Achilles injections show no meaningful benefit over sham treatment
Commonly used injections for Achilles tendinopathy—pain, stiffness and swelling in the Achilles tendon—offer no meaningful clinical advantage over placebo (sham) treatment, finds a clinical trial published by The BMJ.
A recent clinical trial published in The BMJ has found that high-volume injections for Achilles tendinopathy, a condition causing pain, stiffness, and swelling in the Achilles tendon, do not offer any significant clinical benefits over placebo (sham) treatment at 12 months. These injections, which may contain saline, local anesthetic, and sometimes a low dose of corticosteroid, did not lead to improvements in pain and disability compared to the sham injections.
While exercise-based therapy is the recommended treatment, up to 44% of patients do not recover and may turn to alternative options, such as injection therapy. Some studies suggest corticosteroid injections could provide short-term symptom relief, but the long-term effects and cost-effectiveness of these high-volume injections with or without corticosteroid remain unclear.
To investigate this further, researchers enrolled 192 adults with midportion Achilles tendinopathy, randomly assigning them to either a sham injection group, a high-volume injection without corticosteroid group, or a high-volume injection with corticosteroid group. All groups also received exercise programs, education, and advice on activity modification.
The main outcome measured was self-reported pain and disability at 52 weeks, based on the Victoria Institute of Sport Assessment-Achilles (VISA_A) scale. At the 12-month mark, there were no significant differences in VISA_A scores between the sham and high-volume injections, either with or without corticosteroid, or between the two high-volume injection groups.
The high-volume injection with corticosteroid provided small, short-term improvements at six weeks, but worse outcomes than the high-volume injection without corticosteroid at 26 weeks. Although the corticosteroid injections were more effective (in terms of QALYs gained) and less costly than sham, the overall clinical findings do not support the routine use of these high-volume injections.
The study acknowledges potential limitations, such as recruitment primarily through social media and the inability to mask injection providers, which may limit the generalizability of the results. However, the authors emphasize that these findings should prompt clinicians to reconsider the rationale for using these injections in people with Achilles tendinopathy.
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