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The Journal of Bone and Joint Surgery (American) 86:802-806 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Fluoroscopically Guided Low-Volume Peritendinous Corticosteroid Injection for Achilles Tendinopathy

A Safety Study

Sanjitpal S. Gill, MD1, Martin K. Gelbke, MD2, Steve L. Mattson, MD3, Mark W. Anderson, MD4 and Shepard R. Hurwitz, MD1

1 Department of Orthopaedic Surgery, University of Virginia, Box 800159, Charlottesville, VA 22908. E-mail address for S.R. Hurwitz: srh5u{at}virginia.edu
2 Department of Orthopaedic Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive, UH Box 0328, Ann Arbor, MI 48109-0328
3 Department of Anesthesia, University of Washington, Box 356540, Seattle, WA 98195
4 Division of Musculoskeletal Radiology, Department of Radiology, University of Virginia, Charlottesville, VA 22908

Investigation performed at University of Virginia Health System, Charlottesville, Virginia

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The safety and efficacy of corticosteroid injection for the treatment of Achilles tendinopathy is not known, with some reports indicating the hazard of tendon rupture and others extolling the efficacy of such injections. This study was undertaken to assess the safety of fluoroscopically guided corticosteroid injections into the peritendinous space for the treatment of Achilles tendinopathy.

Methods: A series of patients was treated with fluoroscopically guided corticosteroid injections into the space surrounding the Achilles tendon. Major and minor complications were recorded, as were the number of repeat injections, the duration of symptomatic relief attained with the injection, and a subjective rating of symptoms related to the Achilles tendon.

Results: Of eighty-three patients who had been treated, seventy-eight were available for follow-up and forty-three met our requirement for a minimum two-year follow-up (average duration of follow-up, 37.4 months). No major complications and one minor complication occurred in the forty-three patients. Seventeen (40%) of the patients reported improvement after the procedure, twenty-three (53%) thought that their condition was unchanged, and three (7%) felt that their condition was worse than it had been prior to the injection.

Conclusions: This retrospective cohort study establishes the safety of low-volume injections of corticosteroids for the treatment of Achilles tendinopathy when the needle is carefully inserted into the peritendinous space under direct fluoroscopic visualization.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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Related articles in JBJS:

Fluoroscopically Guided Low-Volume Peritendinous Corticosteroid Injection For Achilles Tendinopathy. A Safety Study • S.S. Gill, M.K. Gelbke, S.L. Mattson, M.W. Anderson, and S.R. Hurwitz reply:
Narayan Hulse, Swaminathan Raja, Biju Sankar, Sanjitpal S. Gill, Martin K. Gelbke, Steve L. Mattson, Mark W. Anderson, and Shepard R. Hurwitz
JBJS 2004 86: 2567-2568. [Extract] [Full Text]  



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Letters to the Editor:

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Obliteration of peritendinous space in Achilles tendinopathy
Narayan Hulse, et al.
JBJS Online, 27 May 2004 [Full text]
Dr. Hurwitz responds:
shepard r hurwitz, et al.
JBJS Online, 14 Jun 2004 [Full text]