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1418 - High Volume Image-Guided Injections for Improved Outcomes with and without Corticosteroids for Achilles and Patellar Tendinopathy: A Systematic Review and Meta-Analysis

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

AC

Alexis R. Chow, BS

Student
Rowan Virtua School of Osteopathic Medicine
Clementon, New Jersey, United States

Co-Author(s)

KS

Kunal P. Shah, MS

Medical Student
Rowan-Virtua SOM
Stratford, New Jersey, United States
DR

David Rubin, BS

Student
Rowan-Virtua SOM
Stratford, New Jersey, United States
LS

Liana Shehata, MS

Student
Rowan-Virtua SOM
Stratford, New Jersey, United States
AR

Altamash Raja, DO

Associate Program Director-PM&R, Assistant Professor
Inspira Health Network, Rowan-Virtua SOM
Stratford, New Jersey, United States

Objectives: Achilles and patellar tendinopathies have a high incidence in athletes and the general population. High volume image-guided injections (HVIGI) have been used as treatment, but there are minimal studies outlining the effect of HVIGI on these pathologies or and how it is affected by its preparation with or without corticosteroids. The objective of this review is to analyze the effect of HVIGI with and without corticosteroids on clinical outcomes and pain.

Design: A systematic review of clinical trials from five databases (Cochrane, Embase, PubMed, Scopus, Web of Science) was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. A pooled meta-analysis was performed in SPSS. Primary measures included the Victorian Institute of Sport Assessment (VISA) for clinical outcomes at 6, 12, and 24 weeks, and Visual Analogue Scale (VAS) for pain at 24 weeks. Secondary measures included Achilles tendon thickness and neovascularity.

Results: 7 studies fit the inclusion and exclusion criteria. VISA scores were significantly improved at 12 weeks 24 weeks for the HVIGI group without corticosteroids, but not at 6. The corticosteroid group showed improved VISA scores at 6, 12, and 24. HVIGI with corticosteroids showed improved VISA scores compared to the non-corticosteroid group at 6 weeks and 12 weeks, but not at 24 weeks. The corticosteroid VISA scores showed a steady decline over time, while the non-corticosteroid VISA scores increased over time. Both groups showed improved VAS scores at 12 and 24 weeks. VAS scores at 24 weeks were not significantly different between corticosteroid and non-corticosteroid groups.

Conclusions: HVIGI without corticosteroids are an effective treatment option for Achilles and patellar tendinopathies, though it may take longer to produce meaningful clinical outcomes than HVIGI with corticosteroids. More randomized trials are needed to indicate the effectiveness of HVIGI.