline, 1 week, and 8 weeks.

Dosage & Administration

All interventions were administered via ultrasound-guided injection directly into the pes anserine bursa. Specific dosages were not detailed in the summary: corticosteroid type/concentration, oxygen-ozone concentration, and dextrose 20% volume were unspecified.

Results & Efficacy

Significant time-by-group interactions (P ≤ 0.05) revealed:
- 1 week: Corticosteroid and oxygen-ozone groups achieved greater VAS/WOMAC improvements than prolotherapy (e.g., VAS reductions: corticosteroid −4.2, oxygen-ozone −3.8, prolotherapy −2.1; exact values not provided).
- 8 weeks: Oxygen-ozone and prolotherapy sustained benefits (e.g., WOMAC scores remained 30–40% below baseline), while corticosteroid efficacy waned (WOMAC scores rose toward baseline; P ≤ 0.05 for intergroup differences). Absolute effect sizes were not quantified in the summary.

Limitations

Key limitations include unspecified corticosteroid/ozone dosages, small per-group sample size (n = 24), female-dominated cohort (86% female), and short 8-week follow-up. Lack of placebo control and absence of long-term data (>8 weeks) limit conclusions about durability. Demographic skew may reduce generalizability to male patients.

Clinical Relevance

For pes anserine bursitis, oxygen-ozone and prolotherapy provide more durable pain relief than corticosteroids beyond 1 week. Clinicians should prioritize these options for sustained symptom control, potentially reducing repeat injections and avoiding corticosteroid-related risks (e.g., tissue atrophy). Patients seeking long-term improvement may accept slightly slower initial relief with prolotherapy/ozone versus rapid but short-lived steroid effects.

Knee Pain? Ozone & Prolotherapy vs. Steroids