PROLOTHERAPY

None of the high-level studies indicated benefit with prolotherapy versus control. Three moderate quality studies demonstrated the following results: better SPADI at three months (Kazempour Mofrad, 2021) with prolotherapy when compared to exercise, improved pain level (Chang, 2021), and better patient satisfaction (Bertrand, 2016). One low quality study (Eroglu, 2022) demonstrated better PROs (SPADI, WORC) when compared to exercise (PT).

When comparing prolotherapy to CS injection, there are four high quality, three moderate quality, and two low quality studies. Lin et al (2023) found better SPADI scores, improved pain, and ROM with CS injection, whereas Sari et al (2020) and Cole et al (2018) found no differences (ASES, WORC; OSS, ROM, strength) despite improved pain with CS at 1.5 months (Sari). Sabaah et al (2020) found better pain control at 3 months with prolotherapy than CS injection.

Based upon the studies, prolotherapy is not recommended for patients with full-thickness rotator cuff tears.