Technical Innovation Case Report: Ultrasound-Guided Prolotherapy Injection for Insertional Achilles Calcific Tendinosis

Buchanan, Benjamin K.; DeLuca, Jesse P.; Lammlein, Kyle P.

doi:10.1155/2016/1560161

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…The reason for separating out this finding here is to draw attention to the differences in treating calcific tendonopathy compared to non-calcific tendonopathy. Calcifications within the tendon may respond to extracorporeal shock wave therapy, prolotherapy, and surgery [ 123 , 124 , 125 ].…”

Section: Calcific Tendonopathymentioning

confidence: 99%

A Narrative Review of the Classification and Use of Diagnostic Ultrasound for Conditions of the Achilles Tendon

Mascarenhas

2020

Diagnostics

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Enthesitis is a cardinal feature of spondyloarthropathies. The Achilles insertion on the calcaneus is a commonly evaluated enthesis located at the hindfoot, generally resulting in hindfoot pain and possible tendon enlargement. For decades, diagnosis of enthesitis was based upon patient history of hindfoot or posterior ankle pain and clinical examination revealing tenderness and/or enlargement at the site of the tendon insertion. However, not all hindfoot or posterior ankle symptoms are related to enthesitis. Advanced imaging, including magnetic resonance imaging (MRI) and ultrasound (US), has allowed for more precise evaluation of hindfoot and posterior ankle conditions. Use of US in diagnosis has helped confirm some of these cases but also identified other conditions that may have otherwise been misclassified without use of advanced imaging diagnostics. Conditions that may result in hindfoot and posterior ankle symptoms related to the Achilles tendon include enthesitis (which can include retrocalcaneal bursitis and insertional tendonopathy), midportion tendonopathy, paratenonopathy, superficial calcaneal bursitis, calcaneal ossification (Haglund deformity), and calcific tendonopathy. With regard to classification of these conditions, much of the existing literature uses confusing nomenclature to describe conditions in this region of the body. Some terminology may imply inflammation when in fact there may be none. A more uniform approach to classifying these conditions based off anatomic location, symptoms, clinical findings, and histopathology is needed. There has been much debate regarding appropriate use of tendonitis when there is no true inflammation, calling instead for use of the terms tendinosis or tendonopathy. To date, there has not been clear examination of a similar overuse of the term enthesitis in conditions where there is no underlying inflammation, thus raising the need for more comprehensive taxonomy.

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Section: Calcific Tendonopathymentioning

confidence: 99%

A Narrative Review of the Classification and Use of Diagnostic Ultrasound for Conditions of the Achilles Tendon

Mascarenhas

2020

Diagnostics

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“…All of studies reported about good improvement of pain using the VAS score after dextrose prolotherapy treatment. A total of 6 studies reported improvement in supraspinatus tendon tear or pathology [8][9][10][11][12][13], 6 studies reported in Achilles tendon cases [4,[14][15][16][17][18] studies reported improvement in pain VAS score in treatment of patellar tendon, meniscus, acromion enthesopathy, anterior cruciate ligament laxity and anterior tibiofibular ligament injury [19][20][21][22][23].…”

Section: Pain Visual Analog Scale Scorementioning

confidence: 99%

“…Eleven studies reported there were improvement of functional outcome after dextrose prolotherapy [9][10][11][13][14][15]18,19,[21][22][23]. Five studies used a special scoring to evaluate the outcome.…”

Section: Functional Outcomementioning

confidence: 99%

“…There are nine studies (52%) used the concentration of dextrose with 25% [8,9,12,14,16,17,22,23,28] while three studies each used concentrations with 20% [11,15,18] or 15% [19][20][21]. The other two studies used concentrations of 10% [23] and 16.5% [13].…”

Section: Concentration Of Dextrose and Injection Protocolmentioning

confidence: 99%

“…Five studies (29.4%) performed prolotherapy monthly [8,18,19,20,23] and four studies performed it with only a single injection [10][11][12]14]. Four studies performed prolotherapy every 1 week or 2 weeks [9,13,15,21].…”

Section: Concentration Of Dextrose and Injection Protocolmentioning

confidence: 99%

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Dextrose Prolotherapy for Muscle, Tendon and Ligament Injury or Pathology: A Systematic Review

Рhatomy

Margaretha

Rahmadian

2020

ARRB

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Background: Prolotherapy with dextrose has recently gained attention as a potential treatment for muscle, ligament or tendon pathology/injury. Questions/Purpose: This review aimed to: 1) evaluate the main outcome of dextrose prolotherapy treatment for muscle, ligament or tendon pathology/injury; 2) determine the concentrations of dextrose and protocol of injection; and 3) assess complications or adverse effects after dextrose prolotherapy. Methods: Four electronic databases were searched for related published articles. Articles that met the following criteria were included in this review: 1) articles on peer-reviewed level 1 to 4 studies; 2) articles published in English; 3) articles on dextrose prolotherapy study for tendon or ligament or muscle injury/pathology; and 5) articles that describe dose of dextrose. Published articles that met this inclusion criteria were included in this systematic review. Results: Twenty four studies fulfilled inclusion criteria,consisting of seventeen clinical studies, four animal studies and three invitro studies. Eleven studies reported there were improvement of functional outcome after dextrose prolotherapy. Three Studies reported improvement of patient satisfaction after dextroprolotherapy in supraspinatus tear, Achilles tendinopathy. And patellar tendinopathy, meniscus tear and anterior tibiofibular ligament tear. Three studies reported there are increasing of neovascularization in Achilles tendinopathy and patellar tendinopathy in animal studies, increasing of inflammatory response in animal studies and in vitro studies and increasing of cell proliferation and collagen production. Nine studies (52%) use dextrose 25% concentration. A few adverse effects were reported and minor effect, such as discomfort Minor soreness, extreme pain, skin burns 2nd grade, hypotension, Deep Vein Thrombosis (DVT) ( patient has history DVT). Conclusions: Dextrose Prolotherapy is a potentially effective treatment for patients with muscle, tendon or ligament tear or pathology. Efficacy in long term follow-up, as single therapy or first-line therapy cannot be determined from the current literature.

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Ansatznahe Erkrankungen der Achillessehne

et al. 2017

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Achilles tendinopathy at the calcaneal insertion is classified into insertional tendinopathy, retrocalcaneal and superficial bursitis. The aim of this study was to present the current evidence on conservative and surgical treatment of insertional tendinopathy of the Achilles tendon. Conservative first-line therapy includes reduction of activity levels, administration of non-steroidal anti-inflammatory drugs (NSAID), adaptation of footwear, heel wedges and orthoses or immobilization. In addition, further conservative therapy options are also available. Eccentric stretching exercises should be integral components of physiotherapy and can achieve a 40% reduction in pain. Extracorporeal shock wave therapy has been shown to reduce pain by 60% with a patient satisfaction of 80%. Due to the limited evidence, injections with platelet-rich plasma (PRP), dextrose (prolotherapy) or polidocanol (sclerotherapy) cannot currently be recommended. Operative therapy is indicated after 6 months of unsuccessful conservative therapy. Open debridement allows all pathologies to be addressed, including osseous abnormalities and intratendinous necrosis. The success rate of over 70% is contrasted by complication rates of up to 40%. The Achilles tendon should be reattached, if detached by >50%. No valid data are available for the transfer of the tendon of the flexor hallucis longus (FHL) muscle but it is frequently applied in cases of more than 50% debridement of the diameter of the Achilles tendon. Lengthening of the gastrocnemius muscle cannot be recommended because insufficient data are available. Tendoscopy is a promising treatment option for isolated retrocalcaneal bursitis and has shown similar success rates to open debridement with significantly lower complication rates.

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Technical Innovation Case Report: Ultrasound-Guided Prolotherapy Injection for Insertional Achilles Calcific Tendinosis

Cited by 4 publications

References 9 publications

A Narrative Review of the Classification and Use of Diagnostic Ultrasound for Conditions of the Achilles Tendon

A Narrative Review of the Classification and Use of Diagnostic Ultrasound for Conditions of the Achilles Tendon

Dextrose Prolotherapy for Muscle, Tendon and Ligament Injury or Pathology: A Systematic Review

Ansatznahe Erkrankungen der Achillessehne

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