Optimal Dextrose Concentration for Prolotherapy in TendinopathyA Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE

To compare the effectiveness of different dextrose concentrations used in prolotherapy for reducing pain in patients with tendinopathy.

DATA SOURCES: PubMed, Cochrane Library, and ScienceDirect were searched from inception to July 2025.

STUDY SELECTION: Randomized controlled trials (RCTs) of dextrose prolotherapy in tendinopathy were included; trials reporting 0-10 pain scores at 6-12 weeks against saline were eligible for network meta-analysis.

DATA EXTRACTION: Two reviewers independently extracted data and assessed risk of bias (RoB 2.0); certainty of evidence was rated with CINeMA.

DATA SYNTHESIS: A frequentist common-effect network meta-analysis estimated mean differences (MDs) with 95% confidence intervals (CIs) versus saline, interpreted against a minimal clinically important difference (MCID) of 1.4 points.

RESULTS

Nine RCTs (490 participants) were included; six were at low risk of bias and three had some concerns. Three trials (111 participants) formed the network, each comparison being informed by a single trial. Compared with saline, 15% dextrose (MD -4.66; 95% CI -5.36 to -3.96) and 5% dextrose (MD -3.55; 95% CI -4.24 to -2.86) reduced pain beyond the MCID; both estimates came from one three-arm lateral epicondylitis trial, in which 15% exceeded 5% by 1.11 points (95% CI 0.43 to 1.79). Neither 20% dextrose (MD 0.26; 95% CI -0.22 to 0.74) nor 10.7% dextrose-morrhuate (MD -0.30; 95% CI -1.23 to 0.63) differed from saline. Heterogeneity and inconsistency could not be estimated, and certainty of evidence was low to very low.

CONCLUSIONS

Evidence on the optimal dextrose concentration for tendinopathy is limited. The apparent advantage of 5% and 15% dextrose rests on a single trial and may reflect differences in tendon site, injection schedule, and follow-up rather than concentration alone. Adequately powered trials directly comparing concentrations are needed before dosing recommendations can be made.