Document Detail


Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial.
MedLine Citation:
PMID:  15688235     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Local injections of the sclerosing substance Polidocanol has been demonstrated to give good clinical results in a pilot study on patients with chronic Achilles tendinopathy. In this study, 20 consecutive patients (9 men and 11 women, mean age 50 years) with chronic painful mid-portion Achilles tendinopathy were randomised to injection treatment with either Polidocanol (5 mg/ml) (group A) or Lidocaine hydro-chloride (5 mg/ml) + Adrenaline (5 microg/ml) (group B). Both substances have a local anaesthetic effect, but Polidocanol also has a sclerosing effect. The patients and the treating physician were blinded to the substance injected. The short-term effects were evaluated after a maximum of two treatments, 3-6 weeks apart. Before treatment, all patients had structural tendon changes and neo-vascularisation demonstrated with US and colour doppler. Under US and colour doppler-guidance, the injections targeted the area of neo-vascularisation just outside the ventral part of the tendon. For evaluation, the patients recorded the severity of Achilles tendon pain during tendon loading activity, before and after treatment, on a VAS. Patient's satisfaction with treatment was also assessed. At follow-up (mean 3 months) after a maximum of two treatments, 5/10 patients in group A were satisfied with the treatment and had a significantly reduced level of tendon pain (p < 0.005). In group B, no patient was satisfied with treatment. In the pain-free tendons, but not in the painful tendons, neo-vascularisation was absent after treatment. After completion of the study, treatment with Polidocanol injections (Cross-over in group B and additional treatments in group A) resulted in 10/10 and 9/10 satisfied patients in group A and B, respectively. In summary, injections with the sclerosing substance Polidocanol have the potential to reduce tendon pain during activity in patients with chronic painful mid-portion Achilles tendinopathy.
Authors:
Håkan Alfredson; Lars Ohberg
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial     Date:  2005-02-02
Journal Detail:
Title:  Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA     Volume:  13     ISSN:  0942-2056     ISO Abbreviation:  Knee Surg Sports Traumatol Arthrosc     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-05-05     Completed Date:  2005-09-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9314730     Medline TA:  Knee Surg Sports Traumatol Arthrosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  338-44     Citation Subset:  IM    
Affiliation:
Department of Surgical and Perioperative Science Sports Medicine, Centre for Musculoskeletal Research, National Institute for Working Life, University of Umea, 90187, Umeå, Sweden. hakan.alfredson@idrott.umu.se
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MeSH Terms
Descriptor/Qualifier:
Achilles Tendon / blood supply,  injuries*
Anesthetics, Local / therapeutic use
Double-Blind Method
Epinephrine / therapeutic use
Female
Humans
Lidocaine / therapeutic use
Male
Middle Aged
Polyethylene Glycols / therapeutic use*
Sclerosing Solutions / therapeutic use*
Sclerotherapy / methods*
Statistics, Nonparametric
Tendon Injuries / therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 0/Polyethylene Glycols; 0/Sclerosing Solutions; 137-58-6/Lidocaine; 51-43-4/Epinephrine; 9002-92-0/polidocanol

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