Abstract
Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6–8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.
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References
Alfredson H, Öhberg L (2005) Sclerosing injections to areas of neovascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 13:338–344
Conrad P, Malouf GM, Stacey MC (1995) The Australian polidocanol (aethoxysklerol) study. Results at 2 years. Dermatol Surg 21(4):334–336
Guex JJ (1993) Indications for the sclerosing agent polidocanol. J Dermatol Surg Oncol 19(10):959–961
Kvist M (1994) Achilles tendon injuries in athletes. Sports Med 18(3):173–201
Lind B, Öhberg L, Alfredson H (2006) Sclerosing polidocanol injections in midportion Achilles tendinosis: remaining good clinical results and decreased tendon thickness at 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 14:1327–1332
Paavola M, Paakkala T, Kannus P et al (1998) Ultrasonography in the differential diagnosis of Achilles tendon injuries and related disorders. Acta Radiol 39:612–619
Terslev L, Qvistgaard E, Torp-Pedersen S, Laetgaard J, Danneskiold-Samsøe B, Bliddal H (2001) Ultrasound and power Doppler findings in jumper’s knee - preliminary observations. Eur J Ultrasound 13:183–189
Weinberg EP, Adams MJ, Hollenberg GM (1998) Colour Doppler sonography of patellar tendinosis. AJR 171(3):743–744
Winter H, Drager E, Sterry W (2000) Sclerotherapy for treatment of hemangiomas. Dermatol Surg 26(2):105–108
Åström M, Gentz CF, Nilsson P et al (1996) Imaging in chronic Achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases. Skeletal Radiol 25:615–620
Öhberg L, Alfredson H (2002) Ultrasound guided sclerosing of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med 36:173–177
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Funding for the study has been achieved through the Swedish Research Council for Sports.
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Willberg, L., Sunding, K., Öhberg, L. et al. Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol. Knee Surg Sports Traumatol Arthr 16, 859–864 (2008). https://doi.org/10.1007/s00167-008-0579-x
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DOI: https://doi.org/10.1007/s00167-008-0579-x