Symposium: Molecular and Clinical Developments in Tendinopathy

Clinical Orthopaedics and Related Research

, Volume 466, Issue 7, pp 1625-1632

First online:

Successful Management of Tendinopathy With Injections of the MMP-inhibitor Aprotinin

  • John OrchardAffiliated withSports Medicine at Sydney University, University of Sydney Email author 
  • , Andrew MasseyAffiliated withUniversity of Bath
  • , Richard BrownAffiliated withBrisbane Orthopaedic and Sports Medicine Centre
  • , Adéline Cardon-DunbarAffiliated withUniversity of New South Wales
  • , Jamie HofmannAffiliated withFree University

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Aprotinin is a broad spectrum proteinase inhibitor (including matrix metalloproteinase [MMP] inhibitor) used for treating patellar and Achilles tendinopathies. One previous randomized control trial demonstrated aprotinin injections superior to both corticosteroid and saline injections in patellar tendinopathy (Level II), whereas results reported for aprotinin treatment in Achilles tendinopathy have been mixed. We performed a case review and followup questionnaire for 430 consecutive patients with tendinopathy treated by 997 aprotinin injections (30,000 KIU). A response rate of 72% was achieved with a minimum followup of 3 months (average, 12.2 months; range, 3–54 months). Seventy-six percent of patients had improved, 22% of patients reported no change, and 2% were worse. Sixty-four percent of patients thought aprotinin injections were helpful, while 36% believed they had neither a positive nor negative effect. Mid-Achilles tendinopathy patients (84% improvement) were more successfully treated than patellar tendinopathy patients (69% improvement). Despite stronger published evidence of benefit in patellar tendinopathy, clinical outcomes appeared better with aprotinin use in Achilles tendinopathies.

Level of Evidence: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.