Can Achilles tendinosis be treated effectively with lidocaine and glucose infiltrations, and if so, is the effect lasting? A longitudinal, observational on 27 consecutive patients

A. Bello Baez , M.L. Nieto Morales , P. Mora Guanche , A. Cavada Laza , Lina Inmaculada Pérez Méndez
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Abstract

Objective

Our aim was to add to the small but growing body of evidence on the effectiveness of ultrasound-guided Achilles intratendinous hyperosmolar dextrose prolotherapy and introduce a novel, preceding step of paratenon hydrodissection with lidocaine in patients with chronic Achilles tendinosis resistant to rehabilitation therapy.

Methods

We conducted a longitudinal, observational study on 27 consecutive patients diagnosed with Achilles tendinosis, in whom conservative treatment, ie, physiotherapy or shock wave therapy, had failed. A 2% lidocaine paratenon anesthesia and hydrodissection was followed by ultrasound-guided, intratendinous injections of 25% glucose every 5 weeks. Visual analogue scales (VAS) were used for pain assessment at rest, for activities of daily living, and after moderate exercise at the begining and at the end of the treatment. Moreover, tendon thickness and vascularisation were recorded at baseline and final treatment consultation. Effectiveness was estimated from scoring and relative pain reduction using a 95% CI. The non-parametric Wilcoxon test and a general linear model for repeated measures were applied. Statistical significance was established as p < 0.05.

Results

A median of 5 (1–11) injection consultations per patient were required. Pain scores decreased significantly in all three conditions (p < 0.001). Relative reductions were 75% in pain at rest (95% CI;61–93%), 69% in pain with daily living activities (95% CI; 55–83%), and 70% in pain after moderate exercise (95% CI; 57–84%). Tendon neo-vascularisation was significantly reduced (p < 0.001). We did not observe significant changes in tendon thickness (p = 0.083).

Conclusions

Achilles tendinosis treatment with paratenon lidocaine hydrodissection and subsequent prolotherapy with hyperosmolar glucose solution is safe, effective, inexpensive, and virtually painless with results maintained over time.

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利多卡因和葡萄糖浸润能有效治疗跟腱炎吗?如果能,效果持久吗?对27名连续患者进行的纵向观察。
目的:我们的目的是为超声引导下跟腱内高渗葡萄糖增生疗法的有效性增加少量但不断增加的证据,并介绍一种新的、预先用利多卡因对副藤酮水切除术治疗对康复治疗有抵抗力的慢性跟腱炎患者。方法:我们对27名连续被诊断为跟腱炎的患者进行了一项纵向观察性研究,这些患者的保守治疗,即物理治疗或冲击波治疗失败。2%利多卡因副藤酮麻醉和水切除术后,在超声引导下,每5周在肌腱内注射25%葡萄糖。在治疗开始和结束时,视觉模拟量表(VAS)用于休息时、日常生活活动和适度运动后的疼痛评估。此外,在基线和最终治疗咨询时记录肌腱厚度和血管形成情况。使用95%置信区间从评分和相对疼痛减轻来评估疗效。应用非参数Wilcoxon检验和重复测量的一般线性模型。统计学显著性为p<0.05。结果:每位患者平均需要5(1-11)次注射咨询。在所有三种情况下,疼痛评分都显著降低(p<0.001)。休息时疼痛的相对降低率为75%(95%CI;61-93%),日常生活活动疼痛的相对减少率为69%(95%CI,55-83%),适度运动后疼痛的相对减少率为70%(95%CI:57-84%)。肌腱新生血管形成显著减少(p<0.001)。我们没有观察到肌腱厚度的显著变化(p=0.083)。
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