Polidocanol injections have been used to treat chronic Achilles tendinopathy in clinical settings, but the few studies published show inconsistent results. The aim of this study was to evaluate the mid-term effect of Polidocanol in patients with chronic Achilles tendinopathy. It was hypothesised that patients treated with Polidocanol would have significant improvements in the outcome measures investigated compared to patients treated with a placebo treatment at mid-term follow-up.
This randomised controlled trial included forty-eight patients aged 32–77 years with a history of Achilles tendinopathy for at least 3 months and with neovascularisation demonstrated by ultrasonography was included. A minimum of 3 months of eccentric exercise treatment was required before participating. The patients were allocated to a maximum of two injection of either Polidocanol or Lidocaine (placebo). The primary outcome measure was pain during walking reported on a visual analogue scale. Secondary outcome measures were Foot and Ankle Outcome Score (FAOS), patient satisfaction with treatment and, shortly after inclusion, the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A) was also included. Follow-up examinations were performed after 3 and 6 months.
Pain during walking decreased during the 6-month follow-up period, but no significant differences were seen between the two groups. The same tendency was seen for FAOS and VISA-A in which both groups showed an improvement at 3- and 6-month follow-up, but no mid-term differences between the groups were seen. An equal number of patients in the two groups were satisfied with the treatment at follow-up.
The results indicate that Polidocanol is a safe treatment, but the mid-term effects are the same as a placebo treatment. This further questions the use of Polidocanol in the treatment of chronic Achilles tendinopathy.
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Alfredson H, Ohberg L (2005) Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 13:338–344
de Jonge S, de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL (2011) One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial. Am J Sports Med 39:1623–1629
de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL (2010) Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 303:144–149
Gross CE, Hsu AR, Chahal J, Holmes GB Jr (2013) Injectable treatments for noninsertional achilles tendinosis: a systematic review. Foot Ankle Int 34:619–628
Kingma JJ, de Knikker R, Wittink HM, Takken T (2007) Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med 41:e3
Lind B, Ohberg L, Alfredson H (2006) Sclerosing polidocanol injections in mid-portion Achilles tendinosis: remaining good clinical results and decreased tendon thickness at 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 14:1327–1332
Maffulli N, Papalia R, D’Adamio S, Diaz Balzani L, Denaro V (2015) Pharmacological interventions for the treatment of Achilles tendinopathy: a systematic review of randomized controlled trials. Br Med Bull 113:101–115
Maffulli N, Sharma P, Luscombe KL (2004) Achilles tendinopathy: aetiology and management. J R Soc Med 97:472–476
Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, Taunton JE, Khan KM, Victorian Institute Of Sport Tendon Study Group (2001) The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 35:335–341
Rompe JD, Furia J, Maffulli N (2009) Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: a randomized controlled trial. Am J Sports Med 37:463–470
Roos EM, Engstrom M, Lagerquist A, Soderberg B (2004) Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy: a randomized trial with 1-year follow-up. Scand J Med Sci Sports 14:286–295
Sussmilch-Leitch SP, Collins NJ, Bialocerkowski AE, Warden SJ, Crossley KM (2012) Physical therapies for Achilles tendinopathy: systematic review and meta-analysis. J Foot Ankle Res 5:15
van Sterkenburg MN, de Jonge MC, Sierevelt IN, van Dijk CN (2010) Less promising results with sclerosing ethoxysclerol injections for midportion achilles tendinopathy: a retrospective study. Am J Sports Med 38:2226–2232
Wijesekera NT, Chew NS, Lee JC, Mitchell AW, Calder JD, Healy JC (2010) Ultrasound-guided treatments for chronic Achilles tendinopathy: an update and current status. Skeletal Radiol 39:425–434
Willberg L, Sunding K, Ohberg L, Forssblad M, Fahlstrom M, Alfredson H (2008) Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol. Knee Surg Sports Traumatol Arthrosc 16:859–864
Conflict of interest
The authors declare that they have no conflict of interest related to this study.
This study was supported by grants from Hans og Nora Buchards Fond, Speciallæge Heinrich Kopps Legat and Region of Northern Denmark.
The study was performed in accordance with the Declaration of Helsinki and approved by the local ethical committee (VN-20060028) and the Danish Health and Medicines Authority (2006-002586-39), and was registered at ClinicalTrials.gov (NCT00377910).
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Ebbesen, B.H., Mølgaard, C.M., Olesen, J.L. et al. No beneficial effect of Polidocanol treatment in Achilles tendinopathy: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 26, 2038–2044 (2018). https://doi.org/10.1007/s00167-017-4675-7