title: The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy.
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.
authors: Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK.
authors: Joel
authors: J
authors: Humphrey
authors: Otto
authors: O
authors: Chan
authors: Tom
authors: T
authors: Crisp
authors: Nat
authors: N
authors: Padhiar
authors: Dylan
authors: D
authors: Morrissey
authors: Richard
authors: R
authors: Twycross-Lewis
authors: John
authors: J
authors: King
authors: Nicola
authors: N
authors: Maffulli
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D007267:Injections / Q000379:methods*; D008297:Male; D008875:Middle Aged; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D006854:Hydrocortisone; D002045:Bupivacaine