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Short-term benefit from ultrasonography-guided steroid injection for Achilles tendinopathy
Clinical Question
Is the combination of physical therapy and an ultrasonography-guided corticosteroid injection safe and beneficial for the treatment of Achilles tendinopathy?
Bottom line
This study found that the addition of an ultrasonography-guided corticosteroid injection to standard physical therapy for the treatment of Achilles tendinopathy resulted in a significant improvement in the composite outcome of pain relief, increased function, and activity at 6 months compared with a placebo injection. However, pain during physical activity was not significantly improved with the steroid injection compared with the placebo at any time. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Foundation
Setting: Outpatient (specialty)
Synopsis
These investigators from a university-based sports medicine clinic and local rheumatology clinics identified adults, aged 18 to 65 years, with pain in the Achilles tendon region aggravated by weight-bearing activities, pain and swelling located 2 cm to 6 cm proximal to the tendon insertion site, and pain lasting longer than 3 months. Eligible patients (N = 100) randomly received up to 3 treatments with an ultrasonography-guided injection with either (1) 1 mL methylprednisolone (40 mg/mL) and 1 mL lidocaine (10 mg/ML) or (2) 1 mL lipid emulsion and 1 mL lidocaine. There was an interval of at least 4 weeks between treatments. Both injections were placed anterior to the tendon as close as possible to the thickest part of the tendon. Patients were told to refrain from jumping activity and running for 3 months, with a slow return to normal sports participation thereafter. All patients also received standard physical therapy consisting of a heavy slow resistance program. Outcome assessments occurred by individuals masked to treatment group assignment. The primary outcome measure was a change in the total score of a previously validated questionnaire that assessed pain, function, and activity (on a scale of 1 to 100, where 100 represents no symptoms). Complete follow-up occurred for approximately 90% and 80% of participants at 6 and 12 months, respectively. Using intention-to-treat analyses, patients in the treatment group reported a significantly larger improvement score than the placebo group at 6 months (17.7 points; 8.4 - 27.0). However, there were no longer any group differences at 12 months and at no time was there any significant difference in pain during activity reported. Finally, overall improvement assessment was in favor of the corticosteroid group at 1 and 3 months, but not at 6, 12, or 24 months.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Achilles Steroid Injection
Surprised that steroid injection into the Achilles tendon is without long term risk of rupture
Steroid injections for Achilles tendonopathy
Not too surprising in the3 sense that steroid injection led to short term improvement only. Lots of other clinical uses with this same outcome. It would have been useful for me if the reviewer had mentioned the minimum clinically important difference between scores related to the outcome scale. How does the observed difference of 17 points compare wrt the treatment groups?
achilles tendoni grew up in an era in which the ortopedic w
I grew up in an era in which the orthopedic wisdom was that injecting the ACHILLES TENDON was associated with increased risk of rupture.
STEROID INJECTIONS IN ACHILLES TENDON
IMPROVES 6 MONTHS RECOVERY OF FUNCTION