A Comparison of Two Different High-Volume Image-Guided Injection Procedures for Patients With Chronic Noninsertional Achilles Tendinopathy: A Pragmatic Retrospective Cohort Study.
We undertook a comparison evaluation of outcomes after 2 different high-volume image-guided injection (HVIGI) procedures performed under direct ultrasound guidance in patients with chronic noninsertional Achilles tendinopathy. In group A, the HVIGI involved high-volume (10 mL of 1% lidocaine combined with 40 mL of saline) and no dry needling. In group B, the HVIGI involved a smaller volume (10 mL of 1% lidocaine combined with 20 mL of saline) and dry needling of the Achilles tendon. A total of 34 patients were identified from the clinical records, with a mean overall age of 50.6 (range 26 to 83) years and an overall mean follow-up duration of 277 (range 49 to 596) days. The change between the preinjection and postinjection Victorian Institute of Sports Assessment-Achilles scores of 33.4 ± 22.5 points in group A and 6.94 ± 22.2 points in group B, was statistically significant (p = .002). In group A, 3 patients (16.7%) required surgical treatment compared with 6 patients (37.5%) in group B requiring surgical treatment (p = .180). Our results indicated that a higher volume without dry needling compared with a lower volume with dry needling resulted in greater improvement in noninsertional Achilles tendinopathy. However, confounding factors mean it is not possible to categorically state that this difference was solely due to different injection techniques.
Consultant, Sport and Exercise Medicine, Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK; School for Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK; National Centre for Sport and Exercise Medicine, East Midlands, Loughborough, UK. Electronic address: Patrick.wheeler@uhl-tr.nhs.uk.
Patrick C
PC
Wheeler
Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK; and Orthopaedic Departments, Royal Berkshire NHS Foundation Trust, Reading, UK.
Dev
D
Mahadevan
Consultant Musculoskeletal Radiologist, Radiology Department, University Hospitals of Leicester NHS Trust, Leicester, UK.
Raj
R
Bhatt
Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.
Maneesh
M
Bhatia
D000125:Achilles Tendon; D015670:Acupuncture Therapy; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015552:Injections, Intralesional / Q000379:methods; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D052256:Tendinopathy / Q000188:drug therapy / Q000628:therapy*; D018084:Ultrasonography, Interventional
D000779:Anesthetics, Local; D008012:Lidocaine
Achilles tendon; dry needling; injection; outcome study; patient assessment; tendon disorder