American Journal of Roentgenology
Sonographically Guided Intratendinous Injection of Hyperosmolar Dextrose to Treat Chronic Tendinosis of the Achilles Tendon: A Pilot Study
Norman J. Maxwell1,2, Michael B. Ryan3, Jack E. Taunton4, Jean H. Gillies5 and Anthony D. Wong1
1 Department of Radiology, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada. 2 Present address: Department of Radiology, University of Pittsburgh Medical Center,
200 Lothrop St., Pittsburgh, PA. 3 Department of Medicine, Experimental Medicine Program, University of British Columbia, Vancouver, BC V6T 1Z3, Canada. 4 Division
of Sports Medicine, Faculty of Medicine and School of Human Kinetics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada. 5 Department of Rheumatology,
St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada.
OBJECTIVE. Chronic tendinosis of the Achilles tendon is a common overuse injury that is difficult to manage. We report on a new injection treatment for this condition.
SUBJECTS AND METHODS. Thirty-six consecutive patients (25 men, 11 women; mean age, 52.6 years) with symptoms for more than 3 months (mean, 28.6 months) underwent
sonography-guided intratendinous injection of 25% hyperosmolar dextrose every 6 weeks until symptoms resolved or no improvement was shown. At baseline and before
each injection, clinical assessment was performed using a visual analogue scale (VAS) for pain at rest (VAS1), pain during normal daily activity (VAS2), and pain
during or after sporting or other physical activity (VAS3). Sonographic parameters including tendon thickness, echogenicity, and neovascularity were also recorded.
Posttreatment clinical follow-up was performed via telephone interview.
RESULTS. Thirty-three tendons in 32 patients were successfully treated. The mean number of treatment sessions was 4.0 (range, 2–11). There was a
mean percentage reduction for VAS1 of 88.2% (p < 0.0001), for VAS2 of 84.0% (p < 0.0001), and for VAS3 of 78.1% (p < 0.0001). The mean tendon
thickness decreased from 11.7 to 11.1 mm (p < 0.007). The number of tendons with anechoic clefts or foci was reduced by 78%. Echogenicity improved
in six tendons (18%) but was unchanged in 27 tendons (82%). Neovascularity was unchanged in 11 tendons (33%) but decreased in 18 tendons (55%);
no neovascularity was present before or after treatment in the four remaining tendons. Follow-up telephone interviews of the 30 available patients
a mean of 12 months after treatment revealed that 20 patients were still asymptomatic, nine patients had only mild symptoms, and one patient had moderate symptoms.
CONCLUSION. Intratendinous injections of hyperosmolar dextrose yielded a good clinical response—that is, a significant reduction in pain at
rest and during tendon-loading activities—in patients with chronic tendinosis of the Achilles tendon.
Arch Phys Med Rehabil. 2008 Feb;89(2):377-85.
High-resolution ultrasound and magnetic resonance imaging to document tissue repair after prolotherapy: a report of 3 cases.
Fullerton BD. Patient-Physician Partnership, Austin, TX, USA. drbdf@aol.com
Abstract
High-resolution ultrasound imaging of musculoskeletal tissue is increasing in popularity because of patient tolerability,
low cost, ability to visualize tissue in real-time motion, and superior resolution of highly organized tissue such as a
tendon. Prolotherapy, defined as the injection of growth factors or growth factor production stimulants to grow normal cells
or tissue, has been a controversial procedure for decades; it is currently gaining in popularity among physiatrists and other
musculoskeletal physicians. This report describes imaging of tendons, ligaments, and medial meniscus disease (from trauma or degeneration).
Although these tissues have been poorly responsive to nonsurgical treatment, it is proposed that tissue growth and repair after prolotherapy
in these structures can be documented with ultrasound and confirmed with magnetic resonance imaging.