Effect of Ultrasonography-Guided Corticosteroid Injection vs Placebo Added to Exercise Therapy for Achilles Tendinopathy

Johannsen, Finn Elkjær; Olesen, Jens Lykkegaard; Øhlenschläger, Tommy Frisgaard; Lundgaard-Nielsen, Mathilde; Cullum, Camilla Kjaer; Jakobsen, Anna Svarre; Rathleff, Michael Skovdal; Magnusson, Peter; Kjær, Michael

doi:10.1001/jamanetworkopen.2022.19661

Cited by 13 publications

(9 citation statements)

References 29 publications

(73 reference statements)

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“…A previous case-control study showed that continuous glucocorticoid treatment increased the odds ratio of tendinopathy, whereas intermittent use exhibited low odds ratio ( Spoendlin et al, 2015 ). In a recent clinical trial, local injections of steroids (maximum three times at 4-week intervals) combined with exercise showed better outcomes in the treatment of tendinopathy than with placebo injections and exercise at 6 months ( Johannsen et al, 2022 ). In the rat tendon injury model, tendon healing was enhanced, and their mechanical properties improved when dexamethasone was administered for 5 days ( Dietrich-Zagonel et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Increased expression of glutathione peroxidase 3 prevents tendinopathy by suppressing oxidative stress

et al. 2023

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Tendinopathy, a degenerative disease, is characterized by pain, loss of tendon strength, or rupture. Previous studies have identified multiple risk factors for tendinopathy, including aging and fluoroquinolone use; however, its therapeutic target remains unclear. We analyzed self-reported adverse events and the US commercial claims data and found that the short-term use of dexamethasone prevented both fluoroquinolone-induced and age-related tendinopathy. Rat tendons treated systemically with fluoroquinolone exhibited mechanical fragility, histological change, and DNA damage; co-treatment with dexamethasone attenuated these effects and increased the expression of the antioxidant enzyme glutathione peroxidase 3 (GPX3), as revealed via RNA-sequencing. The primary role of GPX3 was validated in primary cultured rat tenocytes treated with fluoroquinolone or H2O2, which accelerates senescence, in combination with dexamethasone or viral overexpression of GPX3. These results suggest that dexamethasone prevents tendinopathy by suppressing oxidative stress through the upregulation of GPX3. This steroid-free approach for upregulation or activation of GPX3 can serve as a novel therapeutic strategy for tendinopathy.

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Section: Discussionmentioning

confidence: 99%

Increased expression of glutathione peroxidase 3 prevents tendinopathy by suppressing oxidative stress

et al. 2023

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“…An RCT of 100 patients with at least 3 months of midportion Achilles tendinopathy symptoms compared CSI with supervised Achilles resistance training vs placebo injection with the same resistance therapy . Patients were given up to 3 injections at least 4 weeks apart, and all injections were performed with ultrasonography guidance.…”

Section: Discussionmentioning

confidence: 99%

Common Painful Foot and Ankle Conditions

Cooper

2023

JAMA

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ImportanceMorton neuroma, plantar fasciitis, and Achilles tendinopathy are foot and ankle conditions that are associated with pain and disability, but they can respond to nonoperative treatment.ObservationsMorton neuroma, consisting of interdigital neuronal thickening and fibrosis, is characterized by burning pain in the ball of the foot and numbness or burning pain that may radiate to the affected toes (commonly the third and fourth toes). First-line nonoperative therapy consists of reducing activities that cause pain, orthotics, and interdigital corticosteroid injection; however, approximately 30% of patients may not respond to conservative treatment. Plantar fasciitis accounts for more than 1 million patient visits per year in the US and typically presents with plantar heel pain. Fifteen years after diagnosis, approximately 44% of patients continue to have pain. First-line nonoperative therapy includes stretching of the plantar fascia and foot orthotics, followed by extracorporeal shockwave therapy, corticosteroid injection, or platelet-rich plasma injection. Midportion Achilles tendinopathy presents with pain approximately 2 to 6 cm proximal to the Achilles insertion on the heel. The primary nonoperative treatment involves eccentric strengthening exercises, but extracorporeal shockwave therapy may be used.Conclusions and RelevanceMorton neuroma, plantar fasciitis, and Achilles tendinopathy are painful foot and ankle conditions. First-line therapies are activity restriction, orthotics, and corticosteroid injection for Morton neuroma; stretching and foot orthotics for plantar fasciitis; and eccentric strengthening exercises for Achilles tendinopathy.

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“…The authors found that the group that underwent exercise therapy and corticosteroid injection had an increase of 17.7 points (95% CI, 8.4 to 27.0 points; p < 0.001) in Victorian Institute of Sport Assessment-Achilles (VISA-A) scores at 6 months compared with the group that underwent placebo injection with exercise. The group that underwent exercise therapy and corticosteroid injection in the management of Achilles tendinopathy also had no adverse events over 2 years 32 .…”

Section: Foot and Anklementioning

confidence: 91%