Surgery · 3 h ago
High-volume injections do not improve Achilles tendinopathy at 12 months
In a single-centre, three-arm randomised trial of 192 adults with midportion Achilles tendinopathy, high-volume injections with or without corticosteroid were compared with sham injection. Neither injection improved pain or disability over sham at 52 weeks; corticosteroid injection showed mixed results at earlier time points.
- Neither injection improved 12-month VISA-A scores versus sham.
- Corticosteroid injection showed mixed results at six and 26 weeks.
- No serious trial-related adverse events were recorded.
- Economic findings do not offset the lack of long-term clinical benefit.
The Inject trial randomly assigned 192 adults with midportion Achilles tendinopathy to sham injection (n=64), high-volume injection without corticosteroid (n=63), or high-volume injection with 25 mg hydrocortisone (n=65). All participants received the same exercise programme, education and activity-modification advice. The primary clinical outcome was the VISA-A pain and disability score at 52 weeks; the study also assessed cost effectiveness from a societal perspective.
At 12 months, data were available for 181 participants. Neither high-volume injection with corticosteroid nor injection without corticosteroid showed a clear benefit over sham on VISA-A scores: between-group differences were -3.5 (98.33% CI -12.0 to 5.0) and 4.0 (-4.2 to 12.3), respectively. Corticosteroid injection had a short-term advantage over sham at six weeks, but outcomes were worse than injection without corticosteroid at 26 weeks. No serious trial-related adverse events were recorded. The economic analysis found corticosteroid injection less costly than sham, with similar quality-adjusted life-years, but the clinical findings do not support routine use. Results come from a single-centre trial and do not establish benefit beyond the study period.
In practice
For adults with midportion Achilles tendinopathy similar to those enrolled, this single-centre randomised trial found no improvement in pain or disability at 52 weeks from high-volume injections, with or without corticosteroid, compared with sham; all groups also received exercise and advice. Corticosteroid injection showed a short-term benefit at six weeks but worse outcomes than injection without corticosteroid at 26 weeks. These findings do not support routine use of the tested injections. Follow-up was 12 months, and the economic analysis does not demonstrate a clinical advantage.
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The BMJ: Efficacy and cost effectiveness of high volume injections with and without corticosteroid compared with sham for midportion Achilles tendinopathy (Inject trial): randomised controlled trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.