|doi:10.1016/j.jsams.2009.09.007 | How to Cite or Link Using DOI |
Copyright © 2009 Sports Medicine Australia Published by Elsevier Ltd
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The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy
Received 16 January 2009;
revised 24 September 2009;
accepted 25 September 2009.
Available online 27 November 2009.
AbstractWe investigated neovascularisation, tendon thickness and clinical function in chronic resistant Achilles tendinopathy following high volume image guided injections (HVIGI). The subjects involved 11 athletes (mean age 43.5 years ± 11.6, range 22–59) with resistant tendinopathy of the main body of the Achilles tendon for a mean of 51.4 months (±55.56, range 4–144) who failed to improve with an eccentric loading program (mean 11.8 months ± 2.6, range 8–16). The morphological features, neovascularisation and maximal tendon thickness were assessed with power Doppler ultrasound. Clinical function was measured with the Victorian Institute of Sports Assessment-Achilles tendon (VISA-A) questionnaire. All the tendinopathic Achilles tendons were injected with 10 mL of 0.5% bupivacaine hydrochloride, 25 mg of hydrocortisone acetate, and 40 mL of 0.9% NaCl saline solution under real time ultrasound guidance. All outcome measures were recorded at baseline and after a short-term follow-up (mean 2.9 weeks, range 2–4). The results showed a statistically significant difference between baseline and 3-week follow-up in all the outcome measures after HVIGI. The grade of neovascularisation reduced (3–1.1, p = 0.003), the maximal tendon diameter decreased (8.7–7.6 mm, p < 0.001), and the VISA-A scores improved (46.3–84.1, p < 0.001). In conclusion, HVIGI for resistant tendinopathy of the main body of the Achilles tendon is effective to improve symptoms, reduce neovascularisation, and decrease maximal tendon thickness at short-term follow-up.
Keywords: Tendinopathy; Non-operative management; Peritendinous injection; Ultrasound
Fig. 1. Transverse plane of an Achilles tendon under ultrasound. Medial approach of the needle. Stripping of the paratenon from the surrounding soft tissues, at the anterior aspect of the Achilles tendon.
Table 1. Sports activities of the 11 patients with resistant tendinopathy of the main body of the Achilles tendon prior to their symptoms.