High-volume injections did not improve long-term outcomes
High-volume injections used for midportion Achilles tendinopathy provided no meaningful clinical advantage over sham injections at 12 months in a randomized clinical trial published by The BMJ.
The finding challenges the routine use of an intervention intended to treat a painful, persistent tendon condition that can interfere with walking and other everyday activity. In the study, participants who received high-volume injections with or without a low dose of corticosteroid did not show clear improvement in pain and disability compared with participants who received a sham procedure.
Achilles tendinopathy involves pain, stiffness and swelling affecting the Achilles tendon. The condition is a leading cause of persistent lower-limb pain and affects an estimated 6% of people during their lives, according to the report. Exercise-based therapy is recommended, but many patients continue to have symptoms and seek other treatment options.
How the trial was conducted
Researchers enrolled 192 adults with midportion Achilles tendinopathy at a radiology clinic in Melbourne, Australia, between December 2019 and July 2022. The participants had a mean age of 49, 55% were male, and their symptoms had lasted a median of two years.
At the start of the trial, participants had moderate to high levels of pain and disability. Their mean score on the Victoria Institute of Sport Assessment-Achilles scale, or VISA-A, was 48.7. The scale runs from 0 to 100, with 100 representing no pain or disability.
Participants were randomly assigned to one of three groups: a sham injection group with 64 people; a high-volume injection group without corticosteroid containing 63 people; and a high-volume injection group with corticosteroid containing 65 people. High-volume injections deliver saline and local anesthetic around the Achilles tendon and may also include a low dose of corticosteroid.
All three groups received the same underlying care: an exercise program, education and advice about activity modification. That common treatment is important because the comparison tested whether adding the injection approach produced an additional benefit beyond the shared conservative-care program.
No clear difference at one year
The trial’s main outcome was self-reported pain and disability after 52 weeks, measured with the VISA-A scale. Researchers also assessed cost per quality-adjusted life-year, a measure that combines length and quality of life.
Data were available at 12 months for 181 of the 192 participants, or 94% of the full study group. The results showed no clear differences between the sham procedure and either high-volume injection approach. There was also no clear difference between high-volume injections given with corticosteroid and those given without it.
In practical terms, the study did not find evidence that the high-volume injection techniques improved the longer-term outcome patients care about most: pain and functional limitation. The result applies to the treatment approaches tested in this trial and to the 12-month follow-up period studied.
Why the result matters
Injection therapy can be attractive when tendon symptoms persist despite exercise-based treatment. The report notes that up to 44% of patients may not recover with recommended exercise-based therapy, creating demand for alternatives. Earlier data had suggested that corticosteroid-containing injections could produce short-term symptom improvement, while the longer-term effects and cost-effectiveness of high-volume injections remained uncertain.
This trial directly addressed that uncertainty by comparing both versions of the high-volume treatment against a sham injection while keeping the accompanying exercise and education program the same across groups. Its results do not support routine use of high-volume injections, with or without corticosteroid, for the studied form of Achilles tendinopathy.
That conclusion does not establish that every injection strategy for every tendon condition has the same outcome. It does provide a controlled, longer-term result for a commonly used approach in adults with midportion Achilles tendinopathy. For clinicians and patients considering treatment options, it adds evidence that the procedure itself did not deliver a meaningful advantage over a sham procedure when paired with the same exercise, education and activity-modification plan.
What remains central to care
Exercise-based therapy remains the recommended treatment described in the report. The study participants all received an exercise program and related support, but the available results do not show that high-volume injection added meaningful benefit to that foundation.
The trial also illustrates why sham-controlled studies matter for procedures aimed at chronic pain and disability. When a treatment is delivered alongside education, activity advice and a structured exercise program, improvements can occur for several reasons. A sham comparison helps determine whether the specific intervention contributes a benefit beyond those shared elements.
For people with ongoing Achilles symptoms, the study is evidence about a particular treatment option rather than a substitute for individual clinical assessment. But its central result is straightforward: at one year, high-volume injections with or without corticosteroid did not improve pain and disability more clearly than sham treatment in this randomized trial.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
