title: High volume image guided injections for the management of chronic tendinopathy of the main body of the Achilles tendon.
abstract: OBJECTIVE
  Several substances are routinely injected in and around tendons. The present study evaluated the long term effects of high volume image guided injection (HVIGI) of normal saline, local anaesthetic and aprotinin in athletic patients with resistant tendinopathy of the main body of the Achilles tendon.
  
  
  METHODS
  Case series.
  
  
  METHODS
  The study included a series of 94 athletes (69 men and 25 women; average age 37.5 years, range 22-63) with ultrasound confirmed tendinopathy of the main body of the Achilles tendon. All the patients had not improved after at least three months of conservative management. Patients were injected with 10 mL of 0.5% Bupivacaine Hydrochloride, 25 mg aprotinin, and up to 40 mL of injectable normal saline. We prospectively administered the Victorian Institute of Sport Assessment-Achilles tendon (VISA-A) to assess the short- and long-term pain and functional improvement.
  
  
  RESULTS
  At baseline (n = 94), the VISA-A score was 41.7 ± 23.2 (range 11-60), and had improved to 74.6 ± 21.4 (range 71-100) by 12 months (n = 87) (p = 0.003), with no significant difference between sexes.
  
  
  CONCLUSIONS
  HVIGI with aprotinin significantly reduces pain and improves function in patients with chronic Achilles tendinopathy in the short- and long-term follow up.
authors.affiliation: Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK. n.maffulli@qmul.ac.uk
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Filippo
authors.initials: F
authors.lastname: Spiezia
authors.forename: Umile Giuseppe
authors.initials: UG
authors.lastname: Longo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
authors.forename: Gayle D
authors.initials: GD
authors.lastname: Maffulli
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000187:drug effects*; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D007611:Aprotinin / Q000008:administration & dosage*; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D006490:Hemostatics; D007611:Aprotinin; D002045:Bupivacaine
keywords: Achilles tendon; Athletes; Injections; Neovascularization; Sports