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What is the best treatment for Sacroiliac (SI) dysfunction. PRP or Prolotherapy?

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What is the best treatment for Sacroiliac (SI) dysfunction. PRP or Prolotherapy?

Updated: Aug 14, 2021

A comparison of ultrasound guided PRP injection and prolotherapy for mechanical dysfunction of the sacroiliac joint

Jennifer Saunders, MBBS, FACSP, Mel Cusi, MBBS, PhD, FACSP, FFSEM (UK), Lisa Hackett, AMS, Hans Van der Wall, MBBS, PhD, FRACP


Objective: The sacroiliac joint (SIJ) can become dysfunctional through trauma and/ or pregnancy. The mechanism involves direct or repetitive microtrauma to the buttocks/ lower back. Treatment with specialised physiotherapy alleviates the problems in ~ 80% of cases. The remainder may respond to prolotherapy (hypertonic glucose injections into the dorsal intra-osseous ligament (DIOL) after multiple injections. We hypothesised that the response may be more rapid with injection of platelet enriched plasma (PRP) into the DIOL under ultrasound guidance.

Design: Following Ethics approval, a study was undertaken to compare the efficacy of PRP injections Vs Standard prolotherapy.

Setting: A group of 45 patients (35F, 10M, Age range:18-70 yrs) was studied and the results compared to the control group who had received hypertonic glucose injections following tertiary referral from specialized sports medicine physicians.

Main outcome measures: All patients were assessed clinically at baseline, 3 and 12 months. Outcome measures included VAS, Roland-Morris questionnaire and Quebec Back Pain inventory, as well as clinical tests of SIJ incompetence.

Results: The outcome measures of change in pain scores, improvement in function between the groups was superior for the PRP group, All PRP patients experiencing significant improvement in pain score and function. The number of injections required was less for the PRP group (mean of 1.6) than the controls (mean 3.0).

Conclusion: PRP is a viable alternative to hypertonic dextrose injections into the DIOL in patients who have failed physiotherapy for SIJ incompetence. It is better tolerated as less injections are required and avoids radiation exposure in a relatively young group of patients.Journal of Prolotherapy. 2018;10:e992-e999.

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