Sclerosing polidocanol injections in mid-portion Achilles tendinosis: remaining good clinical results and decreased tendon thickness at 2-year follow-up

Abstract

The short-term results after treatment with sclerosing polidocanol injections have been shown to be good in patients with chronic painful mid-portion Achilles tendinosis. This study aimed to evaluate the longer-term effects on tendon thickness, structure and vascularity, patient satisfaction with treatment, and pain during tendon loading activity. Ultrasonography (US) + colour Doppler (CD) was used for evaluation of the tendon, and the patients graded the amount of pain during tendon loading activity on a VAS. Forty-two patient's tendons (23 men and 19 women, mean age 53 years) with a long duration (mean 32 months) of pain symptoms from mid-portion Achilles tendinosis (US + CD showed a localised thickening, structural changes and neovascularisation), were at three (mean) occasions (6-8 weeks in between) treated with US and CD guided injections of the sclerosing substance polidocanol, targeting the area with neovessels ventral to the tendon. After treatment, 37 patients were satisfied with the results of the treatment and back to previous (before injury) activity level. At the 2-year follow-up (mean 23 months), 38 patients were satisfied with the results of the treatment, and there was a significant reduction in VAS (from 75 to 7; P < 0.05). US showed a significant reduction in the mean mid-portion tendon thickness (from 10 to 8 mm, P < 0.05) and a "more normal" structure. CD showed no, or a few, remaining neovessels in the majority of the successfully treated tendons. In conclusion, treatment with sclerosing polidocanol injections in patients with chronic painful mid-portion Achilles tendinosis showed remaining good clinical results at a 2-year follow-up. Decreased tendon thickness and improved structure after treatment, might indicate a remodelling potential?

Neovascularization in Achilles tendinopathy: have we been chasing a red herring?

“…In the Swedish studies, the investigators were able to detect neovessels in 100 % of the symptomatic tendons [1,26,37,38]. This observation was not supported by other researchers, who reported a percentage varying from 47 to 88 % [13,41,42,54].…”

Radiological interventions for soft tissue injuries in sport

“…Polidocanol sclerotherapy has shown good short-and mid-term response in chronic Achilles tendonopathy. Pain reduction and improvement in ultrasound appearance at 2-year follow-up has been recorded, but there are no RTC studies [41].…”

Current Strategy in the Treatment of Achilles Tendinopathy

“…However, studies have demonstrated a positive therapeutic effect in treating Achilles tendinopathy through the use of Doppler ultrasound guided polidocanol injections [Ohberg, 2002], and this effect appears to persist at 2 year follow-up [Lind, 2006]. Ohberg et al reported that the pain reducing effect was in the order of 80% pain reduction in approximately 80% of patients when using between one and five guided polidocanol injection sessions.…”

“…The therapeutic use of isolated growth factors for specific musculoskeletal injury is still in its infancy, and is currently prohibited for competitive athletes under the World Anti-Doping Authority (WADA) code January, 2011. The evidence for the use of autologous blood products, including platelet rich plasma, to treat Achilles tendinopathy or other tendinopathies is scant and most well conducted clinical trials do not show evidence of effect [de Vos, 2010 andPaoloni, 2010]. However many facets of the use of these injections have not been established, including; what is the optimal blood product injection type, what is the optimal volume of injection, what is the optimal timing of injection after injury, what is the optimal number and spacing of injections (single injection versus injection series, and what the optimal rehabilitation is after injection.…”