Joint Reconstruction Therapy

What Is It?

The history of Joint Reconstruction Therapy (a.k.a. “Sclerotherapy”, “Prolotherapy,””Reconstructive Therapy”) dates back to ancient times.  It is said that the dislocated shoulder was treated by Hippocrates in the Fifth Century B.C. on the battle fields with red hot needle cauterization of the weakened part of the shoulder. 

The technique of injecting solutions into the tissues for the purpose of proliferating new fibrous tissue has its roots nearly a century-and-a-half ago when Velpeau, in 1835, treated hernias by injections of a solution of iodine.  For 100 years, from 1835 to 1935, many injected proliferants were reported as giving “good results” in the treatment of hernias.  In the mid 1930’s, Manoil, Rice, and Mattson reviewed the various proliferants by making histological studies of animal injection sites. 

Reconstructive Therapy and Prolotherapy, when applied to joints and tendons, are terms that can be used interchangeably.  Essentially, it is an injection technique that is uses a solution to stimulate growth ligament or tendon cells and fibers at their attachment points on the bone.  The solution stimulates growth of new tissue by dehydrating or chemically irritating the growth centers of tendons or ligaments at their osseous junctions.  The new tissue produces added tensile strength to the injured or degenerated structures that are causing pain and/or joint instability. 

The solutions that are injected do not contain cortisone or steroids.  Instead, the solutions used to stimulate repair of torn or worn out ligaments and tendons are usually substances such as concentrated sugar (e.g., dextrose) or cod liver oil (e.g., sodium morrhuate).  These substances are diluted to the proper concentration with local anesthetics, such as Lidocaine, Procaine, or Marcaine. 

How Does It Work?

Ligaments, cable-like structures similar in design to a rope, hold joints and bones together.  Auto accidents, falls, sports injuries, or repetitive movements can cause ligaments to become slack or tear, much as a rope stretches, separates, or frays.  Over time, the consequences may be joint damage, disk degeneration, and pain. 

Reconstructive therapy involves injections of an irritant–usually concentrated glucose–into areas where ligaments are weak or damaged.  The injection just be precisely at the junction of a bone with a ligament.  Multiple injections are given in one siting because one injection typically affects an area of approximately 5 mm (3/16″) in diameter.  Hence, as many as 20 sites may be injected during the same session. 

Although the body responds to the irritant solution with inflammation, this is a “sterile” inflammation and should not be confused with the type of inflammation caused by an infection.  This “sterile” inflammation, in turn, triggers the development of healthy new ligament tissue.  It works by attracting fibroblast cells, which are used by the body to produce elastin found in connective tissues, to the area of induced inflammation.  The re-growth process, initiated by the fibroblasts, should be complete after six weeks.  It takes this long for new tissue to be created by the body in response to the injections. 

Who Is A Candidate?

Patients with local and/or referred pain problems that are related to one or more of the following are candidates for reconstructive therapy:

1. Chronic joint pain from injury or wear-and-tear degeneration;
2. Arthritis;
3. Problems of posture that cause pain from mechanical problems; and
4. New injuries of joints, ligaments, or tendons of the spine or limbs. 

Patients with chronic back pain who have not responded to physical therapy, medication, chiropractic manipulation, and other conservative measures may also be candidates for reconstructive therapy.  In fact, any condition involving loose or slack ligaments may be treated effectively with this approach.  Other conditions that have responded to this treatment include: spine instability, scoliosis, degenerated discs, sciatica, arthritis, temporomandibular joint (TMJ) pain, and some hip, shoulder, wrist, elbow, knee, and ankle pain. 

How Should I Feel After The Injections?

Patients need to be aware that the response time after injections may resemble a mild to moderately severe sprain.  When the anesthetic wears off, there will be a little soreness and stiffness.  This is a sign that you are getting the proper response to the injection.  This will usually last the same length of time that these symptoms remain following a mild to moderate sprain.  Sometimes there is no soreness at all.  

What Do I Do For Pain?

Patients who experience symptoms should use ice for 20 minutes several times a day for discomfort or swelling and avoid using any heat until the second or third day.  Reduced use or stress of the injected areas is advised for a while but patients should continue to walk and do mild activities which are part of their normal routine.  Strenuous work or sports may need to be stopped or modified for two or three weeks after injections to give the tissue repair a chance to build up.  Do not be concerned if you do not have any discomfort from the injections or if the pain for which you are being treated goes away permanently after the injections.  This actually occurs in 10% of patients. 

Aspirin, Advil, NSAID’s (Non-Steroidal Anti-Inflammatory Drugs), and steroid medications stop inflammation and reduce pain.  Since inflammation is the desired affect in the healing and repair response to injections, these drugs should be avoided if possible to get the strongest response to injections.  Short-term use of narcotics (e.g., Darvocet, Tylenol with codeine, etc.) or extra-strength Tylenol may be necessary in a few cases. 

How Many Treatments Do I Need?

For some, a single treatment is adequate; for others, it is necessary to extend treatments over a period of weeks or months.  Length of treatment depends on the severity of the patient’s condition as well as the patient’s response to the treatment.  On rare occasions, a patient will respond well to one set of injections.  Most mildly severe conditions require three to four sets of injections at one to two-week intervals.  Moderately severe conditions require at least six sets of injections at one to two-week intervals with a four to six week break before considering any additional series.  Very severe conditions may require ten or more sets of injections.  

What Are My Chances For Success?

Patients with arthritic and traumatic conditions that are not complicated by disc herniation or nerve root injury or by any other health conditions, which produce slow healing responses, have about a 90% chance for good to excellent healing response.  Those complicated by a neurological injury (e.g., disc herniation) have from a 50% to 75% chance of a good to excellent response.  Approximately 10% of the more severe conditions in the latter category may not recognize any improvement. 

How Much Does It Cost?

Reconstructive therapy is covered by many major health insurance companies.  Costs range from $75-$400 for treatment, which includes the cost of an office visit.  However, multiple joint areas injected during the same office visit must be billed separately.  In addition, supplements, IV infusions, and/or electromagnetic stimulation are often recommended to be taken to help with the healing process.