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Outcomes of prolotherapy for intra-tendinous Achilles tears: A case series
Outcomes of prolotherapy for intra-tendinous Achilles tears: A case series
Submitted on 02 Nov 2018

Ben Havard, Otto Chan, Dylan Morrissey, Sarah Morton
Queen Mary, University of London
This poster was presented at BIR Annual Congress 2018
Poster Views: 324
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Poster 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.

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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