Hassan Rifat, Poku Daryl, Miah Nafisa, Maffulli Nicola
Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ, United Kingdom.
Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom.
Br Med Bull. 2024 Dec 12;152(1):35-47. doi: 10.1093/bmb/ldae015.
Achilles tendinopathy (AT) is common, particularly in runners. High-volume injections (HVIs) may be beneficial in the management of AT compared to other conservative management options, including exercise regimens, platelet-rich plasma (PRP) injections, and extracorporeal shockwave therapy. The published research on the effectiveness of HVI in the treatment of AT was evaluated in this systematic review.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed when conducting this systematic review. The electronic databases PubMed, Embase, Cochrane, Web of Science, CINAHL, and OVID were thoroughly searched, from inception to 13 September 2023, for articles assessing HVI for AT.
A total of 10 studies with 460 participants met the inclusion criteria. HVI typically consisted of saline, local anaesthetic, and corticosteroids. HVI combined with corticosteroids demonstrated immediate and long-term improvements in ankle function. Compared to HVI without corticosteroids, HVI with corticosteroids exhibited greater, early improvements in pain and function, with no significant differences at later follow-up points. Significant reductions in tendon thickness and neovascularity were also found with HVI treatment over time.
No adverse events were reported with HVI, despite the use of corticosteroids.
HVI is an effective and safe modality, particularly in the short term, to significantly reduce pain and discomfort in the Achilles tendon, especially when supplemented with corticosteroids.
More robust randomized controlled trials, with longer-term follow-ups and homogeneity, are needed to fully establish its efficacy for AT.
跟腱病（AT）很常见，在跑步者中尤为如此。与其他保守治疗方案（包括运动疗法、富血小板血浆（PRP）注射和体外冲击波疗法）相比，大容量注射（HVI）可能对AT的治疗有益。本系统评价评估了已发表的关于HVI治疗AT有效性的研究。
进行本系统评价时遵循了系统评价和Meta分析的首选报告项目指南。对电子数据库PubMed、Embase、Cochrane、科学网、CINAHL和OVID进行了全面检索，从建库至2023年9月13日，以查找评估HVI治疗AT的文章。
共有10项研究、460名参与者符合纳入标准。HVI通常由生理盐水、局部麻醉剂和皮质类固醇组成。HVI联合皮质类固醇可使踝关节功能立即和长期改善。与不使用皮质类固醇的HVI相比，使用皮质类固醇的HVI在疼痛和功能方面早期改善更大，在后期随访点无显著差异。随着时间的推移，HVI治疗还发现肌腱厚度和新生血管明显减少。
尽管使用了皮质类固醇，但未报告HVI有不良事件。
HVI是一种有效且安全的治疗方式，尤其是在短期内，可显著减轻跟腱疼痛和不适，特别是在补充皮质类固醇时。
需要更有力的随机对照试验，进行长期随访并保持同质性，以充分确定其对AT的疗效。
