Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.
Foot Ankle Int. 2013 May;34(5):619-28. doi: 10.1177/1071100713475353. Epub 2013 Feb 4.
Although there has been a recent increase in interest regarding injectable therapy for noninsertional Achilles tendinosis, there are currently no clear treatment guidelines for managing patients with this condition. The objective of this study was (1) to conduct a systematic review of clinical outcomes following injectable therapy of noninsertional Achilles tendinosis, (2) to identify patient-specific factors that are prognostic of treatment outcomes, (3) to provide treatment recommendations based on the best available literature, and (4) to identify knowledge deficits that require further investigation.
We searched MEDLINE (1948 to March week 1 2012) and EMBASE (1980 to 2012 week 9) for clinical studies evaluating the efficacy of injectable therapies for noninsertional Achilles tendinosis. Specifically, we included randomized controlled trials and cohort studies with a comparative control group. Data abstraction was performed by 2 independent reviewers. The Oxford Level of Evidence Guidelines and GRADE recommendations were used to rate the quality of evidence and to make treatment recommendations.
Nine studies fit the inclusion criteria for our review, constituting 312 Achilles tendons at final follow-up. The interventions of interest included platelet-rich plasma (n = 54), autologous blood injection (n = 40), sclerosing agents (n = 72), protease inhibitors (n = 26), hemodialysate (n = 60), corticosteroids (n = 52), and prolotherapy (n = 20). Only 1 study met the criteria for a high-quality randomized controlled trial. All of the studies were designated as having a low quality of evidence. While some studies showed statistically significant effects of the treatment modalities, often studies revealed that certain injectables were no better than a placebo.
The literature surrounding injectable treatments for noninsertional Achilles tendinosis has variable results with conflicting methodologies and inconclusive evidence concerning indications for treatment and the mechanism of their effects on chronically degenerated tendons. Prospective, randomized studies are necessary in the future to guide Achilles tendinosis treatment recommendations using injectable therapies.
Level II, systematic review.
尽管近年来人们对非插入性跟腱病的注射治疗越来越感兴趣，但目前尚无明确的治疗指南来管理此类患者。本研究的目的是：（1）系统评价非插入性跟腱病注射治疗后的临床疗效；（2）确定与治疗结果相关的患者特异性因素；（3）根据现有最佳文献提供治疗建议；（4）确定需要进一步研究的知识空白。
我们检索了 MEDLINE（1948 年至 2012 年 3 月第 1 周）和 EMBASE（1980 年至 2012 年第 9 周），以评估非插入性跟腱病注射治疗的疗效。具体而言，我们纳入了随机对照试验和具有对照组的队列研究。数据提取由 2 名独立的审查员进行。采用牛津证据等级指南和 GRADE 推荐对证据质量进行评分，并提出治疗建议。
9 项研究符合我们的综述纳入标准，最终随访时共有 312 跟腱纳入。感兴趣的干预措施包括富含血小板的血浆（n = 54）、自体血注射（n = 40）、硬化剂（n = 72）、蛋白酶抑制剂（n = 26）、血液透析液（n = 60）、皮质类固醇（n = 52）和普鲁卡因疗法（n = 20）。只有 1 项研究符合高质量随机对照试验的标准。所有研究的证据质量均较低。虽然一些研究显示治疗方法有统计学意义上的效果，但通常研究表明某些注射剂并不比安慰剂好。
非插入性跟腱病注射治疗的文献结果各不相同，方法学存在差异，且关于治疗指征和它们对慢性退行性肌腱影响机制的证据尚无定论。未来需要前瞻性、随机研究，以使用注射疗法指导跟腱病的治疗建议。
II 级，系统评价。
