Background: Achilles tendinopathy (AT) affects ca. 10 million recreational runners in Europe; the practice of hyaluronic acid (HA) infiltration is being increasingly adopted. The aim of this pilot study was to monitor the effects of a three-local time-spaced injections regimen of HA in the treatment of AT in middle-aged runners combining for the first time viscoelastometric, biochemical, and functional methodologies with routine clinical examinations. Methods: Eight male runners (Age 49.3 ± 3.9), diagnosed for unilateral AT, were given three ultrasound (US) guided peritendinous HA injections at the baseline (T0) and every fifteenth day with a follow-up on the forty-fifth day (T1, T2, and T3). At all-time points patients were assessed for viscoelastic tone and stiffness, maximal voluntary isometric contraction (MVIC), and pain level (Likert scale 0–5). The peritendinous effusions of the injured tendon were collected at T0 and T2 to quantify the volume variations and the IL-1β and MMP-3 levels. Results: At T0 MVIC and pain score were significantly lower and higher, respectively, in injured tendons. The volume, IL-1β and MMP-3 levels decreased in the course of treatment and the clinical endpoints ameliorated over time. Tone, stiffness, and functional performance also varied significantly at T2 and T3, as compared to T0. Conclusions: The sequential peritendinous injections of HA were effective in the amelioration of the clinical symptoms, as well as of the functional and viscoelastic state associated with AT. The determination of the viscoelastometric state may help to precisely evaluate the healing process in AT patients.

Background. This study evaluates the clinical and biochemical effects of sequential intra-articular (IA) injections of linear (LHA) and cross-linked hyaluronic acid (CLHA) in patients with Gonarthrosis (GA). Methods. Thirty-nine (39) patients (age 64.89 ± 8.83) received first the LHA injection (0.8-1.2 MDa, 32mg/2ml) and after 1 week the CLHA (1.0 MDa and 2.0 MDa, 75mg/3ml) one; this round was repeated after 6 months. Clinical assessments-i.e. ultrasonography, visual analogic scale (VAS) for pain, range of motion (ROM) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index-were performed at baseline and at specific time points up to 12 months. Relevant markers were determined in blood and synovial fluid (SF) at selected intervals. SF from patients with recurrent effusion was subjected to proteomic analysis. Results. This schedule improved joint pain and function, and promoted a reduction of inflammatory cytokines (IL-1β, IL-9 and IL-17) in plasma and SF; cartilage thickness increased at 12 months and the increase negatively correlated with the baseline levels of C-telopeptide of type II collagen (CTX-II). SF proteomic revealed that proteins associated with inflammation (Apolipoprotein A-1, α-1 antitrypsin and IgK) decreased, while the IL-1 inhibitor Transthyretin increased. Conclusions. This schedule represents an effective treatment whose benefits persist up to 12 months after baseline.