The groups were similar at baseline, and follow-up was 100%. At 3 months, NPPS scores improved more in dextrose-treated knees than in either the lidocaine-treated knees (3.9 vs 2.4; P=.004) or those who received usual care (3.9 vs 1.2; P=.001), and lidocaine alone was significantly better than usual care (2.4 vs 1.2; P=.024). More than 90% of participants in both injection groups achieved unlimited sports participation by 3 months. However, knees treated with dextrose were significantly more likely than lidocaine-treated knees to allow asymptomatic participation (NPPS=0), with 14 of 21 knees and 5 of 22 knees, respectively, being pain-free. After one year, more dextrose-treated knees than lidocaine-treated knees were asymptomatic with sports participation (32 of 38 vs 6 of 13; P=.024).
There were no reported adverse effects during this study and fewer than 10% of subjects required acetaminophen for postinjection pain control.
WHAT’S NEW: OSD can be safely and effectively treated
This study found dextrose injections to be safe, well tolerated, and effective in treating patients with intractable OSD symptoms. The results suggest that the duration of both the sports limitation and sports-related symptoms may be reduced with dextrose injections in adolescent athletes with recalcitrant OSD.
CAVEATS: Lack of validated measure, controls
NPPS is not an ideal measure of OSD symptoms because it has not been validated. The failure to use a validated measure of tendinopathy symptoms (eg, the Victorian Institute of Sport Assessment-Patella8) is a significant limitation of this trial. The athletes included in this study had already failed to respond to the usual treatment, which suggests that injections should be reserved for those who have tried hamstring stretching and quad-strengthening exercises.
CHALLENGES TO IMPLEMENTATION: Patient and provider comfort may be an issue
Although the injections in this study were well tolerated, there is a risk of infection, bleeding, and pain with any injection or invasive procedure. In addition, adolescents often have difficulty tolerating injections, especially repeated needlesticks like those called for in the proposed treatment. The nonviscous nature of dextrose allows 27- to 30-gauge needles to be used, which may make the injections easier for teens to tolerate. Some physicians may be hesitant to start these young patients on a new injectable therapy.