Monday, 10 May 2010

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


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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Original paper

The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy
Joel Humphreynext terma, Otto Chanb, Tom Crispa, b, Nat Padhiara, b, Dylan Morrisseya, Richard Twycross-Lewisa, John Kingb and Nicola Maffullia, Corresponding Author Contact Information, E-mail The Corresponding Author
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


Corresponding author.

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