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Sonographically Guided Intratendinous Injection of Hyperosmolar Dextrose to Treat Chronic Tendinosis of the Achilles Tendon: A Pilot Study

Norman J. Maxwell1,2, Michael B. Ryan3, Jack E. Taunton4, Jean H. Gillies5 and Anthony D. Wong1

1 Department of Radiology, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada.
2 Present address: Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA.
3 Department of Medicine, Experimental Medicine Program, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
4 Division of Sports Medicine, Faculty of Medicine and School of Human Kinetics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
5 Department of Rheumatology, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada.


Figure 1
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  		Fig. 1A —58-year-old woman with midportion Achilles tendinosis. Longitudinal sonographic image obtained using 5-12–MHz linear array transducer shows large anechoic cleft in midportion of Achilles tendon.

 

Figure 2
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  		Fig. 1B —58-year-old woman with midportion Achilles tendinosis. Transverse sonographic image of same anechoic cleft after insertion of 27-gauge needle shows tip of needle is located at edge of cleft.

 

Figure 3
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  		Fig. 2 —Sonographic image obtained after injection in 82-year-old man with midportion Achilles tendinosis shows hyperechoic dextrose solution dispersing within abnormal tendon.

 

Figure 4
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  		Fig. 3A —49-year-old man with insertional Achilles tendinosis. Sonographic image shows typical appearance of insertional tendinosis.

 

Figure 5
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  		Fig. 3B —49-year-old man with insertional Achilles tendinosis. Sonographic images obtained after single hyperosmolar dextrose injection into distal thickened portion of tendon show large bursal-surface partial-thickness tear that has opened up. This patient was withdrawn from study and referred for surgical consultation.

 

Figure 6
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  		Fig. 3C —49-year-old man with insertional Achilles tendinosis. Sonographic images obtained after single hyperosmolar dextrose injection into distal thickened portion of tendon show large bursal-surface partial-thickness tear that has opened up. This patient was withdrawn from study and referred for surgical consultation.

 

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