Royce Chan, Abstract Co-Author: Nothing to Disclose

Otto Chan MD, Presenter: Nothing to Disclose

Tom Crisp MD, Abstract Co-Author: Nothing to Disclose

Nat Padhiar MS, Abstract Co-Author: Nothing to Disclose

Dylan Morrissey PhD, Abstract Co-Author: Nothing to Disclose

Nicola Maffulli, Abstract Co-Author: Nothing to Disclose

In patients with symptomatic chronic recalcitrant Achilles tendinopathy (CRAT) neovascularisation and neoneural ingrowth have been shown to be associated with symptoms. HVIGI has been shown to be a safe and effective treatment in patients with CRAT. Does the neovascularization grade change with clinical response in patients after high volume image guided injection (HVIGI)?

This is a prospective study using a new grading system to systematically categorise the degree of neovascularisation(NV) in CRAT. Patients were referred to a specialised sports injury clinic with a clinical diagnosis of mid-tendon CRAT.Inclusion criteria for the study included being aged between 18-65,failed 6 weeks of eccentric exercise and had no past history of Achilles rupture.Verbal and written consent was obtained.Using an aseptic technique and real-time US guidance,patients were injected with 10mls of 0.5% Bupivacaine hydrochloride mixed with 25mg of Hydrocortisone Acetate.Followed by a further 40mls of 0.9% NaCl saline solution under the guidance of real-time ultrasound.NV was recorded.After the HVIGI, patients followed an eccentric rehabilitation program.Victorian Institute of Sports Assessment (VISA-A) questionnaires were used as a measure of the function and symptom change.Patients were reviewed at 2 weeks and both NV grades and VISA-A scores were compared before and after the HVIGI.  

32 CRAT patients with a mean age of 43.4(range 25-59) and had experienced a mean of 13 months of symptoms(range 3-42)were included.4 patients were lost to follow up but were able to complete the VISA-A.There was a mean improvement of 33.9 in the VISA-A scores and a mean improvement of 1 NV grade.3 patients reported a lower VISA-A score after the HVIGI but with a change in NV grade of 0,1 and 2.NV grade improved in 79% of patients with the rest reporting no change.In the group where VISA-A scores decreased compared to increased, the mean NV change was 1 (range 0-2) and 1.32 (range 0-3) respectively.Overall,it showed that HVIGI improved clinical symptoms and NV by 90.6% and 79% respectively.

This study shows that there is a correlation between the VISA-A scores and the NV scores in patients treated with HVIGI

NV grading has been shown in this study to be a good US indicator for clinical response after HVIGI and therefore should be done routinely in all patients both pre- and post-HVIGI treatment.

Chan, R, Chan, O, Crisp, T, Padhiar, N, Morrissey, D, Maffulli, N, Does Grading of Neovascularisation Change with Clinical Response in High Volume Image-guided Injection (HVIGI) for Chronic Recalcitrant Achilles Tendinopathy?.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8015338.html