Open AccessThe effect of high‐volume image‐guided injection in the chronic non‐insertional Achilles tendinopathy: a retrospective case series
Author(s) -
Nielsen Torsten Grønbech,
Miller Lene Lindberg,
MygindKlavsen Bjarne,
Lind Martin
Publication year - 2020
Publication title -
journal of experimental orthopaedics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 18
ISSN - 2197-1153
DOI - 10.1186/s40634-020-00264-4
Subject(s) - medicine , tendinopathy , achilles tendon , ultrasound , retrospective cohort study , surgery , tendon , orthopedic surgery , eccentric training , rehabilitation , eccentric , physical therapy , radiology , physics , quantum mechanics
Purpose To evaluate if High‐volume Image‐guided Injection (HVIGI)‐treatment for chronic mid‐portion Achilles tendinopathy (AT) improve function and reduce pain at 12‐months follow‐up. Methods Patients with resistant mid‐portion AT who failed to improve after a three‐month eccentric loading program were included in the study. Maximal tendon thickness was assessed with ultrasound. All patients were injected with 10 mL of 0.5% Marcaine, 0.5 mL Triamcinolonacetonid (40 mg/mL) and 40 mL of 0.9% NaCl saline solution under real‐time ultrasound‐guidance and high pressure. All outcome measures were recorded at baseline and 12 months. A standardized eccentric rehabilitation protocol was prescribed after HVIGI‐treatment. Clinical outcome was assessed with the Victorian Institute of Sports Assessment‐Achilles tendon questionnaire (VISA‐A) and statistically analyses were performed. Results The study included 30 single treatment HVIGI procedures in AT in 28 patients (23 men, 5 women) with a mean age of 45.1 (range 16–63). The mean duration of symptoms before HVIGI was 37 months. The baseline VISA‐A score of 50 ± 15 (range 14–74) improved to 61 ± 21 (range 31–94) after 1 year ( p = 0.04). Of the 30 AT procedures 10 patients (11 AT) were not satisfied after the initial HVIGI procedure. Of these, 8 patients (9 AT) needed additional HVIGI and two patients needed surgery. Of the remaining 18 patients (19 AT), 10 patients had more than a 10‐point improvement in the VISA‐A score after 1 year. Conclusions In this retrospective case‐study, only 10 patients (33%) did benefit of a single HVIGI treatment at 12‐months and an 11‐point significant improvement was seen at on the VISA‐A score.