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19 High-volume injection with and without corticosteroid in chronic midportion achilles tendinopathy – a randomised double blinded prospective study
  1. Anders Ploug Boesen1,2,
  2. Henning Langberg3,
  3. Rudi Hansen2,
  4. Peter Malliaras4,
  5. Morten Ilum Boesen5
  1. 1Arthroscopic Centre, Ortopaedic department, Hvidovre Hospital, Kettegårds Alle´ 30, Denmark
  2. 2Institute of Sportsmedicine, Bispebjerg Hospital, Bispebjerg Bakke 23, Denmark
  3. 3CopenRehab, Institute of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Henrik Pontoppidansvej 6, Denmark
  4. 4Department of Physiotherapy, School of Primary Health Care Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Australia
  5. 5Department of Ortopaedic, Køge Hospital, Lykkebækvej 1, Denmark


Introduction High Volume Injection (HVI) seems to show promising results in Achilles tendinopathy (AT). HVI consist of a large volume of saline with a small amount of corticosteroid.

Purpose To determine the effect of corticosteroid in HVI.

Material and methods A total of 28 men (>18 years) with chronic (>3 month) AT were included and followed for 24-wks. Eccentric training was performed in all patients and randomised to either HVI with corticosteroid or HVI without corticosteroid. Outcomes included VISA-A, VAS and ultrasound imaging.

Results VISA-A improved in both groups (p<0.05), with greater improvement in HVI with corticosteroid (mean ±SEM; 6-wks=31±3 points; 12-wks=32±5 points) versus HVI without corticosteroid (6-wks=14±3; 12-wks=17±3) at 6 and 12-wks (p<0.05), but with no differences at 24-wks. VAS scores improved in both groups (p<0.05), with greater decrease in HVI with corticosteroid (6-wks=55±3 mm; 12-wks=53±5 mm) versus HVI without corticosteroid (6-wks=16±3 mm; 12-wks=25±5 mm) at 6 and 12-wks (p<0.05) with no differences after 24-wks. Tendon thickness showed a significant decrease in both groups (p<0.05), with a greater decrease in HVI with corticosteroid versus HVI without corticosteroid at 6 and 12-wks (p<0.05) with no difference at 24-wks.

Conclusion Treatment with HVI with or without corticosteroid in combination with eccentric training in chronic AT seems effective in reducing pain, improving activity level and reducing ultrasound tendon thickness and intra-tendinous vascularity. HVI with corticosteroid improved the conditions significantly better than HVI without corticosteroid in the short term. Thereby we argue that there is a corticosteroid effect in HVI treatment for AT.

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