ACHILLES TENDINITIS - ARE CORTICOSTEROID INJECTIONS USEFUL OR HARMFUL

Objective: The use of local corticosteroid injections for the treatmen t of Achilles tendonitis is controversial. Some authors advocate their use based on efficacy in accelerating the healing process of Achilles tendonitis; others feel the associated side effects should preclude t heir use altogether. The purpose of this study was to comprehensively review and critically appraise the available literature in order to ex amine the evidence concerning this clinical dilemma. Data sources: MED LINE was searched using MeSH and textwords for English- and French-lan guage articles related to Achilles tendonitis and corticosteroids publ ished since 1966. Additional references were reviewed from the bibliog raphies of the retrieved articles. The total number of articles review ed was 145. Study selection: All clinical study designs were included as well as related animal studies using experimental and quasi-experim ental designs. Data extraction and synthesis: In reviewing the literat ure, particular attention was paid to the relative strengths of the di fferent study designs. From these data, the factors associated with ef fectiveness and safety of injected corticosteroids were examined. Main results: The only rigorous studies (one randomized controlled trial, one cohort study) showed no benefit of corticosteroids over placebo. I n animal studies, corticosteroid injections decrease adhesion formatio n, temporarily weaken the tendon if given intratendinously, but have n o effect on tendon strength if injected into the paratenon. The overal l incidence of side effects with locally injected corticosteroids is s imilar to 1%. Most side effects are temporary, but skin atrophy and de pigmentation can be permanent. Although there are many case reports of Achilles tendon rupture following local corticosteroid injection, the re are no published rigorous studies that evaluate the risk of rupture with or without corticosteroid injection. Conclusions: There are insu fficient published data to determine the comparative risks and benefit s of corticosteroid injections in Achilles tendonitis. The decreased t endon strength with intratendinous injections in animal studies sugges ts that rupture may be a potential complication for several weeks foll owing injection.