High volume image guided injections in chronic Achilles tendinopathy

Abstract

HVIGI significantly reduces pain and improves function in patients with resistant Achilles tendinopathy in the short- and long-term.

Neovascularization in Achilles tendinopathy: have we been chasing a red herring?

“…In a relatively small cohort of patients, this therapy improved the short-term functional outcome and reduced the neovascularization score, though there was no significant association between a decrease of the neuro-vascular ingrowth and functional outcome [9,11,21].…”

Achilles tendon: functional anatomy and novel emerging models of imaging classification

“…Until the histological cause of positive colour and power Doppler sonography is identified, the mechanism of this increased flow remains speculative [24]. Eccentric calf strengthening exercises [16] decreases these infiltrating vessels possibly by repeated constriction but, when patients are unresponsive, the injection under US guidance of sclerosing chemical substances or high volume formulation may remove these aberrant vessels, possibly normalising the Achilles tendon structure, and significantly relieving clinical symptoms [9].…”

Ultrasound-guided intervention in the ankle and foot

“…The process of using saline stripping along the Achilles tendon is to strip off the blood vessels which also bring nerve fibres from the anterior aspect of the tendon. By stripping these vessels, it has been noticed that there is a reduction in pain and a correlation between the number of vessels and the amount of pain is evident 46,47 ( Figure 3). The technique includes injections into the pre-Achilles fascia using 10 ml of 0.5% bupivacaine, 25 mg hydrocortisone acetate and up to 40 ml of normal saline under ultrasound guidance.…”

“…Published evidence suggests short-term improvement with pain and function scores and a significant improvement in the Victorian Institute of Sport AssessmentAchilles tendon (VISA-A) score at 30 weeks and at 12 months post injection. 46,47 Chronic inflammation of the paratenon may result in adhesions between the paratenon and the Achilles tendon, leading to paratenonitis. Brisement, also known as paratenon stripping, includes the injection of saline solution into the tendon/ peritenon interspace to break up adhesions.…”