Exploring dextrose prolotherapy in rotator cuff disorders: A systematic review and meta-analysis

Rotator cuff (RC) disorders have a varied range of treatment. Multiple interventional, non-surgical treatments are often opted for by patients. This study evaluates the effectiveness of dextrose prolotherapy in treating RC pathologies.

A comprehensive review of databases (PubMed, Google Scholar, Embase, Scopus, and Cochrane databases) from 2000 to June 2025 identified 13 relevant studies involving 936 patients. The randomised clinical trials, which compared dextrose prolotherapy with interventions such as platelet-rich plasma, steroids, physiotherapy, or placebos, were included in the systematic review. A risk-of-bias analysis was conducted using the Risk of Bias Visualisation Tool. It indicated that seven studies had low bias. Studies with a high risk of bias were excluded from the meta-analysis. The protocol was registered beforehand (PROSPERO ID: CRD42024520747).

Review Manager software was used to analyse the data and generate the plots. The analysis showed that prolotherapy significantly reduced pain (MD = -0.76; 95% CI: -1.26, -0.27; P = 0.003), improved functional outcomes (shoulder pain and disability index (MD = -8.58; 95% confidence interval (CI): -13.00, -4.17; P = 0.0001)), and enhanced ultrasonography features. No major adverse effects were reported, indicating that the treatment is safe.

This systematic review and meta-analysis suggests that dextrose prolotherapy may be a feasible and effective alternative for RC disorders, and it can be considered for patients with limited treatment options. However, to reach the required information size, further trials are required. Uniformity in protocols, intervention strategies, and outcome reporting is necessary for longer follow-up periods to facilitate more effective evidence synthesis. This study received no external funding.