A Comparison of Two Different High-Volume Image-Guided Injection Procedures for Patients With Chronic Noninsertional Achilles Tendinopathy: A Pragmatic Retrospective Cohort Study

Effectiveness of dry needling and high-volume image-guided injection in the management of chronic mid-portion Achilles tendinopathy in adult population: a literature review

“…Wheeler et al [23] has further added that HVIGI without dry needling is more effective than HVIGI with dry needling. Achilles tendinopathy is a difficult condition to treat.…”

“…Conversely, Chan et al and Humphrey et al used hydrocortisone in their injection, but there was no reported tendon rupture in their study. Wheeler et al did not use steroids in their technique to avoid the risk of tendon damage [23]. …”

“…Studies were done in a single centre in London hospital. Wheeler et al [23] compared effect of HVIGI with or without dry needling in two groups.…”

“…Then a mixture of 10 mL 0.5% bupivacaine hydrochloride and 25 mg of hydrocortisone acetate is injected, followed by 4 × 10 mL of injectable normal saline [20–22]. Some authors have described using more volume and without adding corticosteroids [23]. …”

Hydrodissection of an Achilles Tendinopathy on a Professional Athlete

“…The case review was limited due to a small sample size; however, all three methods (regardless of solution/substance used) performed hydrodissection and showed symptomatic improvement. A second study comparing lower volume (30mL saline/1% lidocaine mixture) to higher volume (50mL saline/1% lidocaine mixture) found that higher volumes injected into the ankle to perform a hydrodissection of Kager's fat pad and Achilles tendon had improvement in both pain scores and overall function, based on a 100 point scale called the Victorian Institute of Sports Assessment -Achilles (VISA-A) questionnaire [6].…”