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

Patrick C. Wheeler

Research output: Contribution to journalArticlepeer-review

10 Citations (SciVal)


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.
Original languageEnglish
Pages (from-to)96-103
JournalInternational Musculoskeletal Medicine
Issue number3
Publication statusPublished - Jul 2014


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