Dextrose & oxygen–ozone injection · Ultrasound-guided · Glastonbury, CT
The original regenerative injection, performed here since 1995 — a dextrose solution, with or without medical ozone, placed into the ligament, tendon attachment or joint that has stopped healing on its own.
Quick answer
Prolotherapy is an injection of concentrated dextrose with a local anesthetic into an injured ligament, tendon attachment or joint, which provokes a controlled healing response in tissue that has stalled. Prolozone is the same injection with medical oxygen–ozone gas added. Both are done in office under ultrasound guidance, take about 30 to 45 minutes, and are given as a series of three to six sessions two to four weeks apart. They cost less than PRP and provide a milder biologic stimulus.
Time in office
30 to 45 minutes
Anesthesia
Local only — no sedation
Typical course
3 to 6 sessions, 2 to 4 weeks apart
Return to work
Same or next day
First results
Often after the second or third session
Guidance
Live ultrasound, every injection
Relative strength
1 PRP ≈ 2 to 3 prolotherapy sessions
Insurance
Generally not covered
Definition
Both are injections that deliberately provoke healing — not drugs that mask pain, and not steroids that suppress the repair response.
Prolotherapy — “proliferative therapy” — injects a concentrated dextrose solution with a local anesthetic directly into the structure that is failing. The dextrose acts as a mild irritant at the attachment site, restarting the inflammatory and repair sequence the body normally uses to strengthen ligament and tendon. It has been in clinical use for roughly seventy years, and Dr. Tortland has been performing it since 1995 — longer than nearly any practice in the country.
Prolozone adds medical-grade oxygen–ozone gas, and often B vitamins, to that same dextrose base. The rationale is oxygen delivery: chronically degenerated tissue is poorly perfused, and ozone is used to improve local oxygen utilization in tissue that has run out of metabolic capacity to repair itself.
Neither is a strong biologic stimulus compared with PRP or cellular treatment. Their value is elsewhere: they are inexpensive, well tolerated, repeatable, and unusually good at ligament laxity and attachment-site pain — problems that respond to being provoked rather than flooded with growth factors.
Indications
Most useful where ligaments have become lax, where a tendon meets bone, and in mild to moderate joint arthritis.
Step by step
01
Dynamic ultrasound identifies which structure is actually generating the pain — a lax ligament, a degenerated tendon attachment, a joint capsule. Prolotherapy only works when the target is correct, and the target is confirmed on the screen before anything is injected.
02
Dextrose concentration is selected for what is being treated: lower concentrations for intra-articular work, higher for ligament and tendon attachments. Prolozone adds oxygen–ozone gas where local perfusion is the limiting factor.
03
Skin and deeper tissue are anesthetized, then the solution is placed under live ultrasound — often at several attachment points in one session, which is why prolotherapy sessions can involve multiple small injections rather than one.
04
You walk out. Expect soreness for one to three days. No NSAIDs and no cortisone in the treated area, because both blunt the healing response the injection is meant to start.
05
Treatments are spaced two to four weeks apart, typically three to six in a series. Progress is judged on function and on repeat ultrasound, not on how you feel the day after an injection.
06
If a proper series produces only partial benefit, the conversation moves to PRP or cellular treatment rather than repeating the same injection indefinitely.
Candidacy
Comparison
The honest trade-off is stimulus against cost. Ultrasound findings, not budget, decide when the stronger option is genuinely necessary.
Frequently asked
Prolotherapy injects a dextrose (sugar) solution with a local anesthetic into the ligament, tendon or joint that is failing. Prolozone uses the same dextrose base and adds medical-grade oxygen–ozone gas, and often B vitamins, on the theory that ozone improves local oxygen utilization in tissue that is poorly perfused. The needle work, the ultrasound guidance and the aftercare are the same; the solution differs.
Dextrose prolotherapy is one of the better-studied injection treatments in this field. A blinded randomized trial in Annals of Family Medicine found that dextrose prolotherapy produced clinically meaningful, sustained improvement in knee osteoarthritis pain, function and stiffness at 52 weeks compared with blinded saline injection and at-home exercise. A separate triple-blinded trial in 2020 found intra-articular hypertonic dextrose superior to saline. The effect is real but moderate, and it is not equivalent to a cure.
Ozone has been studied mostly in knee osteoarthritis, where randomized trials show pain and function benefits over placebo, and a Level I meta-analysis found intra-articular ozone and hyaluronic acid achieved similar pain control at four to six months. The literature is heterogeneous, doses vary between studies, and long-term data are limited. Ozone is not an FDA-approved drug for injection; it is used here under the practice of medicine and that is stated plainly rather than glossed over.
Typically three to six sessions, two to four weeks apart, depending on the tissue and how long it has been symptomatic. In this practice's experience one PRP treatment is roughly equivalent to two or three prolotherapy or Prolozone treatments — which is the trade-off: lower cost per visit, more visits.
The solution contains local anesthetic, so many patients feel immediate relief during the visit. When the anesthetic wears off, expect soreness, stiffness and a sense of fullness at the injection site for one to three days. That post-injection ache is expected — it reflects the inflammatory response the treatment is meant to provoke.
When the tissue damage is structural rather than simply painful and lax — a substantial tendon tear, moderate to advanced joint arthritis, or a case that has already failed a proper prolotherapy series. Ultrasound findings decide this, not price.
No. NSAIDs, and cortisone in the treated area, work directly against the healing response these injections are designed to trigger. Acetaminophen, ice for comfort and relative rest are used instead, and you leave with written instructions.
Generally no. Most insurers classify prolotherapy as investigational and do not cover it; ozone injections are likewise not covered. Diagnostic ultrasound and the office evaluation are often billable. Injection pricing is quoted in writing before anything is scheduled.
Resources
The trials and reviews this page relies on, including the ones with mixed findings.
01
Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, Zgierska A. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013;11(3):229–237.
02
Sit RWS, Wu RWK, Rabago D, Reeves KD, Chan DCC, Yip BHK, Chung VCH, Wong SYS. Efficacy of intra-articular hypertonic dextrose (prolotherapy) for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2020;18(3):235–242.
03
Sit RW, Chung VCH, Reeves KD, Rabago D, et al. Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic review and meta-analysis. Sci Rep. 2016;6:25247.
04
Migliorini F, et al. Intra-articular injections of ozone versus hyaluronic acid for knee osteoarthritis: a level I meta-analysis. Eur J Orthop Surg Traumatol. 2024.
05
Lopes de Jesus CC, et al. Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: a randomized, double-blinded, placebo-controlled study. PLoS One. 2017;12(7):e0179185.
06
Noori-Zadeh A, et al. Intra-articular ozone therapy efficiently attenuates pain in knee osteoarthritic subjects: a systematic review and meta-analysis. Complement Ther Med. 2019;42:240–247.
07
The time-effect relationship of intra-articular ozone injection for knee osteoarthritis: a systematic review and meta-analysis. Front Pain Res. 2026.
08
Rabago D, Lee KS, Ryan M, et al. Hypertonic dextrose and morrhuate sodium injections (prolotherapy) for lateral epicondylosis (tennis elbow): a single-blind, pilot-level randomized controlled trial. Am J Phys Med Rehabil. 2013;92(7):587–596.
09
Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger joints. J Altern Complement Med. 2000;6(4):311–320.
10
Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139–159.
11
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
This page is written for patient education and does not constitute medical advice or establish a physician–patient relationship. Treatment decisions require an in-person examination. Prolotherapy is considered investigational by most insurers, and medical ozone is not an FDA-approved drug for injection; both are performed under the practice of medicine. Published results vary between studies and no outcome is guaranteed. Dr. Tortland reports no financial interest in the products or devices described on this page.
One ultrasound evaluation tells you whether prolotherapy is the right starting point or whether you should skip straight to PRP. You get that answer in a single visit.