The effect of sclerotherapy and prolotherapy on chronic painful Achilles tendinopathy—a systematic review including meta‐analysis

  title={The effect of sclerotherapy and prolotherapy on chronic painful Achilles tendinopathy—a systematic review including meta‐analysis},
  author={Oliver Morath and Eva Johanna Kubosch and Jan Taeymans and J{\"o}rn Zwingmann and Lukas Konstantinidis and Norbert P S{\"u}dkamp and A Hirschm{\"u}ller},
  journal={Scandinavian Journal of Medicine \& Science in Sports},
  pages={15 - 4}
Chronic painful Achilles tendinopathy (AT) is a common disorder among athletes. Sclerotherapy (ST) and prolotherapy (PT) are two promising options among the numerous other conservative therapies. As their efficacy and potential adverse effects (AE) are still unclear, we systematically searched, analyzed, and synthesized the available literature on ST and PT for treating AT. Electronic databases, Google Scholar and articles’ reference lists were searched according to PRISMA guidelines… 
Sclerotherapy and prolotherapy for chronic patellar tendinopathies - a promising therapy with limited available evidence, a systematic review
There seems to be some evidence that ST and PT may be effective treatment options to treat pain and to improve function in patients with CPT, but more research is needed with larger volume studies and randomized controlled studies with long term follow up.
Effects of dextrose prolotherapy on tendinopathy, fasciopathy, and ligament injuries, fact or myth?
There is insufficient evidence to support the clinical benefits of dextrose prolotherapy in managing dense fibrous tissue injuries and more high-quality randomized controlled trials are warranted to establish the benefits.
Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials
No trials were at low risk of bias and there was large uncertainty in the comparative estimates in the living network meta-analysis, but clinicians could consider starting treatment with a calf-muscle exercise programme.
Which treatment is most effective for adults with Achilles tendinopathy
This study commenced on 1st November 2018, and its expected completion date is 15 August 2019, and it will seek publication in an international peer-reviewed journal and publish translational articles to disseminate the work to clinicians.
Whiplash injury successfully treated with prolotherapy: a case report with long-term follow up.
Background: Chronic whiplash-associated disorder (WAD) can develop after flexion/extension injuries and may be refractory to standard-of-care therapies. Aim: To present successful treatment of
Injection therapies for patellar tendinopathy
  • S. Nuhmani
  • Medicine
    The Physician and sportsmedicine
  • 2019
The literature reveals many different injection methods are being used by clinicians for the treatment of patellar tendinopathy, and Platelet rich plasma, corticosteroids, autologous blood, and aprotinin are the most commonly used injection treatments.
Insertional and mid-substance Achilles tendinopathies: eccentric training is not for everyone – updated evidence of non-surgical management
This review summarises the evidence for managing Achilles tendon pain, the effects on non-clinical outcomes such as imaging and performance are not included.
Ultrasound-observed tendon abnormalities in lateral epicondylalgia: Exploring associations with neurosensory and clinical outcomes
This thesis demonstrates that the composite US scoring method has good inter-and intra-rater reliability in grading tendon abnormalities in LE and investigates the effectiveness of prolotherapy injections, manual therapy/exercise, both singly and in combination in improving tendon structural and sensory abnormalities over time.
Efficacy of hypertonic dextrose infiltrations for pain control in rotator cuff tendinopathy: systematic review and meta-analysis.
It is found that hypertonic dextrose infiltrations reduced pain in individuals with rotator cuff in the long-term and could be an alternative to non-invasive treatments when no favorable results can be achieve.
Achilles Tendinopathy, A Brief Review and Update of Current Literature
A brief review of the relevant anatomy, differential diagnosis, imaging findings, and an update of the literature on conservative and minimally invasive managements of chronic Achilles tendinopathy are provided.


Physical therapies for Achilles tendinopathy: systematic review and meta-analysis
Practitioners can consider eccentric exercise as an initial intervention for AT, with the addition of laser therapy as appropriate, with limited evidence from an individual RCT suggests microcurrent therapy to be an effective intervention.
Injection therapies for Achilles tendinopathy.
A review of randomised trials evaluating injection therapies in adults with an investigator-reported diagnosis of Achilles tendinopathy found that there was very low quality evidence in favour of the injection therapy group in short-term pain and in the return to sports.
Prolotherapy and Achilles tendinopathy: a prospective pilot study of an old treatment
Prolotherapy is a safe, effective, and cheap treatment for Achilles tendinopathy in this pilot study and the study recovergram showed a positive correlation between initial VAS score and number of treatments.
Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies
It is concluded that study methodology may influence reported surgical outcome and practical guidelines for improving study design are suggested, as improved study design would provide clinicians with a more rigorous evidence‐base for treating patients who have recalcitrant patellar tendinopathy.
Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial
For Achilles tendinosis, prolotherapy and particularly ELE combined with prolotherapy give more rapid improvements in symptoms than ELE alone but long-term VISA-A scores are similar.
Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment
Sclerosing neovessels appears to be an effective treatment for painful chronic Achilles tendinosis, suggesting that neovessel play a key part in causing chronic tendon pain.
Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial
In injections with the sclerosing substance Polidocanol have the potential to reduce tendon pain during activity in patients with chronic painful mid-portion Achilles tendinopathy.
Sclerosing injections in midportion Achilles tendinopathy: a retrospective study of 25 patients
It is concluded that sclerosing injections is a promising alternative to surgery in chronic Achilles midportion tendinosis, but the procedure is less invasive.
Less Promising Results with Sclerosing Ethoxysclerol Injections for Midportion Achilles Tendinopathy
This study did not confirm the high beneficial value of sclerosing neovascularization in patients with midportion Achilles tendinopathy, and it is important to stress that injection of Ethoxysclerol may not be as promising as was thought.