Republished research: Impact of autologous blood injections in treatment of mid-portion Achilles tendinopathy: double blind randomised controlled trial

STUDY QUESTION

Do peritendinous autologous blood injections improve pain and function in people with mid-portion Achilles tendinopathy?

SUMMARY ANSWER

The administration of two unguided peritendinous autologous blood injections one month apart, in addition to a standardised eccentric training programme, provides no additional benefit in the treatment of mid-portion Achilles tendinopathy.

WHAT IS KNOWN AND WHAT THIS PAPER ADDS

Several studies have suggested that injection of autologous blood can help in the treatment of various tendinopathies. There is a lack of high quality evidence showing relevant benefit for autologous blood injections, particularly in the management of mid-portion Achilles tendinopathy. We found no additional reduction in pain or improvement in function when these injections were combined with an eccentric calf training programme.

Estimating insulin demand for protein-containing foods using the food insulin index

BACKGROUND/OBJECTIVE

The Food Insulin Index (FII) is a novel algorithm for ranking foods on the basis of insulin responses in healthy subjects relative to an isoenergetic reference food. Our aim was to compare postprandial glycemic responses in adults with type 1 diabetes who used both carbohydrate counting and the FII algorithm to estimate the insulin dosage for a variety of protein-containing foods.

SUBJECTS/METHODS

A total of 11 adults on insulin pump therapy consumed six individual foods (steak, battered fish, poached eggs, low-fat yoghurt, baked beans and peanuts) on two occasions in random order, with the insulin dose determined once by the FII algorithm and once with carbohydrate counting. Postprandial glycemia was measured in capillary blood glucose samples at 15-30  min intervals over 3 h. Researchers and participants were blinded to treatment.

RESULTS

Compared with carbohydrate counting, the FII algorithm significantly reduced the mean blood glucose level (5.7±0.2  vs 6.5±0.2 mmol/l, P=0.003) and the mean change in blood glucose level (-0.7±0.2 vs 0.1±0.2 mmol/l, P=0.001). Peak blood glucose was reached earlier using the FII algorithm than using carbohydrate counting (34±5 vs 56±7 min, P=0.007). The risk of hypoglycemia was similar in both treatments (48% vs 33% for FII vs carbohydrate counting, respectively, P=0.155).

CONCLUSIONS

In adults with type 1 diabetes, compared with carbohydrate counting, the novel FII algorithm improved postprandial hyperglycemia after consumption of protein-containing foods.

Impact of autologous blood injections in treatment of mid-portion Achilles tendinopathy: double blind randomised controlled trial

OBJECTIVE

To assess the effectiveness of two peritendinous autologous blood injections in addition to a standardised eccentric calf strengthening programme in improving pain and function in patients with mid-portion Achilles tendinopathy.

DESIGN

Single centre, participant and single assessor blinded, parallel group, randomised, controlled trial.

SETTING

Single sports medicine clinic in New Zealand.

PARTICIPANTS

53 adults (mean age 49, 53% men) with symptoms of unilateral mid-portion Achilles tendinopathy for at least three months. Participants were excluded if they had a history of previous Achilles tendon rupture or surgery or had undergone previous adjuvant treatments such as injectable therapies, glyceryl trinitrate patches, or extracorporeal shockwave therapy.

INTERVENTIONS

All participants underwent two unguided peritendinous injections one month apart with a standardised protocol. The treatment group had 3 mL of their own whole blood injected while the control group had no substance injected (needling only). Participants in both groups carried out a standardised and monitored 12 week eccentric calf training programme. Follow-up was at one, two, three and six months.

MAIN OUTCOME MEASURES

The primary outcome measure was the change in symptoms and function from baseline to six months with the Victorian Institute of Sport Assessment-Achilles (VISA-A) score. Secondary outcomes were the participant's perceived rehabilitation and their ability to return to sport.

RESULTS

26 participants were randomly assigned to the treatment group and 27 to the control group. In total, 50 (94%) completed the six month study, with 25 in each group. Clear and clinically worthwhile improvements in the VISA-A score were evident at six months in both the treatment (change in score 18.7, 95% confidence interval 12.3 to 25.1) and control (19.9, 13.6 to 26.2) groups. The overall effect of treatment was not significant (P=0.689) and the 95% confidence intervals at all points precluded clinically meaningful benefit or harm. There was no significant difference between groups in secondary outcomes or in the levels of compliance with the eccentric calf strengthening programme. No adverse events were reported.

CONCLUSION

The administration of two unguided peritendinous autologous blood injections one month apart, in addition to a standardised eccentric training programme, provides no additional benefit in the treatment of mid-portion Achilles tendinopathy.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12610000824066, WHO U1111-1117-2641.

An evaluation of the posterior leaf spring orthosis using joint kinematics and kinetics

The primary function of the posterior leaf spring orthosis (PLS) is to prevent excessive equinus or drop foot in swing. The name of the orthosis, posterior leaf "spring," suggests that it also mechanically augments push-off in stance. The purpose of this study was to determine the effect of the PLS on ankle function by using computerized gait-analysis techniques. Multiple barefoot versus brace walks were compared in 31 children with cerebral palsy. Results indicate that the PLS reduces excessive equinus in swing and is sufficiently flexible to allow ankle dorsiflexion in midstance. In terminal stance, the peak power-generating capabilities of the ankle were reduced when the child was wearing the PLS. Energy results indicate that more mechanical energy was absorbed during midstance and less produced during terminal stance with the PLS. Therefore, the PLS improved ankle function but did not augment ankle function through storage and return of mechanical, or spring, energy.

Parawalker: energy cost of walking

Relative oxygen cost (ml/kg/m) was compared in five paraplegic subjects (4 children, 1 adult) while wearing a reciprocating gait orthosis (RGO) and Parawalker. An Oxylog was used to record oxygen consumption while the subjects ambulated during steady state. Although all of the subjects trained and used the orthoses for varying amounts of time, the trend from these data shows that the Parawalker enables a more energy efficient gait. On the average the oxygen cost while using the Parawalker was 27% less compared to the RGO. The reductions in oxygen cost ranged from 12 to 42%. Following this trend of greater efficiency, the subjects ambulated 33% faster (on the average) with the Parawalker than with the RGO. These preliminary results indicate that the Parawalker appears to be a more efficient orthosis for level ambulation in the paraplegic population.