title: Pharmacological interventions for the treatment of Achilles tendinopathy: a systematic review of randomized controlled trials.
abstract: BACKGROUND
  Several pharmacological interventions have been proposed for the management of Achilles tendinopathy, with no agreement on which is the overall best option available. This systematic review investigates the efficacy and safety of different local pharmacological treatments for Achilles tendinopathy.
  
  
  METHODS
  We included only randomized controlled studies (RCTs) focusing on clinical and functional outcomes of therapies consisting in injection of a substance or local application. Assessment of the methodological quality was performed using a modified version of the Coleman methodology score (CMS) to determine possible risks of bias.
  
  
  RESULTS
  Thirteen RCTs were included with a total of 528 studied patients. Eleven studies reported the outcomes of injection therapies. Two studies examined the outcomes of patients who applied glyceryl trinitrate patch. The mean modified CMS was 70.6 out of 90.
  
  
  RESULTS
  There was no significant evidence of remarkable benefits provided by any of the therapies studied.
  
  
  CONCLUSIONS
  There is not univocal evidence to advise any particular pharmacological treatment as the best advisable non-operative option for Achilles tendinopathy as equivalent alternative to the most commonly used eccentric loading rehabilitation program. However, potential was shown by the combination of different substances administered with physical therapy.
  
  
  METHODS
  There is a need for more long-term investigations, studying large enough cohort with standardized scores and evaluations shared by all the investigations to confirm the healing potential, and provide a stronger statistical comparison of the available treatments.
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 Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Via Salvador Allende, Baronissi, Salerno 84081, Italy n.maffulli@qmul.ac.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: D'Adamio
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Diaz Balzani
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D000125:Achilles Tendon / Q000293:injuries*; D001804:Blood Transfusion, Autologous / Q000379:methods*; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D053657:Platelet-Rich Plasma; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D052256:Tendinopathy / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014945:Wound Healing
chemical_list: D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols
keywords: Achilles; conservative treatment; soft tissue therapy; tendinopathy; tendon pathology