| Achilles Tendon Novel Treatment |
OBJECTIVE. Chronic tendinosis of the Achilles tendon is a common overuse injury that
is difficult to manage. We report on a new injection treatment for this condition.
SUBJECTS AND METHODS. Thirty-six consecutive patients (25 men, 11 women;
mean age, 52.6 years) with symptoms for more than 3 months (mean, 28.6 months) underwent
sonography-guided intratendinous injection of 25% hyperosmolar dextrose every 6 weeks until
symptoms resolved or no improvement was shown. At baseline and before each injection, clinical
assessment was performed using a visual analogue scale (VAS) for pain at rest (VAS1), pain during
normal daily activity (VAS2), and pain during or after sporting or other physical activity
(VAS3). Sonographic parameters including tendon thickness, echogenicity, and neovascularity
were also recorded. Post treatment clinical follow-up was performed via telephone interview.
RESULTS. Thirty-three tendons in 32 patients were successfully treated. The mean number
of treatment sessions was 4.0 (range, 2–11). There was a mean percentage reduction for
VAS1 of 88.2% (p < 0.0001), for VAS2 of 84.0% (p < 0.0001), and for VAS3 of 78.1%
(p < 0.0001). The mean tendon thickness decreased from 11.7 to 11.1 mm (p < 0.007). The
number of tendons with anechoic clefts or foci was reduced by 78%. Echogenicity improved
in six tendons (18%) but was unchanged in 27 tendons (82%). Neovascularity was unchanged
in 11 tendons (33%) but decreased in 18 tendons (55%); no neovascularity was present before
or after treatment in the four remaining tendons. Follow-up telephone interviews of the 30 available
patients a mean of 12 months after treatment revealed that 20 patients were still asymptomatic,
nine patients had only mild symptoms, and one patient had moderate symptoms.
CONCLUSION. Intratendinous injections of hyperosmolar dextrose yielded a good clinical
response—that is, a significant reduction in pain at rest and during tendon-loading activities—
in patients with chronic tendinosis of the Achilles tendon. |
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