Comparative Efficacy of Intra-articular vs. MRI-guided Extra-articular Dextrose Injections in Knee Osteoarthritis Management

"IA injection: 5 ml of 20% dextrose (2ml vitagen in 2ml normal saline and 1ml 1% xylocain) will be injected. The ultrasound transducer (L18-4, Philips EPI Q5) is placed transversely over the patient's suprapatellar pouch while the patient lies supine with the knee actively extended and ankle dorsiflexed. The injectate will be injected into the suprapatellar pouch via transverse view, in-plane, lateral-to-medial approach with a 3.8 cm 22-gauge needle under US guidance.~Physical therapy: The physical therapy program includes physical modalities (heat therapy and electric therapy) and therapeutic exercise (stretching, ROM exercise, and strengthening), three times a week, and will be continued for 4 weeks."

Patients in the EA group will receive MRI examination of the knee without contrast. Detailed physical examinations (PE) will also be done for each subject. The PEs include inspection, palpation for local tenderness and crepitus, signs of effusion, assessment of range of motion, provocative meniscal testing, and ligamentous tests for laxity. A total of 5 ml of 20% dextrose (2ml vitagen in 2ml normal saline and 1ml 1% xylocain) will be injected to the target areas which has been shown abnormal on MRI images with a 3.8 cm 22-gauge needle under US guidance. For lesions of the deep structures or bone marrow lesion, a 7-cm 23 or 21 gauge needles may be used. Same as the IA group, EA hypertonic dextrose injection will be done at the 0, 2nd, and 4th weeks, as well as physical therapy during the first 4 weeks.