Changes in levels of cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen in subjects with knee osteoarthritis after dextrose prolotherapy: A randomized controlled trial.

High dropout rate: Only 47 of 76 allocated participants completed the study, which the authors admit introduces considerable bias. Baseline imbalances: The dextrose prolotherapy group started with significantly worse pain and function than the hyaluronic acid group, requiring statistical adjustment that may not fully account for these differences. Small sample size: The study was underpowered, with fewer participants analysed than the calculated minimum of 18 per group required for 90% power (though 26 and 21 remained, the attrition was high). Short follow-up: Outcomes were assessed only 3 weeks after the final injection, which is insufficient to determine long-term effects on cartilage preservation or clinical durability. Confounding comorbidities: The study did not exclude patients with other diseases, which may have affected the serum biomarker levels (sCOMP).

Do not conclude that dextrose prolotherapy is superior for all knee osteoarthritis patients. The prolotherapy group had significantly worse pain and function at baseline, and the high dropout rate means the remaining participants may not represent the broader population. The primary finding of reduced cartilage degradation markers does not necessarily translate to long-term structural benefit.