19 High-volume injection with and without corticosteroid in chronic midportion achilles tendinopathy – a randomised double blinded prospective study

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IntroductionHigh Volume Injection (HVI) seems to show promising results in Achilles tendinopathy (AT). HVI consist of a large volume of saline with a small amount of corticosteroid.PurposeTo determine the effect of corticosteroid in HVI.Material and methodsA total of 28 men (>18 years) with chronic (>3 month) AT were included and followed for 24-wks. Eccentric training was performed in all patients and randomised to either HVI with corticosteroid or HVI without corticosteroid. Outcomes included VISA-A, VAS and ultrasound imaging.ResultsVISA-A improved in both groups (p<0.05), with greater improvement in HVI with corticosteroid (mean ±SEM; 6-wks=31±3 points; 12-wks=32±5 points) versus HVI without corticosteroid (6-wks=14±3; 12-wks=17±3) at 6 and 12-wks (p<0.05), but with no differences at 24-wks. VAS scores improved in both groups (p<0.05), with greater decrease in HVI with corticosteroid (6-wks=55±3 mm; 12-wks=53±5 mm) versus HVI without corticosteroid (6-wks=16±3 mm; 12-wks=25±5 mm) at 6 and 12-wks (p<0.05) with no differences after 24-wks. Tendon thickness showed a significant decrease in both groups (p<0.05), with a greater decrease in HVI with corticosteroid versus HVI without corticosteroid at 6 and 12-wks (p<0.05) with no difference at 24-wks.ConclusionTreatment with HVI with or without corticosteroid in combination with eccentric training in chronic AT seems effective in reducing pain, improving activity level and reducing ultrasound tendon thickness and intra-tendinous vascularity. HVI with corticosteroid improved the conditions significantly better than HVI without corticosteroid in the short term. Thereby we argue that there is a corticosteroid effect in HVI treatment for AT.

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