Abstract

Objective: High volume image guided injections of local anaesthetic and saline plus steroid plus structured rehabilitation (HVIGI and SR) have been shown to improve outcomes in Achilles tendinopathy (AT) patients. Due to concerns about steroid safety, our aim was to determine whether omitting the steroid altered the clinical effects of HVIGI and SR.
Methods: 23 consecutively recruited patients with AT (26 symptomatic tendons) were treated with a HVIGI composed of 10mls of 0.5% Marcaine mixed with either 40 ml of normal saline including 25 mg of hydrocortisone or 40 ml of saline only. Treatment allocation was determined by patient selection. The VISA-A questionnaire and visual analogue scales (VAS) were administered at pre-injection; 2, 6 and 10 weeks; and 12-month follow-up.
Results: VISA-A scores improved significantly in both groups, from a pre-injection mean (± SD) of 42.0 (± 20.5) to 86.9 (± 11.8) (p<0.01) in the ‘with steroid’ group, and from 42.6 (± 9.1) to 83.3 (± 12.2) (p<0.01) in the non-steroid group at final follow-up. VAS scores improved significantly in both groups. There was no statistically significance difference between the groups at baseline or any follow-up, in either VISA-A and VAS changes. A stronger effect size in favour of no steroid was seen at 10 weeks.
Conclusion: Overall, HVIGI and SR without steroid yields similar effects on pain reduction and functional improvement in comparison to HVIGI and SR with steroid. These results suggest that the effects of the injection may be mechanical rather than chemical, and that the steroid can be omitted. A randomised controlled trial is required to confirm this.

Keywords: Injection; Ultrasound; Corticosteroid; Achilles tendinopathy; Victorianinstitute of sports assessment–Achilles; Visual analogue scale; High volume