Aprotinin in the management of Achilles tendinopathy: a randomised controlled trial

Background: Achilles tendinopathy is a common condition, which can become chronic and interfere with athletic performance. The proteinase inhibitor aprotinin ( as injection) has been found to improve recovery in patellar tendinopathy(1) ( evidence level 1b(2)) and Achilles tendinopathy. 3 Internationally this therapy is being used based on this limited knowledge base. Aim: To evaluate whether aprotinin injections decrease time to recovery in Achilles tendinopathy. Method: A prospective, randomised, double blind, placebo controlled trial was performed comparing saline ( 0.9%) plus local anaesthetic injections and eccentric exercises with aprotinin ( 30 000 kIU) plus local anaesthetic injection and eccentric exercise. Three injections were given, each a week apart. In total, 26 patients, with 33 affected tendons, were enrolled for this study. Results: At no follow up point ( 2, 4, 12, or 52 weeks) was there any statistically significant difference between the treatment group and placebo. This included VISA-A scores(4) and secondary outcome measures. However, a trend for improvement over placebo was noted. Conclusion: In this study on Achilles tendinopathy, aprotinin was not shown to offer any statistically significant benefit over placebo. Larger multicentre trials are needed to evaluate the efficacy of aprotinin in Achilles tendinopathy.