TL;DR
Get health and wellness essentials delivered free with Prime
- Fast, free delivery on millions of items
- Prime Video, Amazon Music and more included
- Member-only deals all year
A randomized trial of 192 adults found that high-volume injections for midportion Achilles tendinopathy did not improve symptoms more than sham treatment at 12 months. Hydrocortisone added to the injection was linked to greater relief at six weeks, but that advantage faded by week 12 and pain and disability scores were worse at week 26 than with bupivacaine alone.
A randomized trial of 192 adults found that high-volume injections for midportion Achilles tendinopathy did not produce significantly better outcomes than sham injections after 12 months. The hydrocortisone-containing treatment improved symptoms more at six weeks, but the difference faded and scores later suggested worse pain and disability than with bupivacaine alone.
The study, reported in The BMJ by Peter Malliaras of Monash University in Melbourne and colleagues, assigned adults with gradual-onset Achilles tendon pain to one of three groups: a high-volume injection of bupivacaine and saline, the same injection with 25 milligrams of hydrocortisone, or a sham procedure. Participants had ultrasound-confirmed midportion tendinopathy and symptoms lasting at least three months.
The main outcome was change in the Victorian Institute of Sport Assessment-Achilles score, a 100-point measure of pain and disability, at week 52. Average improvements were around 25 to 30 points in all three groups; differences between groups were not statistically significant. Eleven participants did not provide week-52 scores, and the researchers said analyses limited to participants who completed the study gave similar results.
The steroid group showed roughly 10 points more improvement at week six than the other groups. That advantage was no longer present by week 12. By week 26, outcomes in the steroid group were numerically worse than in the sham group and significantly worse than in the bupivacaine-only group; the gap narrowed later and was not statistically significant by the final assessment. No differences between sham and bupivacaine alone were found at any time, according to the report.
The Trade-Off Between Early Relief and Later Scores
The findings matter for patients and clinicians weighing an injection that may offer short-term symptom relief against uncertain or less favorable later outcomes. The trial did not show a lasting advantage over sham, while its results raise a specific concern about whether adding a corticosteroid shifts the timing of relief rather than improving the longer-term course.
The researchers concluded that the clinical data do not support routine use of these injections for midportion Achilles tendinopathy. That conclusion is about the treatment tested and the population studied; it does not establish that every injection approach or every patient will have the same result. The study also found lower overall healthcare costs with the steroid-containing regimen, but the available report does not provide enough detail to treat that economic result as proof of better value for every patient.
In an accompanying editorial, sports medicine physician John W. Orchard argued that any short-term gain should be explained alongside the possibility of worse longer-term outcomes. His comments underline the practical issue raised by the trial: treatment decisions may depend on how patients weigh near-term function against the prospect of later symptoms, with uncertainty about the balance made clear.
Products Worth Considering
Fitbit Versa 2 Health and Fitness Smartwatch with Bonus Bands
Fitbit Versa Smart Watch – Black Aluminum, One Size (S & L Bands Included)
Fitbit Sense Advanced Smartwatch – Sage Grey/Silver (One Size, S & L Bands Included)
As an affiliate, we earn on qualifying purchases.
How the Trial Tested Achilles Injections
High-volume injections using saline, local anesthetic and sometimes corticosteroids have been used for tendon problems despite limited rigorous evidence. For Achilles tendinopathy, the approach described in the report involved injecting a relatively large volume of saline, sometimes with medication, near the junction of the tendon and Kager’s fat pad. Earlier trials had produced mixed findings, according to the source report.
In this study, the two active high-volume groups received 10 milliliters of 0.5% bupivacaine and 40 milliliters of saline, with hydrocortisone added to one group. The sham group received a smaller volume of bupivacaine at least 10 millimeters away from the targeted junction, at a site not expected to affect tendon pain or swelling. Researchers said the local anesthetic could still numb the area, helping preserve blinding; a sleeve also concealed the temporary bulge caused by the larger injections.
Participants were about 50 years old on average, and just under half were women. Their average baseline VISA-A score was around 50 points. The trial therefore addressed adults with persistent, gradual-onset midportion symptoms, rather than every form of Achilles injury or tendon pain.
“The clinical data do not support routine use for midportion Achilles tendinopathy.”
— Peter Malliaras and colleagues
Limits of the Evidence and Cost Findings
The findings concern one trial and one treatment protocol; the report does not establish how results would differ with other injection volumes, medicines, schedules or patient groups. It also does not show that injections have no effect for every individual. Group averages and statistical comparisons cannot predict a particular patient’s response.
The steroid group’s worse week-26 comparison with bupivacaine alone was statistically significant, but its later gap narrowed and was not statistically significant at 12 months. The report also says the steroid regimen reduced overall healthcare costs, but does not provide the full cost figures or enough detail here to determine which costs drove the difference. The reasons for the changing symptom scores are not established by the supplied findings.
How Clinicians May Apply the Results
The trial report and accompanying editorial put the next decision in clinical discussions: whether a patient’s priorities make a possible short-lived benefit worth the uncertainty about later outcomes. Orchard said clinicians recommending or performing corticosteroid injections should explain the trade-off as part of informed consent. The study authors’ conclusion argues against routine use of the tested injections for midportion Achilles tendinopathy.
The source material does not identify a scheduled follow-up study or a change to treatment guidelines. Further research would be needed to clarify whether particular patients benefit, how durable any early improvement is, and how treatment costs compare across care options. Until then, the findings should be read as evidence about this trial’s protocol and participants, not as a universal prediction.
Key Questions
Did the injections work better than sham treatment?
Not at 12 months. The trial found similar average improvement across the steroid, bupivacaine-only and sham groups, with no statistically significant difference in the primary outcome.
Did hydrocortisone provide any benefit?
The hydrocortisone group had greater improvement at six weeks, by roughly 10 VISA-A points compared with the other groups. The advantage was gone by week 12, and scores were worse at week 26 than with bupivacaine alone.
What kind of Achilles tendinopathy did the study include?
It included adults with ultrasound-confirmed, gradual-onset midportion Achilles tendinopathy and pain lasting at least three months. The results may not apply to all tendon conditions or injury types.
Does the trial show that no patient should receive an injection?
No. The researchers said the data do not support routine use of the tested injections for midportion Achilles tendinopathy. The trial does not predict every individual response or test every possible injection approach.
What remains unknown about the cost result?
The report says the steroid-containing treatment reduced overall healthcare costs during the study year, but the supplied details do not give the full figures or explain which costs accounted for the difference. The economic finding does not by itself establish value for every patient or health system.
Source: medpagetoday.com
![[Comment] Could enpatoran add to our therapeutic toolbox in SLE?](https://healthdailyguide.com/wp-content/uploads/2026/05/comment-could-enpatoran-add-to-our-therapeutic-toolbox-in-sle-featured-560x300.jpg)
