title: Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol.
abstract: Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6-8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.
authors.affiliation: Capio Artro Clinic, Stockholm Sports Trauma Research Centre, Karolinska Institute, 114 86, Stockholm, Sweden.
authors.forename: Lotta
authors.initials: L
authors.lastname: Willberg
authors.forename: Kerstin
authors.initials: K
authors.lastname: Sunding
authors.forename: Lars
authors.initials: L
authors.lastname: Ohberg
authors.forename: Magnus
authors.initials: M
authors.lastname: Forssblad
authors.forename: Martin
authors.initials: M
authors.lastname: Fahlström
authors.forename: Håkan
authors.initials: H
authors.lastname: Alfredson
mesh_terms: D000125:Achilles Tendon; D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011859:Radiography; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols