Background Tendinopathy is a failed healing response of the tendon. Despite an abundance of therapeutic options, very few randomized prospective, placebo-controlled trials have been carried out to assist physicians in choosing the best evidence-based management. Mechanisms that propose to promote collagen fiber cross-link formation within the tendon, thereby facilitating tendon remodeling would be optimal. Hyaluronan may be a treatment option for midportion Achilles tendinopathy.
Objectives To compare the effectiveness of 2 peri-tendinous injection management strategies utilizing Hyaluronan in patients with mid-portion non-insertional Achilles tendinopathy.
Methods Thirty-five patients with a chronic recalcitrant (>6 months) noninsertional Achilles tendinopathy were enrolled in a randomized controlled study. All patients had also received unsuccessful management for >3 months, including nonsteroidal anti-inflammatory drugs and physiotherapy. A computerized random-number generator was used to draw up an allocation schedule. Hyaluronan (2.8cc, 730-1300kDa) or normal saline (2.8cc) was injected peri-tendinously under ultrasound guidance at baseline and 7 days. Assessments were done at baseline, days 7, 14, 30 and 90. Primary outcome measure was the VISA-A (Victorian Institute of Sport Assessment - Achilles) score. Secondary outcomes included patient’s pain VAS on weight bearing (0-100mm), patients’ global assessment of Achilles injury (5 point categorical scale), patients’ assessment of normal function/activity (5 point categorical scale), physician’s global assessment of Achilles injury (5 point categorical scale), patients/physician satisfaction assessment (10 point categorical scale), time to return to pain-free and disability-free sport and adverse events as per WHO definition.
Results All patients completed the study. Two patients in the placebo group experienced injection pain. There were no severe adverse events. The VISA-A score increased in the Hyaluronan group, from 53 to 81 points (P<0.01) at 30 days and to 92 points at 90 days (P 0.01). No change was noted in the placebo group. There was less weight bearing pain, and higher rated patient and physician global ratings at 14, 30 and 90 days compared to to the placebo group (P< 0.001). There was a faster return to sport in the Hyaluronan group compared to placebo at 90 days (P<0.001).
Conclusions Hyaluronan injection therapy is an effective treatment for chronic noninsertional Achilles tendinopathy.
Disclosure of Interest None Declared
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