Physioinfo Article

High Volume Achillies Tendon Stripping - What is it and is there evidence?

What is high volume Achilles tendon stripping? High volume injection for persistent tendinopathy of mid portion achilles tendinopathy involves injection of 30-40 ml of sodium chloride (in addition to a steroid and local anaesthetic) between the anterior aspect of the Achilles tendon and Kager?s fat pad. The hypothesized rationale behind high volume injection for mid achilles tendinopathy according to Chan, et al. (2008) is to: ?produce local mechanical effects causing neo-vessels to stretch, break or occlude. By occluding and possibly breaking these neo-vessels, the accompanying nerve supply would also be damaged either by trauma or ischaemia, therefore decreasing the pain in patients with resistant Achilles tendinopathy.? Evidence for the efficacy of HVI Achilles stripping Several case series have described the benefit of high-volume (stripping) injection (HVI) for the treatment of recalcitrant Achilles tendinopathy (Chan et al. 2008, Humphrey et al. 2010, Resteghini and Yeoh 2012). Due to concern regarding deleterious effects of steroid, a recent case series from Abdulhussein et al. (2017) compared HVI with 25mg of hydrocortisone to HVI of 40mls of saline without steroid. This study found no significant difference in efficacy between the HVI and steroid vs saline only group. They concluded that it was likely that the mechanical effects were responsible for the improvement rather than the steroid. However until recently there have been no studies with a control group.