Elsevier

The Journal of Foot and Ankle Surgery

Volume 55, Issue 5, September–October 2016, Pages 976-979
The Journal of Foot and Ankle Surgery

Original Research
A Comparison of Two Different High-Volume Image-Guided Injection Procedures for Patients With Chronic Noninsertional Achilles Tendinopathy: A Pragmatic Retrospective Cohort Study

https://doi.org/10.1053/j.jfas.2016.04.017Get rights and content

Abstract

We undertook a comparison evaluation of outcomes after 2 different high-volume image-guided injection (HVIGI) procedures performed under direct ultrasound guidance in patients with chronic noninsertional Achilles tendinopathy. In group A, the HVIGI involved high-volume (10 mL of 1% lidocaine combined with 40 mL of saline) and no dry needling. In group B, the HVIGI involved a smaller volume (10 mL of 1% lidocaine combined with 20 mL of saline) and dry needling of the Achilles tendon. A total of 34 patients were identified from the clinical records, with a mean overall age of 50.6 (range 26 to 83) years and an overall mean follow-up duration of 277 (range 49 to 596) days. The change between the preinjection and postinjection Victorian Institute of Sports Assessment–Achilles scores of 33.4 ± 22.5 points in group A and 6.94 ± 22.2 points in group B, was statistically significant (p = .002). In group A, 3 patients (16.7%) required surgical treatment compared with 6 patients (37.5%) in group B requiring surgical treatment (p = .180). Our results indicated that a higher volume without dry needling compared with a lower volume with dry needling resulted in greater improvement in noninsertional Achilles tendinopathy. However, confounding factors mean it is not possible to categorically state that this difference was solely due to different injection techniques.

Section snippets

Patients and Methods

Patients who had undergone a HVIGI from 2 different departments in a single hospital trust were identified from the specific procedure logs maintained by the 2 of us (P.C.W., R.B.) performing these procedures. These identified patients had undergone this procedure from January 29, 2011 to May 1, 2012 for in group B and May 1, 2013 to January 7, 2015 for group A. Thus, each group had an approximately 18-month collection period. All consecutive patients in the 2 groups undergoing HVIGI procedures

Patient Population

Results were available for all 34 patients (18 in group A and 16 in group B), representing all patients who had undergone treatment and had attended follow-up visits after the procedure. Overall, the mean age was 50.6 ± 11.3 (range 26.4 to 83.1) years at procedure, and the mean follow-up duration was 277 ± 161 (range 49 to 596) days after HVIGI. The demographic and outcome variables stratified by treatment group are listed in Table 1. In group A, the mean patient age was 52.8 ± 9.17 years, and

Discussion

The results from the present study have demonstrated that in group A, which received 10 mL of 1% lidocaine combined with 40 mL of normal, sterile saline, without dry needling of the involved area of the Achilles tendon, significantly greater improvement occurred in the VISA-A score compared with that in group B, which received 10 mL of 1% lidocaine combined with 20 mL of normal, sterile saline, with dry needling of the involved area of the Achilles tendon. The precise explanation for this

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    Citation Excerpt :

    Two studies were reviewed concerning DN. Wheeler et al. performed a prospective cohort study comparing the outcomes of high-volume image-guided injection (HVIGI) with and without DN (Wheeler et al., 2016). Outcome assessments showed that HVIGI without DN compared to individuals receiving DN resulted in a greater improvement; however, as noted by the authors, confounding factors mean it is not possible to categorically state that this difference was solely due to different injection techniques.

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Conflict of Interest: None reported.

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