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High volume image guided injections in chronic Achilles tendinopathy.

Author(s): Chan O, O'Dowd D, Padhiar N, Morrissey D, King J, Jalan R, Maffulli N, Crisp T

Affiliation(s): Department of Imaging, The London Independent Hospital, London, UK.

Publication date & source: 2008, Disabil Rehabil., 30(20-22):1697-708.

PURPOSE: To determine the effectiveness of high volume image guided injections (HVIGI) for chronic Achilles tendinopathy. METHODS: We included in the study 30 consecutive patients (mean age 37.2 years, range 24 - 58 years) with Achilles tendinopathy for a mean of 35.8 months (range 2 - 276 months) who had failed to improve after a three-month programme of eccentric loading of the gastro-soleus complex. Patients were injected with 10 ml of 0.5% Bupivacaine Hydrochloride, 25 mg Hydrocortisone acetate, and up to 40 ml of injectable normal saline. A study-specific questionnaire and the Victorian Institute of Sport Assessment - Achilles tendon (VISA-A) were retrospectively administered to assess short- and long-term pain and functional improvement. RESULTS: Some 21 patients (70%) responded. Patients reported significant short-term improvement at 4 weeks of both pain (mean change 50 mm, [SD 28, p < 0.0001], from a mean of 76 mm [SD 18.2], to a mean of 25 mm [SD 23.3]), and function scores (mean change 51 mm, [SD 31.2, p < 0.0001], from a mean of 78 mm [SD 20.8], to a mean of 27 mm [SD 28.4]). Patients also reported significant long-term improvement in symptoms using the VISA-A questionnaire (mean change 31.2 points, [SD = 28, p < 0.0001], from a mean of 44.8 points [SD 17.7], to a mean of 76.2 points [SD 24.6]) at a mean of 30.3 weeks from the injection. CONCLUSIONS: HVIGI significantly reduces pain and improves function in patients with resistant Achilles tendinopathy in the short- and long-term.

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