| Background: Tendinopathies are conditions characterized by activity-induced pain, local tenderness and swelling for which a gold standard treatment is not established yet. Hyaluronic Acid (HA) is a key-molecule in several cellular activities and it is normally present in the extra-cellular matrix of tendons and ligaments. Amongst its properties, HA injections may reduce pain and determine disease-modifying effects. This study is an investigator-initiated open-label trial conducted to investigate the efficacy and safety of HA (500-730 kDa) peritendinous injections on pain reduction in patients affected by lateral elbow, Achilles or patellar tendinopathy. Methods: A total of 71 tendons (34 with Achilles tendinopathy, 26 with lateral elbow tendinopathy, 11 with patellar tendinopathy) of 62 patients with painful tendinopathy were treated with a cycle of ultrasound-guided peritendinous injections one injection per week for three consecutive weeks. Efficacy assessments included changes in pain intensity measured by Visual Analogue Scale (VAS) at follow-up evaluations were performed 7 (V2), 14 (V3) and 56 days aften first treatment. An Ultrasound (US) assessment was also performed to evaluate changes in tendon thickness and neovascularization. Adverse events were recorded for safety analysis throughout the study. All results were analyzed with descriptive statistics appropriate to the nature of the variables. Results: Significant reduction in VAS (p<0.001) from baseline was observed in Achilles (-6.16 ± 0.45 cm), patellar (-6.16 ± 0.72 cm) and lateral elbow (-5.33 ± 0.43 cm) tendinopathies. The sagittal thickness decreased significantly from baseline at each endpoint (V3 day 14 and V4 day 56) in each type of tendinopathy analyzed (p<0.05). Neovascularization decreased for each tendons at V3 and V4, except for patellar tendon at V3 V1 (p=0.125). Nevertheless, reduction at V4 compared to baseline remained significant (p=0.016). Conclusions: US-guided HA (500-730 kDa) peritendinous injections determine significant pain relief and reduction in tendon thickness and neovascularization in US evaluations. The effect of HA did not show differences regarding the site of affected tendon. The treatment proved to be safe and very well tolerated. Level of evidence: 4. |
Efficacy and safety of hyaluronic acid (500-730kDa) Ultrasound-guided injections on painful tendinopathies: a prospective, open label, clinical study
Fogli M., Giordan N., Mazzoni G.
Original Article, 388 - 395
Keywords: Achilles, colour power doppler, hyaluronic acid., injection, patellar, tendinopathies, tennis elbow.,
Table of Content: Vol. 7 (No. 2) 2017 April/June
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Knocking-out matrix metalloproteinase-13 exacerbates rotator cuff muscle fatty infiltration
Liu X., Ravishankar B., Ning A., Liu M., Kim H.T., Feeley B.T.Original Article, 202 - 207 -
Hyaluronic acid increases tendon derived cell viability and proliferation in vitro: comparative study of two different hyaluronic acid preparations by molecular weight
Gallorini M., Berardi A.C., Berardocco M., Gissi C., Maffulli N., Cataldi A., Oliva F.Original Article, 208 - 214 -
Lactoferrin and parathyroid hormone are not harmful to primary tenocytes in vitro, but PDGF may be
Musson D.S., Tay M.L., Chhana A., Pool B., Coleman B, Naot D., Cornish J.Original Article, 215 - 222 -
Cox-2 inhibition and the composition of inflammatory cell populations during early and mid-time tendon healing
Blomgran P., Blomgran R., Ernerudh J., Aspenberg P.Original Article, 223 - 229 -
How to evaluate bone tunnel widening after ACL reconstruction – a critical review
de Beus J.M., Koch J. EJ, Hirschmann A., Hirschmann M.T.Original Article, 230 - 239 -
Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon
Trinchese G.F., Oliva F., Maffulli N.Technical Note, 240 - 246 -
Arthroscopic ACL reconstruction using patellar bone tendon autograft and Rigidfix fixation – A midterm functional outcome
Sudevan P.J., Chandrasekharan J., Sambandam S.N., Rohinikumar G.J., Annamalai S., Mounasamy V.Original Article, 247 - 255 -
Reverse shoulder arthroplasty patient personalized rehabilitation protocol. Preliminary results according to prognostic groups
Romano A.M., Oliva F., Nastrucci G., Casillo P., Di Giunta A., Susanna M., Ascione F.Original Article, 263 - 270 -
Reverse total shoulder versus angular stable plate treatment for proximal humeral fractures in over 65 years old patients
Giardella A., Ascione F., Mocchi M., Berlusconi M., Romano A.M., Oliva F., Maradei L.Original Article, 271 - 278 -
Normal microscopic architecture of acetabular labrum of hip joint: a qualitative original study with clinical aspects
Kapetanakis S., Gkantsinikoudis N., Dermon A., Kommata V., Papathanasiou J., Soukakos P., Dermon C.Original Article, 279 - 285 -
Effects of hip flexion angle on surface electromyographic activity of the biceps femoris and semitendinosus during isokinetic knee flexion
Kellis E., Galanis N., Kofotolis N., Hatzi A.Original Article, 286 - 292 -
Functional leg length discrepancy between theories and reliable instrumental assessment: a study about newly invented NPoS system
Mahmoud A., Abundo P., Basile L., Albensi C., Marasco M., Bellizzi L., Galasso F., Foti C.Validation Studies, 293 - 305 -
Characterising the proximal patellar tendon attachment and its relationship to skeletal maturity in adolescent ballet dancers
Rudavsky A., Cook J., Magnusson S.P., Kjaer M., Docking S.Original Article, 306 - 314 -
The Royal London Hospital Test for the clinical diagnosis of patellar tendinopathy
Maffulli N., Oliva F., Loppini M., Aicale R., Spiezia F., King J.B.Original Article, 315 - 322 -
Reliability of a device for the knee and ankle isometric and isokinetic strength testing in older adults
Bergamin M., Gobbo S., Bullo V., Vendramin B., Duregon F., Frizziero A., Di Blasio A., Cugusi L., Zaccaria M., Ermolao A.Original Article, 323 - 330 -
Ultrasound guided injection of a painful knee osteoarthritis with medial meniscus extrusion: a case series study
Di Sante L., Venditto T., Ioppolo F., Paoloni M., Mangone M., Alviti F.Original Article, 331 - 337 -
“Percutaneous release of the plantar fascia. New surgical procedure”
Oliva F., Piccirilli E., Tarantino U., Maffulli N.Technical Note, 338 - 340 -
Endoscopic Flexor Halluces Longus transfer for Chronic Achilles Tendon rupture – technique description and early post-operative results
Baumfeld D., Baumfeld T., Figueiredo A.R., de Araujo Junior L.F., Macedo B., Alves Silva T.A., Raduan F., Nery C.Technical Note, 341 - 346 -
Triceps surae elasticity modulus measured by shear wave elastography is not correlated to the plantar flexion torque
Lima K., Martins N., Pereira W., Oliveira L.Original Article, 347 - 352 -
Soft tissue pseudotumours: a pictorial review with emphasis on MRI
Perdikakis E., Tsifountoudis I., Kalaitzoglou I., Rountas C., Malliaropoulos N., Maffulli N.Review Article, 353 - 375 -
Perivascular Adductor Longus muscle injury: Ultrasound and Magnetic Resonance Imaging findings
Mattiussi G., Baldassi P.T., Pasta G., Burani A., Moreno C.Original Article, 376 - 387 -
Efficacy and safety of hyaluronic acid (500-730kDa) Ultrasound-guided injections on painful tendinopathies: a prospective, open label, clinical study
Fogli M., Giordan N., Mazzoni G.Original Article, 388 - 395 -
Failed synthetic graft after acute Achilles tendon repair
Mohmed A., Oliva F., Nardoni S., Maffulli N.Case Report, 396 - 402