Autologous Blood Injection for Treatment of Achilles Tendinopathy? A Randomised Controlled Trial

Abstract: Aim: To determine whether autologous blood injections added to standard management was effective in alleviating symptoms of achilles tendinopathy. Methods: Thirty three patients (18 female, 15 male) aged 50 years (SD 9) with 40 cases of achilles tendinopathy of 11 months (SD 7) duration were enrolled in the study. Participants were randomised to autologous blood injection added to standard treatment (eccentric-loading exercises) or standard treatment alone for 12 weeks. Victorian Institute of Sport Assessment for Achilles (VISA-A) score and ratings of discomfort during and following the injection were measured at baseline, six and 12 weeks. Analytically-derived effect-size thresholds of 5 (small) and moderate (15) were utilised as the reference values for clinical inference. Results: Improvements in VISA-A of 7.7 units (95%CL: +/-6.7) and 8.7 units (+/-8.8) were observed in the treatment and control groups respectively at six weeks relative to baseline with no clear effect of blood injection. At 12 weeks VISA-A score improved to 18.9 units (+/-7.4) in the treatment group revealing a clinically small blood injection effect of 9.6 units (+/-11.5), relative to a comparatively unchanged condition in control (9.4 units; +/-9.0). Predictors of response to treatment were unremarkable, and a 10% rate of post-injection flare was the only noteworthy side-effect. Most patients described the discomfort experienced during the baseline injection as mild, and while there was greater variability in the change in discomfort over the 48 hours following the injection this was on average mild to moderate discomfort. Conclusions: There is some evidence for small symptomatic improvements in the short-term with the addition of autologous blood injection to standard treatment for achilles tendinopathy, although confirmatory research is required to eliminate a possible placebo effect.