The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy

Journal of Science and Medicine in Sport
Volume 13, Issue 3, May 2010, Pages 295-298

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doi:10.1016/j.jsams.2009.09.007 | How to Cite or Link Using DOI Copyright © 2009 Sports Medicine Australia Published by Elsevier Ltd	Cited By in Scopus (0)
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Original paper

The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy

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Joel Humphrey^a, Otto Chan^b, Tom Crisp^{a, b}, Nat Padhiar^{a, b}, Dylan Morrissey^a, Richard Twycross-Lewis^a, John King^b and Nicola Maffulli^{a, ,}

^a Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
^b Department of Imaging, The London Independent Hospital, London, UK

Received 16 January 2009; 

revised 24 September 2009; 

accepted 25 September 2009. 

Available online 27 November 2009.

Abstract

We 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

Article Outline

1. Introduction

2. Methods

3. Results

4. Discussion

5. Conclusion

Practical implications

Conflict of interest

Ethical standards

Acknowledgements

References

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.

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Table 1. Sports activities of the 11 patients with resistant tendinopathy of the main body of the Achilles tendon prior to their symptoms.

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