Change search
ReferencesLink to record
Permanent link

Direct link
Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
Show others and affiliations
2008 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 16, no 9, 859-864 p.Article in journal (Refereed) Published
Abstract [en]

Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6-8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.

Place, publisher, year, edition, pages
Springer, 2008. Vol. 16, no 9, 859-864 p.
Keyword [en]
Achilles tendon, chronic pain, injections, polidocanol, randomized, controlled trial
National Category
Orthopedics Sport and Fitness Sciences Surgery
URN: urn:nbn:se:umu:diva-22760DOI: 10.1007/s00167-008-0579-xPubMedID: 18633599OAI: diva2:218016
Swedish Research Council
Available from: 2009-05-18 Created: 2009-05-18 Last updated: 2014-02-19Bibliographically approved
In thesis
1. Patellar and Achilles tendinopathy: sclerosing injections and ultrasound guided arthroscopic shaving
Open this publication in new window or tab >>Patellar and Achilles tendinopathy: sclerosing injections and ultrasound guided arthroscopic shaving
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic painful tendinopathy is a common cause for elite- and recreational athletes to stop or decrease the level of their sports activity. Recent research on innervation patterns, histopathology and possible pain mechanisms in tendons has led to an increased knowledge about the chronic painful tendon. Ultrasound (US) and colourDoppler (CD) examination showing localized high blood flow, inside and outside regions with structural tendon abnormalities, has been shown to be of importance for tendon pain. Immuno-histochemical analyses of biopsies have shown sensory and sympathetic nerves in close relation to the high blood flow outside the tendon. These findings have led to new ideas about development of new treatment methods for chronic painful tendinopathy. In study I, we evaluated the already in use, US-guided sclerosing polidocanol injection treatment of midportion Achilles tendinopathy, using two different concentrations of the substance. This study aimed to find out if there was a faster return to pain-free activity by using the concentration 10 mg/ml compared to the formerly used 5 mg/ml. There were no significant differences in the clinical results between the groups. In study II - Technical note, we aimed to develop a new one-stage surgical treatment method for patellar tendinopathy. This method was based on research concerning the innervation patterns and US and CD findings in patellar tendinopathy/ “jumper’s knee”. Technically we added ultrasound guidance to knee arthroscopy to identify and visualize the region of interest during a surgical shaving procedure. In study III, we tested the newly invented US and CD-guided arthroscopic shaving technique in a pilot study. The short-term clinical results were promising and the majority of the patients returned to pain-free activity after a short rehabilitation period. In study IV, we compared the US and CD-guided artrhroscopic shaving method with the already in use sclerosing polidocanol injection treatment in a randomized study. At short-term follow-up, the patients treated with US and CD-guided arthroscopic shaving had significantly less pain during rest and activity, were significantly more satisfied with the treatment, and had a faster return to sports, compared to the patients in the sclerosing injection group. There were no complications. In study V, at longer-term followup (endpoint 46 months) there was a significant decrease in pain during activity in both groups. There were no remaining significant differences in the pain levels during activity between the groups. The tendon structure had improved significantly in both groups. There was a significant decrease in the antero-posterior thickness of the proximal patellar tendon in patients treated with US and CD-guided arthroscopic shaving, but not in the sclerosing injection group. The CD flow had diminished significantly in both groups, and there was a correlation between low CD flow and high patient satisfaction in both groups, The CD flow decreased faster in the surgical group than in the injection group. In conclusion, this newly invented US and CD-guided arthroscopic shaving treatment, focusing on treatment outside the tendon, has shown good clinical results with pain relief and a fast return to sports activity, in patients with patellar tendinopathy.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2013. 128 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1585
arthroscopy, jumper’s knee, sclerosing injection, tendinopathy, ultrasound
National Category
Research subject
urn:nbn:se:umu:diva-80194 (URN)978-91-7459-696-0 (ISBN)
Public defence
2013-10-04, Ejnarsalen, Capio Artro Clinic, Sophiahemmet, hus O, plan 3, Valhallavägen 91, Stockholm, 10:30 (Swedish)
Available from: 2013-09-13 Created: 2013-09-11 Last updated: 2013-09-13Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Willberg, LottaÖhberg, LarsFahlström, MartinAlfredson, Håkan
By organisation
Sports MedicineDiagnostic RadiologyRehabilitation Medicine
In the same journal
Knee Surgery, Sports Traumatology, Arthroscopy
OrthopedicsSport and Fitness SciencesSurgery

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 77 hits
ReferencesLink to record
Permanent link

Direct link