The use of high-volume image-guided injections (HVIGI) for Achilles tendinopathy – A case series and pilot study

Abstract

Objective

To identify outcomes for patients undergoing high-volume image-guided injection (HVIGI) for Achilles tendinopathy symptoms.

Methods

This is a prospective case-series design for all patients undergoing HVIGI in a single NHS Sports Medicine Clinic, performed by a single sports medicine consultant. HVIGI was performed with 10 ml 1% lidocaine, 40 ml saline, but unlike previously published case series, without corticosteroid or aprotinin.

Results

Sixteen patients were identified, of whom 14 had follow-up data available, with a mean duration of follow-up of 347 days. Overall, 50% were pain-free or virtually pain-free (recorded as a score of 0–1 on a 10-point visual analogue scale (VAS)) at the most recent follow-up. There was an average reduction in VAS score overall of 6.1 points on a 0–10 VAS, and an improvement in the Victorian Institute of Sport Assessment - Achilles (VISA-A) score of 41 points on the percentage scale. However, 14% of patients who underwent HVIGI required surgical intervention for on-going symptoms.

Discussion

HVIGI without corticosteroid appears to be an effective procedure for patients with recalcitrant Achilles tendon symptoms. Small sub-group numbers limit formal analysis, but suggest that there may be more benefit of HVIGI in patients with Achilles symptoms of less than 3 years. Further work is needed to formally establish benefits from HVIGI for patients with Achilles tendinopathy and to identify optimal injectate.

Keywords:

• Achilles tendinopathy
• High-volume image-guided injection

Acknowledgements

Wheeler would like to offer his thanks to the whole clinical team at the Sports Medicine Department, Leicester General Hospital for their support in this research. In addition, Wheeler would like to offer his thanks to Dr Otto Chan, Consultant Musculoskeletal Radiologist at Mile End Hospital, who originally taught him this procedure.