Favorable Outcomes After Sonographically Guided Intratendinous Injection of Hyperosmolar Dextrose for Chronic Insertional and Midportion Achilles Tendinosis

OBJECTIVE: The objective of our study was to report on changes in the short-term sonographic appearance and 2-year follow-up for pain outcomes in a large patient population with chronic Achilles tendinosis who underwent sonographically guided dextrose injections. SUBJECTS AND METHODS: One hundred eight tendons (86 midportion and 22 insertional) from 99 patients experiencing pain for greater than 6 months at either the Achilles tendon insertion or midportion were included in the study. Gray-scale (5-12 and 7-15 MHz) and color Doppler sonography examinations preceded the injection procedure using a 27-gauge needle administering a net 25% dextrose-lidocaine solution intratendinously. Structural features of each tendon and presence of neovascularity were noted. Visual analog scale (VAS) items were recorded at baseline, posttest, and 28.6 months follow-up. RESULTS: A median of five (range, 1-13) injection consultations were needed for each patient, spaced 5.6 +/- 3.1 (SD) weeks apart. There was a significant improvement in pain scores for both midportion (rest: 34.1 +/- 27.7-3.3 +/- 7.4, activities of daily living (ADL): 50.2 +/- 25.6-9.5 +/- 16.2, and sport: 70.7 +/- 23.3-16.7 +/- 22.0) and insertional (rest: 33.0 +/- 26.5-2.7 +/- 6.0, ADL: 51.3 +/- 25.4-10.0 +/- 16.3, and sport: 69.6 +/- 24.5-17.7 +/- 29.1) patients from baseline to follow-up for all VAS items. There were reductions in the size and severity of hypoechoic regions and intratendinous tears and improvements in neovascularity. CONCLUSION: Dextrose injections appear to present a low-cost and safe treatment alternative with good long-term evidence for reducing pain from pathology at either the insertion or midportion of the Achilles tendon.