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DOS Kongressen 2017 ·
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The effect of cortisone in High-Volume Injection in
Chronic Midportion Achilles Tendinopathy – A random-
ized double-blinded prospective study
Anders Ploug Boesen
Sports Orthopedic Research Center- Copenhagen (SORC-C), Artroskopisk cen-
ter, Ortopædkirurgisk afdeling, Amager- Hvidovre Hospital
Background:
High-Volume Injection therapy (HVI) seems to show promising
results in chronic Achilles tendinopathy (AT). HVI consist of a large volume of
saline with a small amount of cortisone.
Purpose / Aim of Study:
To determine the effect of cortisone in HVI com-
pared to the volume (saline) effect in AT.
Materials and Methods:
A total of 28 men (age, 18 to 59 years) with chronic
(> 3 month) AT were included and followed for 6 month. All participants per-
formed eccentric training and randomized to either 1) HVI injection with cor-
tisone (HVI+: cortisone, saline and local anesthetic) or 2) HVI injection without
cortisone (HVI%: saline and local anesthetic). Outcomes included function and
symptoms (VISA-A), self-reported tendon pain during activity (visual analog
pain scale [VAS]) and ultrasonographic imaging (tendon thickness and intra-
tendinous vascularity). Outcomes were assessed at baseline and at 6, 12, and
24 weeks of follow-up.
Findings / Results:
VISA-A scores improved in both groups at all time points
(p<0.05), with greater improvement in HVI+ (mean ± SEM; 6- wks=31 ± 3
points; 12-wks=32 ± 5 points) versus HVI% (6-wks=14 ± 3; 12-wks=18 ±
3;) at 6 and 12 weeks (p<0.05) but with no differences at 24 weeks (HVI+ =
26 ± 3; HVI% = 24 ± 3). VAS scores improved in both groups at all time points
(p<0.05), with greater decrease in HVI+ (6-wks= 55 ± 3 mm; 12-wks= 53 ±
5 mm) versus HVI% (6- wks=16 ± 3 mm; 12-wks=25 ± 5 mm) at 6 and 12
weeks (p<0.05) but with no differences after 24 weeks (HVI+ = 40 ± 7 mm vs
HVI% = 34 ± 6). Tendon thickness showed a significant decrease in both groups
at all time-points (p<0.05), with a greater decrease in HVI+ versus HVI% at 6
and 12 weeks (p<0.05) but with no difference at 24 weeks.
Conclusions:
Treatment with HVI with or without cortisone in combination
with eccentric training in chronic AT seems effective in reducing pain, improv-
ing activity level and reducing ultrasound tendon thickness and intra- tendinous
vascularity. HVI with cortisone seemed more effective than without cortisone in
the short term, and we argue that there is a cortisone effect in HVI treatment.
No conflicts of interest reported
89.