High volume injection with and without corticosteroid in chronic midportion achilles tendinopathy

Anders P Boesen*, Henning Langberg, Rudi Hansen, Peter Malliaras, Morten I Boesen

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstract

BACKGROUND: High volume injection (HVI) shows promising results in the treatment of chronic midportion Achilles tendinopathy (AT). HVI consists of a large volume of saline with a small amount of corticosteroid and local anesthetic.

OBJECTIVE: To determine the effect of corticosteroid in HVI in AT.

METHODS: A total of 28 men (18-59 years) with chronic (>3 months) AT were included in a double-blinded RCT and followed for 24 weeks. All performed eccentric training and randomized to either (a) HVI injection with corticosteroid or (b) HVI injection without corticosteroid. Outcomes included self-reported function (VISA-A score) and pain (VAS score) and ultrasound imaging (tendon thickness, Doppler flow).

RESULTS: VISA-A and VAS score improved in both groups at all time-points (P < 0.05). VISA-A improvement was significantly greater in HVI with corticosteroid (mean � SEM; 6-weeks = 31 � 3 points; 12-weeks = 32 � 5 points) vs HVI without corticosteroid (6 weeks = 14 � 3; 12-weeks = 17 � 3) at 6 and 12 weeks (P < 0.05), but not at 24 weeks. Decrease in VAS scores was significantly greater in HVI with corticosteroid (6 weeks = 55 � 3 mm; 12 weeks = 53 � 5 mm) vs HVI without corticosteroid (6 weeks = 16 � 3 mm; 12 weeks = 25 � 5 mm) at 6 and 12 weeks (P < 0.05) but not at 24 weeks. Tendon thickness decreased significantly in both groups at all time-points (P < 0.05), but more in the HVI with corticosteroid vs HVI without corticosteroid at 6 and 12 weeks (P < 0.05) but not at 24 weeks.

CONCLUSION: High volume injection with or without corticosteroid in combination with eccentric training seems effective in AT. HVI with corticosteroid showed a better short-term improvement than HVI without corticosteroid indicating a short-term effect of corticosteroid in HVI treatment of AT.

OriginalsprogEngelsk
Sider (fra-til)1223-1231
Antal sider9
TidsskriftScandinavian Journal of Medicine and Science in Sports
Vol/bind29
Udgave nummer8
DOI
StatusUdgivet - aug. 2019

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� 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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