ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #115

 

The Long-Term Effect of High Volume Image-Guided Injection in the Chronic Non-Insertional Achilles Tendinopathy: A Prospective Case Series

Torsten G. Nielsen, BSc, Aarhus N DENMARK
Lene L. Miller, BS(Phys), Aarhus N DENMARK
Bjarne Mygind-Klavsen, MD, Aarhus C DENMARK
Martin Lind, MD, PhD, Prof., Aarhus N DENMARK

Div. Sports Trauma, Orthopedic Dept., Aarhus , DENMARK

FDA Status Not Applicable

Summary

HVIGI-treatment for chronic non-insertional AT significantly improved function and reduced pain (VISA-A) at long-term follow-up. 34% of the patients did not respond to a single HVIGI treatment.

Abstract

Background

This present study evaluates the long-term effect of high volume image-guided injection (HVIGI) for chronic non-insertional Achilles Tendinopathy(AT).

Purpose/Aim of Study
Does HVIGI-treatment for chronic non-insertional AT improve function and reduce pain at a long-term follow-up?

Materials And Methods

Patients with resistant non-insertional AT who failed to improve with a 3-month eccentric loading program were included in the study. Maximal tendon thickness and neovascularisation was assessed with ultrasound and power Doppler. All the tendinopathic Achilles tendons were injected, ultrasound guided, with 10 mL of 0.5% Marcaine, 0.5 mL Triamcinolonacetonid (40mg/mL) and 40 mL of 0.9% NaCl saline solution under real time ultrasound guidance. All outcome measures were recorded at baseline and after one year follow-up. A standardized eccentric loading rehabilitation protocol was prescribed after HVIGI-treatment. Clinical outcome was assessed with the Victorian Institute of Sports Assessment-Achilles tendon (VISA-A) questionnaire.

Findings/Results
Fifty-four HVIGI procedures were performed in the period 2013-2016. The study included a series of 41 procedures in 33 patients (26 men, 7 women). Mean age 44,4 (range 16-63). Mean duration of symptoms before HVIGI was 36 months. The baseline VISA-A score of 48±15 (range 14-74) improved to 62±21 (range 31-94) by 1 year (p=0,018). 50% of the patients had more than a 10 point improvement at the VISA-A score after one year. Eleven patients (34%) did not respond to treatment with continued pain and had surgery (2 patients) or additional HVIGI treatment (9 patients/11 procedures) before 1-year follow-up.

Conclusions

HVIGI-treatment for chronic non-insertional AT significantly improved function and reduced pain (VISA-A) at long-term follow-up. 34% of the patients did not respond to a single HVIGI treatment.