Repair of a complete anterior cruciate tear using prolotherapy:
a case report
Walter Grote, Rosa Delucia, Robert Waxman, Aleksandra Zgierska, John
Wilson, David Rabago
Sparta Medical Associates, Columbia New Jersey, USA
Department of Family Medicine, University of Wisconsin, Madison, Wisconsin, USA
Diagnostic Radiology Associates PA, Ridgewood, New Jersey, USA
Int Musculoskelet Med. 2009 Dec
Introduction: Surgical reconstruction is considered definitive treatment for anterior cruciate
ligament (ACL) tears but precise surgical indications are debated. Some patients are reluctant or inappropriate
surgical candidates. Prolotherapy is a non-surgical injection therapy for chronic musculoskeletal pain and instability.
This case report documents the non-surgical repair of a torn ACL using prolotherapy and at-home exercise.
Clinical presentation and intervention: An 18-year-old woman sustained a right knee injury during a downhill
skiing accident. Magnetic resonance imaging (MRI) revealed a high-grade partial versus complete rupture; Lachman
examination findings suggested a complete rupture. She deferred surgical treatment. At 21 weeks post-injury, with
unstable gait, inability to climb stairs and more than 1-cm anterior drawer test, she consented to undergo
prolotherapy injections. She received seven prolotherapy sessions over a 15-week period. At-home exercises
were initiated at the third prolotherapy session.
Results: The patient improved. Walking on flat ground improved 4 weeks after initiation of
prolotherapy; she could ride a stationary bicycle for 30 min by 12 weeks. By 15 weeks, the patient
had no instability climbing and descending stairs, the anterior drawer test was negative and MRI
showed an intact ACL with fibrosis. Subsequently, she returned to full sport activity.
Conclusions: We document the non-surgical repair of a high-grade partial or complete ACL tear using
prolotherapy and at-home exercise. Prolotherapy may be an alternative to surgery in carefully selected
patients. This report is consistent with findings of recent pilot-level studies and suggests the need
for rigorous clinical trials assessing prolotherapy as treatment for ligament and tendon injury in
selected patients.