Efficacy and cost effectiveness of high volume injections with and without corticosteroid compared with sham for midportion Achilles tendinopathy (Inject trial): randomised controlled trial.
Peter Malliaras, David Connell, Anders Ploug Boesen et al.
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In 30 seconds
The Inject trial was a single-centre, participant- and assessor-masked, three-arm randomised controlled trial in 192 adults with midportion Achilles tendinopathy. It compared high volume injections with or without hydrocortisone against sham, alongside the same exercise, education, and activity advice. At 52 weeks, neither injection strategy clearly improved VISA-A pain and disability scores compared with sham: the differences were -3.5 (98.33% confidence interval -12.0 to 5.0) with corticosteroid and 4.0 (-4.2 to 12.3) without. The authors concluded that the clinical data do not support routine use of high volume injections with corticosteroid.
Key findings
- At 12 months, VISA-A differences versus sham were -3.5 (98.33% confidence interval -12.0 to 5.0) with corticosteroid and 4.0 (-4.2 to 12.3) without.
- High volume injection with corticosteroid improved VISA-A versus sham at six weeks by 9.2 (1.5 to 16.9), but had worse outcomes than injection without corticosteroid at 26 weeks: -8.6 (-16.4 to -0.7).
- High volume injection with corticosteroid was less costly than sham with similar quality-adjusted life-year effectiveness, with >0.90 probability of cost effectiveness at $AUD50 000 and $100 000 willingness-to-pay thresholds.
- No serious trial-related adverse events were recorded.
Why it matters
The trial found no clear 12-month pain or disability advantage from either injection over sham, despite a short-term signal for corticosteroid. The later comparative result also cautions against interpreting early improvement as sustained benefit. These findings help distinguish short-term outcomes from longer-term clinical effectiveness when assessing injection approaches for midportion Achilles tendinopathy.
What to keep in mind
The trial was single-centre, and VISA-A data were available for 181 of 192 participants at 12 months.