Effect of Ultrasonography-Guided Corticosteroid Injection vs Placebo Added to Exercise Therapy for Achilles Tendinopathy:A Randomized Clinical Trial

IMPORTANCE: Corticosteroid injections and exercise therapy are commonly used to treat chronic midportion Achilles tendinopathy, but the evidence for this combination is limited. OBJECTIVE: To investigate the effect of corticosteroid injection and exercise therapy compared with placebo injection and exercise therapy for patients with Achilles tendinopathy. DESIGN, SETTING, AND PARTICIPANTS: This was a participant-blinded, physician-blinded, and assessor-blinded randomized clinical trial of patients with Achilles tendinopathy verified by ultrasonography. Assessment of pain and function were conducted at baseline and at 1, 2, 3, 6, 12, and 24 months. Patients were recruited from a university medical clinic and a private rheumatology clinic in Denmark between April 2016 and September 2018. Data analysis was performed from June to September 2021. INTERVENTIONS: Corticosteroid injection and placebo injection were performed with ultrasonography guidance. Exercise therapy was based on previous trials and consisted of 3 exercises done every second day. MAIN OUTCOMES AND MEASURES: The primary outcome was the Victorian Institute of Sports Assessment–Achilles (VISA-A) score (range, 1-100, with 100 representing no symptoms) at 6 months. Secondary outcomes included pain measured using a 100-mm Visual Analog Scale for morning pain and pain during exercise (with higher scores indicating worse pain), global assessment (Likert scale), and tendon thickness. RESULTS: A total of 100 patients were included, with 52 randomized to placebo (mean age, 46 years [95% CI, 44-48 years]; 32 men [62%]) and 48 randomized to corticosteroid injection (mean age, 47 years [95% CI, 45-49 years]; 28 men [58%]). Patients in the 2 groups had similar height (mean [SD], 177 [8] cm), weight (mean [SD], 79 [12] kg), and VISA-A score (mean [SD], 46 [18]) at baseline. The group receiving exercise therapy combined with corticosteroid injections had a 17.7-point (95% CI, 8.4-27.0 points; P < .001) larger improvement in VISA-A score compared with patients receiving exercise therapy combined with placebo injections at 6 months. No severe adverse events were observed in either group, and there was no deterioration in the long term (2-year follow-up). CONCLUSIONS AND RELEVANCE: Corticosteroid injections combined with exercise therapy were associated with better outcomes in the treatment of Achilles tendinopathy compared with placebo injections and exercise therapy. A combination of exercise therapy and corticosteroid injection should be considered in the management of long-standing Achilles tendinopathy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT0258063

A systematic review of imaging findings in patients with Osgood‐Schlatter disease

This systematic review aimed to describe the imaging characteristics of Osgood-Schlatter (OSD) compared with controls and imaging findings over time. A systematic search was conducted in Embase, CINAHL, and PubMed from inception until July 2021. Forty studies were eligible and included based on inclusion criteria on OSD diagnosis, the number of patients, and imaging outcomes. In patients with OSD, but not controls, findings were soft-tissue swelling of the cartilage and infrapatellar bursa, tendon changes, increased Doppler flow, and fragmentation of the secondary ossification center. Follow-up studies reported improvements over time, but some identified persistent tendon thickening and/or ossicles. Adults with OSD generally present with free ossicles. Findings were inconsistent on whether different morphometric features were altered in OSD compared to controls. OSD patients were classified within the early stages of tibial tuberosity maturation. This review documents that OSD presents with tissue alterations that do not appear in controls or the patient's asymptomatic knee. Notably, a large portion had tendon involvement, and ossicles seem to be associated with residual symptoms after maturation. Standard imaging of adolescents with OSD needs to be carefully considered when determining if tissue alterations are related to disease progression or part of the normal maturation