Ryan M, Wong A, Taunton J. Favorable outcomes after sonographically guided intratendinous injection of hyperosmolar dextrose for chronic insertional and midportion achilles tendinosis. Am J Roentgenol. 2010 Apr;194(4):1047-53.
Dr. Reeves’ Notes: This study involved patients with chronic tendon symptoms and all had objective evidence of Achilles degeneration by ultrasound at onset of the study. 108 tendons were treated in 99 patients. A median of 5 injections (1-13) were given, with ultrasound findings obtained at study onset and at plateau or symptom elimination point of 5-73 (mean 28) weeks. Treatment method involved injection inside the tendon with ultrasound monitor into areas of degeneration (hypoechogenicity or tear) with 0.5 ml or less dextrose 25% in 1-3 spots at each treatment. All patients were referred from sports medicine docs and had failed previous treatment. A follow-up contact attempt was made for all patients at 12 months following the last treatment for the last patient in the series. Follow ups ranged from 12 to 48 with a mean of 28 months. Although only 71% of patients could be reached for followup, notable is that improvement in pain with everyday living improved further. (From 57% at a mean of 28 weeks to 81% at a mean of 28 months.) Note that ultrasound changes at a mean of 28 weeks were more impressive in the mid Achilles tendinois group with significant reductions in size of hypoechoic regions, intratendinous tears and neovascularization. Note also that the symptomatic resolution in pain occurred despite neovessels still present in 60/108 cases (56%) at the mild to moderate level at the mean 28 week ultrasound follow up.
AN ABSTRACT IS AVAILABLE BELOW.
The objective of our study was to report on changes in the short-term sonographic appearance and 2-year follow-up for pain outcomes in a large patient population with chronic Achilles tendinosis who underwent sonographically guided dextrose injections.
SUBJECTS AND METHODS
One hundred eight tendons (86 midportion and 22 insertional) from 99 patients experiencing pain for greater than 6 months at either the Achilles tendon insertion or midportion were included in the study. Gray-scale (5–12 and 7–15 MHz) and color Doppler sonography examinations preceded the injection procedure using a 27-gauge needle administering a net 25% dextrose–lidocaine solution intratendinously. Structural features of each tendon and presence of neovascularity were noted. Visual analog scale (VAS) items were recorded at baseline, posttest, and 28.6 months follow-up.
A median of five (range, 1–13) injection consultations were needed for each patient, spaced 5.6 ± 3.1 (SD) weeks apart. There was a significant improvement in pain scores for both midportion (rest: 34.1 ± 27.7–3.3 ± 7.4, activities of daily living (ADL): 50.2 ± 25.6–9.5 ± 16.2, and sport: 70.7 ± 23.3–16.7 ± 22.0) and insertional (rest: 33.0 ± 26.5–2.7 ± 6.0, ADL: 51.3 ± 25.4–10.0 ± 16.3, and sport: 69.6 ± 24.5–17.7 ± 29.1) patients from baseline to follow-up for all VAS items. There were reductions in the size and severity of hypoechoic regions and intratendinous tears and improvements in neovascularity.
Dextrose injections appear to present a low-cost and safe treatment alternative with good long-term evidence for reducing pain from pathology at either the insertion or midportion of the Achilles tendon.