High-volume peritendinous injections in the management of Achilles tendinopathy

Abstract

Introduction Achilles tendinopathy can be a significant problem, especially in the sporting population. When conservative treatment fails, injection therapy is often offered. There are various injectable therapies currently being employed for the treatment of recalcitrant Achilles tendinopathy, yet only sparse scientific evidence exists to support any specific injection treatment. High-volume peritendinous glucocorticoid injections are one such injection method growing in popularity, with early studies showing promising results. The aim of this study is to describe the methodology of this technique for the Achilles tendon along with assessing the effectiveness of this treatment, both sonographic and patient derived, at 24-week follow-up. Methods 43 participants with sonographically confirmed chronic Achilles tendinopathy elected to undergo a single high-volume peritendinous glucocorticoid injection in combination with a supervised rehabilitation program. Patients were injected with 1 mL celesone chronodose combined with 2mL xylocaine and 20 mL of cold normal saline. Blinded assessors evaluated participants pre-intervention and at 24-week follow-up sonographically using the Achilles Ultrasound Assessment Tool (AUAT) and clinically with the Victorian Institute of Sport Assessment - Achilles (VISA-A) score. Results At baseline (n=43) the mean AUAT score was 9.79 +/- 3.16 and VISA-A 45.21 +/- 19.75. At follow-up (n=37), this improved with a mean AUAT of 7 +/- 4.17 and VISA-A of 68.35 +/- 24.44. At 24-weeks after intervention, there was a statistically significant reduction in patient reported symptoms as assessed by the VISA-A (p > 0.001) along with a sonographic improvement in tendon morphology as assessed by the AUAT (p > 0.001). Conclusion In chronic Achilles tendinopathy, a single high-volume ultrasound guided peritendinous glucocorticoid injection leads to a significant reduction in pain and improvement in function when combined with exercise therapy. This clinical improvement is associated with a sonographic improvement in tendon morphology at 24-week follow-up. High-volume injections are a clinically applicable technique to improve patient outcomes when exercise therapy alone fails to progress the recalcitrant tendon.