EFFICACY OF ULTRASOUND-GUIDED AUTOLOGOUS BLOOD INJECTION VERSUS EXTRACORPOREAL SHOCKWAVE THERAPY IN CHRONIC ACHILLES TENDINOPATHY: A RANDOMIZED CONTROLLED TRIAL

Objective:To evaluate the efcacy of ultrasound-guided autologous blood injection in chronic Achilles tendinopathy. Design: Prospective randomised controlled trial. Setting:Tertiary care hospital. Participants: 45 patients of chronic Achilles tendinopathy. Intervention: Participants were allocated to 2 groups i.e. autologous blood injection under ultrasound-guidance group (n=23) and extra corporeal shockwave therapy group (n=22) while in both groups eccentric heel drop stretching exercise were added. Outcome measures:VAS, VISA-Aand ultrasonography. Follow up at 4, 12 and 24 weeks. Results: The mean VAS score changes within-subject analysis were signicant in both ABI and ESWT group (p<0.001), however between-group analysis at 4, 12 and 24 weeks were not signicant (p>0.05). The mean VISA-A score within-subject analysis were signicant in both the groups (p<0.001). The between-group analysis show signicant difference at 12 weeks (p=0.006) and 24 weeks (p=0.001). The between-group analysis of mean tendon size were signicant at 24 weeks (p=0.001). Conclusions: This study showed that ultrasound guided autologous blood injection is effective in reducing pain and disability in chronic Achilles tendinopathy at 6 months. ABI might have additive regenerative therapeutic effect.

US-guided high-volume injection for Achilles tendinopathy

Achilles tendinopathy is a common overuse condition affecting the adult population. The incidence is on the rise because of greater participation of people in recreational or competitive sporting activities. Chronic Achilles tendinopathy occurs most commonly in the tendon’s mid-portion, and it is challenging to manage, leading to significant patient morbidity. Despite conservative management many patients still require surgical intervention. The mechanism underlying pain is not entirely understood; however, high-resolution color Doppler ultrasound has shown that neovascularisation could be involved. Minimally-invasive treatments for chronic Achilles tendinopathy may prevent the need for surgery when conservative methods have failed. Ultrasound provides an option to guide therapeutic interventions accurately, so that treatment is delivered to the desired site of pathology. High-volume image-guided injection is a relatively new technique where a high volume of liquid is injected between the anterior aspect of the Achilles tendon and the Kager’s fat pad, used to strip away the neovascularity and disrupt the nerve ingrowth seen in chronic cases of Achilles tendinopathy. Highvolume image-guided injection has shown promising results in terms of reducing pain and improving function in patients where conservative measures have failed. This review aims to describe the fundamental technical factors, and investigate the efficacy of high-volume image-guided injection with reference to the available literature.

Extracorporeal Shockwave Therapy for Patients with Chronic Achilles Tendinopathy in Long or Short Course

Object. In this study, our aim is to evaluate the efficiency of extracorporeal shockwave therapy (ESWT) on chronic Achilles tendinopathy (CAT) with different courses of disease. Methods. The data of 66 patients with CAT received ESWT was reviewed. According to the disease courses, those cases were allocated to short-term group (ST group, symptom duration 3-6 months) and long-term group (LT group, symptom duration >6 months). Propensity scores match (PSM) method was conducted to eliminate the confound factors in baseline features including gender, sport history, sides, type of CAT, BMI (body mass index), age, and scores evaluated by AOFAS (American Orthopedic Foot and Ankle Society) and VAS (Visual Analogue Scale) before ESWT. After balancing the features between ST and LT group, postinterventional VAS, AOFAS, and rate of Likert satisfaction scale at the 3rd month after first ESWT was statistically analyzed. Results. Among the baseline features in ST and LT group, gender (female ratio, 44.4% vs 71.4%, p=0.041) and BMI (23.26±2.15 vs 24.63±2.41, p=0.024) were identified as confound factors. After elimination of biased features with PSM, 3 months after first ESWT, AOFAS and VAS in both groups are significantly improved, when compared with their scores at baseline (p<0.01). Moreover, at postintervention month 3 (PIM3), AOFAS in ST group is significantly higher than LT group (85.08±9.83 vs 76.76±9.85, t=76.76±9.85, p=0.019), and the rate of Likert satisfaction in ST group is better than LT group; although, it did not reach but close to significant level (70.6% vs 47.1%, χ2=1.943, p=0.163). However, there is no statistical difference of VAS scores between two groups after ESWT (1.96±0.98 vs 2.24±1.29, t=0.703, p=0.487). Conclusions. ESWT could effectively relieve pain and improve function of hind foot in patients with chronic Achilles tendinopathy, and especially, it could offer better benefit on functional improvement in patients with short duration of CAT symptom.