Treatment of Insertional Achilles Tendinopathy by Hyaluronic Acid Injection: A Pilot Study on the Clinical and Radiological Changes in Adult Patients

Introduction: The exact pathogenesis of Insertional Achilles tendinitis (IAT) is unclear, and as so the conservative management of IAT is less successful than the management of the Non-insertional tendinopathy. The objective of this study is to evaluate the effects of a weekly injection of sodium hyaluronate administered for 3 week in adult subjects with insertional achilles tendinopathy by assessing pain and daily activity as measured by using the VISA-A score.

Methods and materials: Prospective uncontrolled single center study, in 20 adult patients with IAT. The studied drug was SYNVISC (hylan G-F 20), an elastoviscous high molecular weight fluid containing hylan A and hylan B polymers. Patients who were enrolled in the study signed an informed consent. The medical history was taken and a physical examination was conducted, along with a posterior ankle ultra-sonography (US). Three US guided Hyaluronic- Acid injections were preformed on three consecutive weeks. The VISA-A questionnaire was filled at five points in time during and after the trial and follow up US or MRI was conducted six months following the last injection, along with a physical examination.

Results: While only few patients reported clinical improvement, others continued to suffer pain and stiffness in the Achilles region.

Conclusions: Treating IAT with three consecutive SYNVISC injections showed inconclusive results. When non-operative treatment measures fail to achieve clinical improvement it seems reasonable to try an SYNVISC injection course. Larger scale trials under similar protocol need to be conducted in order to enlarge our knowledge regarding this treatment regimen.