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Outcomes of prolotherapy for intra-tendinous Achilles tears: A case series
Poster Title: Outcomes of prolotherapy for intra-tendinous Achilles tears: A case series
Submitted on 02 Nov 2018
Author(s): Ben Havard, Otto Chan, Dylan Morrissey, Sarah Morton
Affiliations: Queen Mary, University of London
This poster was presented at BIR Annual Congress 2018
Poster Views: 520
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Poster Information
Abstract: Background: The intra-tendinous tear is a newly recognised pathology that is defined as a discontinuity of fibres situated entirely within the tendon. Prolotherapy involves injecting an irritant, such as hyperosmolar dextrose, to stimulate a tissue healing response and ultimately reduce pain.

Hypothesis/Purpose: To determine the effect of prolotherapy, followed by immobilisation and progressive rehabilitation, on pain and function in patients with intra-tendinous Achilles tears. The secondary aim was to evaluate associated sonographic changes.

Study Design: Case series

Methods: 43 consecutive patients diagnosed with an intra-tendinous tear were included (27 males: 16 females, mean (SD) age 41 (11.3). Patients were injected with 0.4ml-1.5ml (mean 0.8ml) of 50% dextrose and 0.5% marcaine mixed in a 1:1 ratio. A 4-6 week period of walking boot immobilisation was followed by progressive rehabilitation (6-8 weeks). Outcomes were assessed with a VISA-A questionnaire at baseline, 3 months and a mean 12.6 (7.0) months post-treatment. Ultrasound (US) scans were conducted before treatment and 5.2 (2.3) weeks later to assess short term sonographic changes.

Results: 30 patients (70%) responded with VISA-A scores increasing by 31 (30.5) points after 3 months (f=0.62, p<0.05) and by 40 (29.3) points after 12.60 (7.0) months (f=0.87, p<0.05). After 5.2 (2.3) weeks, echogenicity was significantly reduced (p<0.05) and 27% of tears were no longer detectable. No significant differences were observed in remaining tears with respect to tear size, tendon thickness or neovascularisation.

Conclusion: Treatment resulted in clinically significant improvements and controlled trials are warranted.
Summary: Case Series evaluating the efficacy of prolotherapy injections for intra-tendinous Achilles tears.References: Chan O, Morton S, Pritchard M, Parkes T, Malliaras P, Maffuli N, Crisp T, Padhiar N, King J, Morrissey D. Intra-tendinous tears of the Achilles tendon – a new pathology? Analysis of a large 4 year cohort. MTLJ.
Ryan M, Wong A, Taunton J. Favorable outcomes after sonographically guided intratendinous injection of hyperosmolar dextrose for chronic insertional and midportion achilles tendinosis. AJR Am J Roentgenol. 2010;194:1047-1053.
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