High volume image guided injections in chronic Achilles tendinopathy

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 10ml of 0.5% Bupivacaine Hydrochloride, 25mg Hydrocortisone acetate, and up to 40ml 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 50mm, [SD 28, p0.0001], from a mean of 76mm [SD 18.2], to a mean of 25mm [SD 23.3]), and function scores (mean change 51mm, [SD 31.2, p0.0001], from a mean of 78mm [SD 20.8], to a mean of 27mm [SD 28.4]). Patients also reported significant long-term improvement in symptoms using the VISA-A questionnaire (mean change 31.2 points, [SD=28, p0.0001], 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.