Introduction While a common problem, achillodynia remains difficult to treat, often chronifying. Excentric exercise is a generally accepted treatment option. Rat experiments have shown in the past that local ACS injection has potential in tendon repair creating a local environment that favours organised tissue repair [Majewski, Heisterbach]. ACS contains anti-inflammatory cytokines and potentially regenerative growth factors [Wehling]. It has shown clinical efficacy in joint and radiculopathy treatment. Here we report the treatment of regular out patients.
Methods Inclusion: 25 achillodynia patients with MRI-confirmed structural changes, tendinous effusion, and thickening, pain upon palpation, at rest and in exercise, persisting during 6 weeks of PT plus reduction of sports activity with no prior injuries or surgery.
Treatment: 3 injections of 5 mL in 7 day intervalls. First injection into punctum dolens. 2 subsequent injection peritendinous. Full weight bearing, no sports for 4 weeks post last injection. Excentric exercise started at 4 weeks after injections. No NSAID for 6 months.
Documentation: MRI at 0 and 6 months past end of injections. VISA-A (NRS-11) at T = 0 and T = 6 months [Figure 1].
Results Of 25 patients (11 female), mean age 50.4 ± 13.7 years with mean duration of symptoms 6.7 ± 0.56 months 100% reported an improvement in pain. 88% reported regained sports activity, 100% experienced structural improvement in MRI at 6 months. Injection into punctum dolens causes discomfort, peritendinous injections are well tolerated.
Discussion ACS has the potential to improve tendon- but also muscle regeneration [Wright-Carpenter]. It is retrieved from autologous patient’s blood which is incubated for 6–9 hrs in patented devices and accumulates both anti-inflammatory cytokines and growth factors [Table 2]. It is proposed that through synergistic action of signalling proteins tendon tissue is enabled to regenerate more effectively.
References Majewski, et al. Am J Sports Med. 2009;37(11):2117–2125
Heisterbach et al. KSSTA. 2012;20:1903–1910
Wehling, et al. Biodrugs 2007;21(5):323–33
Wright-Carpenter, et al. Int J Sports Med. 2007;25(8):582–587
Wright-Carpenter, et al. Int J Sports Med. 2007;25(8):588–59