The use of high-volume image-guided injections (HVIGI) for Achilles tendinopathy – A case series and pilot study

Abstract Objective To identify outcomes for patients undergoing high-volume image-guided injection (HVIGI) for Achilles tendinopathy symptoms. Methods This is a prospective case-series design for all patients undergoing HVIGI in a single NHS Sports Medicine Clinic, performed by a single sports medicine consultant. HVIGI was performed with 10 ml 1% lidocaine, 40 ml saline, but unlike previously published case series, without corticosteroid or aprotinin. Results Sixteen patients were identified, of whom 14 had follow-up data available, with a mean duration of follow-up of 347 days. Overall, 50% were pain-free or virtually pain-free (recorded as a score of 0–1 on a 10-point visual analogue scale (VAS)) at the most recent follow-up. There was an average reduction in VAS score overall of 6.1 points on a 0–10 VAS, and an improvement in the Victorian Institute of Sport Assessment - Achilles (VISA-A) score of 41 points on the percentage scale. However, 14% of patients who underwent HVIGI required surgical intervention for on-going symptoms. Discussion HVIGI without corticosteroid appears to be an effective procedure for patients with recalcitrant Achilles tendon symptoms. Small sub-group numbers limit formal analysis, but suggest that there may be more benefit of HVIGI in patients with Achilles symptoms of less than 3 years. Further work is needed to formally establish benefits from HVIGI for patients with Achilles tendinopathy and to identify optimal injectate.