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Abstract
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].
Example of tendon MRI at T=0 and after 6 months post ACS injections
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.
Improvements after 6 months post ACS injections
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.
Signalling protein content in ACS generated by incubation, centrifugation and filtration with the help of Orthokine syringes by Orthogen Lab Services GmbH, Germany. Modified according to Wehling et al.
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