Less promising results with sclerosing ethoxysclerol injections for midportion achilles tendinopathy: a retrospective study.
BACKGROUND
Local injections of the sclerosing substance polidocanol (Ethoxysclerol) have shown good clinical results in patients with chronic midportion Achilles tendinopathy. After training by the inventors of the technique, sclerosing Ethoxysclerol injections were applied on a group of patients in our center.


OBJECTIVE
Sclerosing Ethoxysclerol injections will yield good results in the majority of patients.


METHODS
Case series; Level of evidence, 4.


METHODS
In 113 patients (140 tendons) with Achilles tendinopathy, we identified 62 patients (70 tendons) showing neovascularization on color Doppler ultrasound. Fifty-three Achilles tendons (48 patients) were treated with sclerosing Ethoxysclerol injections, with intervals of 6 weeks and a maximum of 5 sessions. Treatment was completed when neovascularization or pain had disappeared, or when there was no positive treatment effect after 3 to 4 sessions.


RESULTS
Forty-eight patients (20 women and 28 men) with a median age of 45 years, (range, 33-68 years) were treated. Median symptom duration was 23 months (range, 3-300 months). Fifty-three tendons were treated with a median of 3 sessions of Ethoxysclerol injections. Six weeks after the last injection, 35% of patients had no complaints, 9% had minimal symptoms, 42% were the same, and 14% had more complaints. Women were 3.8 times (95% confidence interval: 1.1-13.8) more likely to have unsatisfactory outcome than men. Pain correlated positively with neovessels on ultrasound (P < .01). At 2.7 to 5.1 year follow-up, 53% had received additional (surgical/conservative) treatment; 3 of these patients (7.5%) still had complaints of Achilles tendinopathy. In 6 patients, complaints that were still present 6 weeks after treatment had resolved spontaneously by final follow-up.


CONCLUSIONS
Our study did not confirm the high beneficial value of sclerosing neovascularization in patients with midportion Achilles tendinopathy. Despite the retrospective design of our study, we consider it important to stress that injection of Ethoxysclerol may not be as promising as was thought.
van Sterkenburg
Maayke N
MN
Academic Medical Center, Department of Orthopaedic Surgery, G4-262, PO Box 22700, 1100 DE Amsterdam, The Netherlands. m.n.vansterkenburg@amc.uva.nl
de Jonge
Milko C
MC
Sierevelt
Inger N
IN
van Dijk
C Niek
CN
D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic / Q000187:drug effects*; D010147:Pain Measurement; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols