Aprotinin in the management of Achilles tendinopathy: a randomised controlled trial

Abstract

Background:Achilles tendinopathy is a common condition, which can become chronic and interfere with athletic performance. The proteinase inhibitor aprotinin (as injection) has been found to improve recovery in patellar tendinopathy1 (evidence level 1b2) and Achilles tendinopathy.3 Internationally this therapy is being used based on this limited knowledge base.Aim:To evaluate whether aprotinin injections decrease time to recovery in Achilles tendinopathy.Method:A prospective, randomised, double blind, placebo controlled trial was performed comparing saline (0.9%) plus local anaesthetic injections and eccentric exercises with aprotinin (30 000 kIU) plus local anaesthetic injection and eccentric exercise. Three injections were given, each a week apart. In total, 26 patients, with 33 affected tendons, were enrolled for this study.Results:At no follow up point (2, 4, 12, or 52 weeks) was there any statistically significant difference between the treatment group and placebo. This included VISA-A scores4 and secondary outcome measures. However, a trend for improvement over placebo was noted.Conclusion:In this study on Achilles tendinopathy, aprotinin was not shown to offer any statistically significant benefit over placebo. Larger multicentre trials are needed to evaluate the efficacy of aprotinin in Achilles tendinopathy.

Successful Management of Tendinopathy With Injections of the MMP-inhibitor Aprotinin

“…The results are in concert with those described in previous published controlled trials [7,9,10]. For treatment of Achilles tendinopathy, there has previously been one semicontrolled study (Level 3) showing promising results with aprotinin injections [9] and multiple other published case series (Level 4) all with good clinical results in Achilles tendinopathy [3,22,38] (Table 7).…”

Conservative treatment of chronic Achilles tendinopathy

“…These treatments include corticosteroids, sclerosing therapy, aprotinin, polidocanol, glycosaminoglycan polysulfate and platelet-rich plasma. [26][27][28][29][30][31][32] Several studies have reported trends that are consistent with a clinically significant improvement, but are hampered by the small number of patients studied.…”

The future of MSK interventions

“…However, when this type of competition involves new and unproven procedures, it may have a particularly pernicious affect. Procedures inevitably proliferate faster than they can be evaluated (coblation for nucleotomy, oxygen-ozone ablation, PRP injection, ultrasound-guided scar tissue lysis), and therefore physicians who wish to be the first to adopt new approaches run the risk of offering treatments of dubious merit, some of which will eventually be discredited [16].…”