Efficacy of hypertonic dextrose infiltrations for pain control in rotator cuff tendinopathy: systematic review and meta-analysis

Introduction. Our study aimed to assess the efficacy of hypertonic dextrose infiltrations (HDI) for pain control in individuals with rotator cuff tendinopathy and to assess the characteristics of the treatment and the presence of side effects or adverse reactions through a systematic review and meta-analysis. Methods. The search for the articles was performed in the electronic databases PLUMED, EMBASE, SCOPUS, SCIELO, DIALNET and Google Scholar, published up to August 2020. The keywords used were "prolotherapy" or "proliferation therapy" or "hypertonic dextrose infiltrations" or "hypertonic dextrose injection" and "Rotator Cuff" or "Rotator Cuff Injury" or "Rotator Cuff Tear" or "Rotator Cuff Tendinosis" or "supraspinatus". The effectiveness of HDI was expressed as standardized mean difference (d) and 95% CI. Results. In the pooled analysis, HDI were an effective intervention to reduce long-term pain in patients with rotator cuff tendinopathy when compared to controls; furthermore, in the individual analyses, HDI were more effective in the short, medium and long terms than noninvasive treatments, and more effective in the long-term than infiltrations with local anesthetics. On the other hand, HDI were not more effective than injections with corticosteroids or PRE Finally; no complications or serious adverse events were observed when HDI were used. Conclusions. We found that HDI reduced long term pain in individuals with rotator cuff. HDI could be an alternative to non-invasive treatments when no favorable results can be achieved. However, due to the small number of studies included in this meta-analysis, new studies are necessary to clarify the efficacy and safety of this intervention.