There is no convincing evidence that any of the pharmacological
interventions for Achilles tendinopathy work, according to a systematic
review.
Current treatments include injectable corticosteroids, high-volume saline solution, prolotherapy, autologous blood, platelet-rich plasma and a variety of other substances, as well as transdermal topical application of glyceryl trinitrate and other drugs.
There are few studies, however, to establish which of these interventions are safe and effective.The recent study found 13 randomized controlled trials (with 528 patients) of pharmacological interventions for the treatment of Achilles tendinopathy.
There were three studies of platelet-rich plasma (PRP), two studies of autologous blood injection, two studies of polidocanol, and one study each of corticosteroids, skin-derived fibroblasts, prolotherapy and aprotinin injections. Two studies investigated the application of glyceryl trinitrate (GTN) patches on the tender site.
The follow-up times averaged 7.3 months (range, three to 14 months). Although some of the studies showed promising results, none of the interventions showed unequivocal evidence of remarkable benefits in terms of pain, disability, quality of life or histological changes.
Promising potentials were shown by different substances administered in combination with physical therapy, but there are not enough data to confirm their real additional benefit.
"There is a need for more long-term investigations, studying large enough cohort(s) with standardized scores and evaluations shared by all the investigations to confirm the healing potential, and provide a stronger statistical comparison of the available treatments," they write.
Current treatments include injectable corticosteroids, high-volume saline solution, prolotherapy, autologous blood, platelet-rich plasma and a variety of other substances, as well as transdermal topical application of glyceryl trinitrate and other drugs.
There are few studies, however, to establish which of these interventions are safe and effective.The recent study found 13 randomized controlled trials (with 528 patients) of pharmacological interventions for the treatment of Achilles tendinopathy.
There were three studies of platelet-rich plasma (PRP), two studies of autologous blood injection, two studies of polidocanol, and one study each of corticosteroids, skin-derived fibroblasts, prolotherapy and aprotinin injections. Two studies investigated the application of glyceryl trinitrate (GTN) patches on the tender site.
The follow-up times averaged 7.3 months (range, three to 14 months). Although some of the studies showed promising results, none of the interventions showed unequivocal evidence of remarkable benefits in terms of pain, disability, quality of life or histological changes.
Promising potentials were shown by different substances administered in combination with physical therapy, but there are not enough data to confirm their real additional benefit.
"There is a need for more long-term investigations, studying large enough cohort(s) with standardized scores and evaluations shared by all the investigations to confirm the healing potential, and provide a stronger statistical comparison of the available treatments," they write.
Maffulli N, Papalia R, D'Adamio S, Diaz Balzani L, Denaro V: Pharmacological interventions for the treatment of Achilles tendinopathy: a systematic review of randomized controlled trials. Br Med Bull. 2015 Jan 12
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