SLR - September 2017 - Anish Y. Amin
Reference: Chan O, Havard B, Morton S, Pritchard M, Maffulli N, Crisp T, Padhiar N, Perry JD, King J, Morrissey D. Outcomes of Prolotherapy for Intratendinous Achilles Tears: A Case Series. Muscles Ligaments Tendons J. 2017 May 10; 7(1): 78–87Scientific Literature Review
Reviewed By: Anish Y. Amin, DPM
Residency Program: Boston University Medical Center, Boston, MA
Podiatric Relevance: The Achilles tendon is the largest and strongest tendon in the body; however, it is also most prone to injury in the foot and ankle. Injuries can include complete or partial ruptures, bursitis, Sever’s disease and tendinopathy. This study aims to evaluate use of prolotherapy on intratendinous Achllies tears. Prolotherapy involves injecting an irritant, such as hyperosmolar dextrose, into a tendon with the goal of stimulating growth factor release, stimulation of collagen deposition and thus tissue repair. Unlike many other studies relating to prolotherapy of the Achilles tendon, this study aims to evaluate the effectiveness of a single prolotherapy injection combined with a specific rehabilitation program.
Methods: A level IV, retrospective study consisting of 43 consecutive patients diagnosed with intratendinous Achilles tear. Patients were injected with ~0.8ml 1:1 50 percent dextrose/0.5 percent Marcaine. They were placed on a four- to six-week period with walking boot immobilization followed by progressive rehabilitation for six to eight weeks. Ultrasound scans were conducted before treatment and at five weeks for comparison. The outcomes were assessed with a VISA-A questionnaire at baseline, then at three months and 12 months after treatment.
Results: 30/43 patients (70 percent) responded with VISA-A scores which increased by 31 points after three months, and 40 points after 12.60 months. It was also found that echogenicity was significantly reduced at 5.2 weeks. Twenty-seven percent of tears were no longer detectable on ultrasound.
Conclusion: This study has found that dextrose prolotherapy with a planned immobilization regimen can significantly improve pain via VISA-A questionnaire. US follow-up also show that tears often filled in with echogenic material, and previous tear borders were difficult to distinguish. The continual improvement of VISA-A scores during the follow-up period highlights the importance of postprocedural rehabilitation. With this information, more randomized controlled trials are warranted to confirm and improve understanding and management of intratendinous tearing of the Achilles tendon.