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As a cofactor, cobalamins are essential for two cellular reactions: the mitochondrial methylmalonyl-CoA mutase conversion of methylmalonic acid (MMA) to succinate, which links lipid and carbohydrate metabolism, and the activation of methionine synthase, which is the rate-limiting step in the synthesis of methionine from homocysteine and 5-methyltetrahydrofolate

Several published studies support the use of prolotherapy for chronic musculoskeletal ligament injuries

While the exact causes remain complex and not fully understood, it is generally believed that a combination of genetic and environmental factors contributes to its development

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