High volume image guided injections for the management of chronic tendinopathy of the main body of the Achilles tendon

Phys Ther Sport. 2013 Aug;14(3):163-7. doi: 10.1016/j.ptsp.2012.07.002. Epub 2012 Nov 4.


Objectives: Several substances are routinely injected in and around tendons. The present study evaluated the long term effects of high volume image guided injection (HVIGI) of normal saline, local anaesthetic and aprotinin in athletic patients with resistant tendinopathy of the main body of the Achilles tendon.

Design: Case series.

Methods: The study included a series of 94 athletes (69 men and 25 women; average age 37.5 years, range 22-63) with ultrasound confirmed tendinopathy of the main body of the Achilles tendon. All the patients had not improved after at least three months of conservative management. Patients were injected with 10 mL of 0.5% Bupivacaine Hydrochloride, 25 mg aprotinin, and up to 40 mL of injectable normal saline. We prospectively administered the Victorian Institute of Sport Assessment-Achilles tendon (VISA-A) to assess the short- and long-term pain and functional improvement.

Results: At baseline (n = 94), the VISA-A score was 41.7 ± 23.2 (range 11-60), and had improved to 74.6 ± 21.4 (range 71-100) by 12 months (n = 87) (p = 0.003), with no significant difference between sexes.

Conclusion: HVIGI with aprotinin significantly reduces pain and improves function in patients with chronic Achilles tendinopathy in the short- and long-term follow up.

Keywords: Achilles tendon; Athletes; Injections; Neovascularization; Sports.

MeSH terms

  • Achilles Tendon / diagnostic imaging
  • Achilles Tendon / drug effects*
  • Adult
  • Anesthetics, Local / administration & dosage*
  • Aprotinin / administration & dosage*
  • Athletic Injuries / diagnostic imaging
  • Athletic Injuries / drug therapy*
  • Bupivacaine / administration & dosage*
  • Female
  • Hemostatics / administration & dosage*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Tendinopathy / diagnostic imaging
  • Tendinopathy / drug therapy*
  • Ultrasonography, Doppler, Color
  • Ultrasonography, Interventional*


  • Anesthetics, Local
  • Hemostatics
  • Aprotinin
  • Bupivacaine