One hundred twenty-eight patients with knee osteoarthritis were randomized to receive prolotherapy with 5% dextrose (n=30), 10% dextrose (n=30), 20% dextrose (n=30), or exercise plus hotpack only (n=30). All prolotherapy groups received three injection sessions at weeks 0, 3, and 6, combined with a home exercise program and hotpack therapy. The primary outcome was pain assessed by VAS. Secondary outcomes included WOMAC scores, knee range of motion, timed up and go (TUG) test, and SF-36 quality of life scores. Outcomes were measured at baseline, 6 weeks, and 12 weeks. Overall, results showed that 10% and 20% dextrose groups had significantly greater pain reduction and functional improvements compared with exercise alone, while 20% dextrose also improved knee flexion. The findings suggest prolotherapy, especially at higher concentrations, offers meaningful clinical benefits for knee osteoarthritis.