Injection therapies for Achilles tendinopathy

Area of Science:

• Orthopedics
• Sports Medicine
• Regenerative Medicine

Background:

• Achilles tendinopathy is a prevalent condition causing significant functional impairment.
• Numerous injection therapies exist, necessitating a review of their efficacy.
• Randomized trials are crucial for informing clinical decisions regarding injection treatments.

Purpose of the Study:

• To evaluate the benefits and harms of various injection therapies for Achilles tendinopathy.
• To synthesize evidence from randomized controlled trials on injection treatments.
• To identify gaps in current research for future studies.

Main Methods:

• Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
• Searched multiple databases (Cochrane, MEDLINE, EMBASE, etc.) up to April 2015.
• Included adult participants with Achilles tendinopathy, comparing injections to placebo, no treatment, or active therapies.
• Primary outcomes: function (VISA-A score) and adverse events.

Main Results:

• 18 trials (732 participants) were included; 7 focused on athletic populations.
• Low-quality evidence showed no significant difference in function (VISA-A scores) between injection therapies and controls at short, medium, or long-term follow-up.
• Very low-quality evidence indicated minimal differences in adverse events, with one Achilles rupture reported with corticosteroid injections.
• Very low-quality evidence favored injections for short-term pain relief and return to sport, but not patient satisfaction.

Conclusions:

• Insufficient evidence exists from randomized controlled trials to support the routine use of injection therapies for Achilles tendinopathy.
• Further high-quality research is needed, particularly in non-athletic and older populations.
• Placebo-controlled trials are considered the most appropriate design for future research in this area.