Corticosteroid injection for Achilles tendinopathy
Trial question
What is the role of ultrasound-guided corticosteroid injection in patients with Achilles tendinopathy?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
40.0% female
60.0% male
N = 100
100 patients (40 female, 60 male).
Inclusion criteria: adult patients with ultrasound-verified Achilles tendinopathy for ≥ 3 months.
Key exclusion criteria: Achilles tendon rupture or surgery in the symptomatic lower limb; known medical diseases; corticosteroid injection for Achilles tendon pain within the past 6 months; BMI > 30.
Interventions
N=48 ultrasound-guided corticosteroid injection (1-3 injections of 1 mL methylprednisolone acetate 40 mg/mL and 1 mL lidocaine 10 mg/mL over 3 months plus exercise therapy).
N=52 ultrasound-guided placebo injection (1-3 injections of 1 mL intralipid and 1 mL lidocaine 10 mg/mL over 3 months plus exercise therapy).
Primary outcome
Improvement in Victorian Institute of Sports Assessment-Achilles score at 6 months
39 points
22 points
39.0 points
29.3 points
19.5 points
9.8 points
0.0 points
Ultrasound-guided corticosteroid
injection
Ultrasound-guided placebo
injection
Significant
increase ▲
Significantly greater improvement in Victorian Institute of Sports Assessment-Achilles score at 6 months (39 points vs. 22 points; AD 17.7 points, 95% CI 8.4 to 27).
Secondary outcomes
Significantly greater improvement in the ultrasound-measured thickness of Achilles tendon at 3 months (2.6 vs. 0.6; AD 2.2 , 95% CI 1.5 to 3).
Significantly greater improvement in morning pain on VAS at 2 months (34 points vs. 18 points; AD 15.6 points, 95% CI 2.6 to 28.6).
Safety outcomes
No significant difference in injection pain.
Conclusion
In adult patients with ultrasound-verified Achilles tendinopathy for ≥ 3 months, ultrasound-guided corticosteroid injection was superior to ultrasound-guided placebo injection with respect to improvement in Victorian Institute of Sports Assessment-Achilles score at 6 months.
Reference
Finn Johannsen, Jens Lykkegaard Olesen, Tommy Frisgaard Øhlenschläger et al. Effect of Ultrasonography-Guided Corticosteroid Injection vs Placebo Added to Exercise Therapy for Achilles Tendinopathy: A Randomized Clinical Trial. JAMA Netw Open. 2022 Jul 1;5(7):e2219661.
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