Comparison of tetradecyl sulfate versus polidocanol injections for stabilisation of joints that regularly dislocate in an Ehlers-Danlos population

Abstract

ObjectivesTo determine whether there is similarity between tetradecyl sulfate and polidocanol in stabilising a joint from dislocating in patients with Ehlers-Danlos syndrome (EDS).MethodA retrospective analysis of patients with EDS in a sole-practice clinic in New Zealand. Patients must have had the diagnosis of EDS, had easily dislocatable joints, had treatment and at least 3 months’ follow-up. 0.11% tetradecyl sulfate solution, or 0.25% polidocanol solution, was injected to ligament attachments (enthesis) on the side of the joints where they dislocated. Patients were deemed successfully treated if their affected joints were no longer dislocated over a minimum of 3 months’ follow-up (out to 3 years).ResultsOf 250 patients at the time of the study, 46 fitted the criteria. There were 37 treated with tetradecyl sulfate and nine with polidocanol. For the tetradecyl group there were a total of 305 injections around 97 joints: mean 3.1, range 1–22, median 2. For the polidocanol group there were 36 injections around 19 joints: mean 1.9, range 1–8, median 2. The difference of means between group 1 (tetradecyl) and group 2 (polidocanol) is 1.2, CIs 0.34 to 2.98. All patients had no further dislocations of treated joints unless they had a major new injury (two patients).ConclusionThere was no difference between the two groups for stabilising joints from dislocating. These two agents appear promising for treating patients with recurrent joint dislocations in the setting of EDS. Prospective multicentre randomised controlled trials are needed to confirm these data.

Evaluation of the Effects of Polidocanol Injection in the Treatment of Temporomandibular Joint Hypermobility - A Prospective Study

“…0.25% polidocanol was used in joints of the shoulders, hips, knees and the TMJs. [ 30 ] In the present study, we used 1% polidocanol compared to the 3% polidocanol used in venous malformations. The commercially available 3% was diluted to 1% by using sterile water.…”

“…This study was a comparison study between the two agents and did not report the effect of the individual agents. [ 30 ] Therefore, we wanted to assess the effect of 1% polidocanol on isolated TMJ dislocation cases, rather than comparing it to other agents. One study reported successful treatment of hypermobility of TMJ by injecting sclerosing solution into the oblique protuberance and simultaneously cauterising the posterior attachment tissues lateral to the protuberance.…”

The Effect of Low Dose OnabotulinumtoxinA on Cervical Dystonia in Hypermobile Ehlers-Danlos Syndrome

“…All patients had undergone physical therapy and prolotherapy [ 12 13 ] for craniocervical stabilization prior to OnabotulinumtoxinA injection. The study was exempted by IRB on 3/15/21; all patients were provided with general informed consent per IRB protocol.…”