title: Comparison of Peritendinous Hyaluronan Injections Versus Extracorporeal Shock Wave Therapy in the Treatment of Painful Achilles' Tendinopathy: A Randomized Clinical Efficacy and Safety Study.
abstract: To compare the safety and efficacy of hyaluronan (HA) injections with standard extracorporeal shock wave therapy (ESWT) in the treatment of painful midportion Achilles' tendinopathy.
  
  
  
  Multinational, prospective, randomized controlled, blinded-observer trial.
  
  
  
  Ambulatory care.
  
  
  
  Adults (N=62) with Achilles' midportion tendinopathy for ≥6 weeks and a pain score of at least 40mm (Huskisson visual analog scale [VAS], 100mm) were randomized, and 59 were analyzed in the intention-to-treat data set. There were no withdrawals because of adverse effects.
  
  
  
  Two peritendinous HA injections versus 3 ESWT applications at weekly intervals.
  
  
  
  Primary efficacy criterion was changed from the Victorian Institute of Sports Assessment-Achilles' questionnaire (VISA-A) score to the percent change in pain (VAS) at 3 months posttreatment, compared with baseline values. Main secondary parameters were VISA-A, Clinical Global Impression (CGI), and clinical parameters.
  
  
  
  HA treatment provided a clinically relevant improvement in Achilles' midportion tendinopathy. A large superiority of the HA group, compared with ESWT application, was observed for percent change in pain (VAS), and this superiority was proven to be statistically significant (Mann-Whitney statistic [MW]=.7507 with P=.0030 lower than required α=.025 significance level 1-sided; Mann-Whitney U test) at 3 months posttreatment. Similar findings for HA were also observed at 4 weeks (MW=.6425, P=.0304) and 6 months (MW=.7172, P=.0018). Advantage of HA treatment was confirmed by VISA-A questionnaire, CGI, and clinical parameters. Ten adverse events, 4 in the HA group and 6 in the ESWT group, were reported, but none were classified as serious.
  
  
  
  Two peritendinous HA injections showed greater treatment success in Achilles' midportion tendinopathy compared with standard ESWT.
authors.affiliation: Praxiszentrum Orthopädie-Unfallchirurgie Nordrhein, Aachen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lynen
authors.affiliation: Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Antwerp, Belgium. Electronic address: tdevroey@skynet.be.
authors.forename: Thierry
authors.initials: T
authors.lastname: De Vroey
authors.affiliation: Praxiszentrum Orthopädie-Unfallchirurgie Nordrhein, Aachen, Germany.
authors.forename: Imke
authors.initials: I
authors.lastname: Spiegel
authors.affiliation: Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Antwerp, Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Van Ongeval
authors.affiliation: Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Antwerp, Belgium.
authors.forename: Niels-Jan
authors.initials: NJ
authors.lastname: Hendrickx
authors.affiliation: Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Gaëtane
authors.initials: G
authors.lastname: Stassijns
mesh_terms: D000125:Achilles Tendon; D000328:Adult; D005260:Female; D019220:High-Energy Shock Waves / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D007267:Injections; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D052256:Tendinopathy / Q000150:complications / Q000628:therapy*; D014464:Ultrasonic Therapy / Q000009:adverse effects; D055675:Viscosupplements / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid
keywords: Achilles tendon; High-energy shock waves; Hyaluronic acid; Rehabilitation; Tendinopathy