The effect of sclerotherapy and prolotherapy on chronic painful Achilles tendinopathy—a systematic review including meta‐analysis

Abstract

Chronic painful Achilles tendinopathy (AT) is a common disorder among athletes. Sclerotherapy (ST) and prolotherapy (PT) are two promising options among the numerous other conservative therapies. As their efficacy and potential adverse effects (AE) are still unclear, we systematically searched, analyzed, and synthesized the available literature on ST and PT for treating AT. Electronic databases, Google Scholar and articles' reference lists were searched according to PRISMA guidelines. Eligibility criteria were set up according to the PICOS-scheme including human and animal studies. Three authors independently reviewed the results and evaluated methodological quality (Coleman Methodology Score and Cochrane Risk of Bias Assessment). The initial search yielded 1104 entries. After screening, 18 articles were available for qualitative synthesis, six of which were subjected to meta-analysis. The mean Coleman Score of the 13 human studies was 50. Four RCTs were ranked as having a low risk of selection bias. Three of those reported a statistically significant drop in the visual analog scale (VAS) score, one a significant increase in the VISA-A Score. 12 of 13 human studies reported positive results in achieving pain relief and patient satisfaction, whereas only one study's finding differed. Meta-analysis revealed an unambiguous result in favor of the intervention (weighted mean difference D=-4.67 cm, 95% CI -5.56 to -3.76 cm [P<.001]). Only one serious AE and two minor AEs were reported in the entire literature. This systematic review suggests that ST and PT may be effective treatment options for AT and that they can be considered safe. Long-term studies and RCTs are still needed to support their recommendation.

Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials

“…Our NMA results conflict with a recent systematic review with head-to-head meta-analysis where prolotherapy and sclerotherapy were superior to other treatments. 13 Differences in study selection criteria (case series were also included vs only randomised clinical trials in our NMA) and outcome measure selection (eg, general Visual Analogue Scale vs a validated patient-reported outcome measure in our NMA) may explain the discrepancy.…”

“…5 6 Wait-and-see, exercise therapy, injections, shockwave therapy, orthosis, medication and surgery are the main treatment options offered to patients with Achilles tendinopathy. [7][8][9][10][11][12][13][14] Most patients receive multiple treatments over time, thereby impacting on healthcare consumption. 15 Trials and conventional meta-analysis do not directly assess the relative effectiveness of all available treatments, challenging patients and clinicians when they make treatment decisions.…”

Sclerotherapy and prolotherapy for chronic patellar tendinopathies - a promising therapy with limited available evidence, a systematic review

“…Furthermore, the reference lists of the eligible articles were screened for further yields. The search strategy was based on the search strategy of a previous work from the same group and adjusted according to the new topic [46]. The search strategy was developed by two reviewers (OM, AH).…”

Gaelic Sport Injuries

“…56 Tendon end retraction can be seen occasionally in acute tears. Imageguided treatment options for Achilles tendinopathy include Doppler ultrasound-guided sclerotherapy with polidocanol, 57 prolotherapy with hyperosmolar dextrose to cause osmotic shock and inflammatory response, 58 and hydrodissection with saline and local anesthetic. 59 The previously mentioned techniques have a theoretical mechanism of disruption of neovascularization and nerve ingrowth.…”