Three-year followup study of topical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy.

Abstract

BACKGROUND:

Topical glyceryl trinitrate treatment has demonstrated short-term efficacy in chronic noninsertional Achilles tendinopathy. No long-term followup is reported. We aimed to assess if the demonstrated efficacy of this treatment persisted 3 years after discontinuation of therapy.

METHODS:

A follow-up study of 52 patients (68 tendons) treated with 6 months of glyceryl trinitrate therapy or placebo was performed 3 years after cessation of therapy. Assessment included pain scores, return to previous activity, the Victorian Institute of Sport Achilles tendon scale (VISA-A), asymptomatic patient outcomes, clinical assessment of tendon tenderness, and functional hop test.

RESULTS:

Patients treated with topical glyceryl trinitrate had significantly less Achilles tendon tenderness (p = 0.03), and improved VISA-A scores (p = 0.04) than those in the placebo group; 88% (28 of 32 tendons) of patients were completely asymptomatic at 3 years (VISA-A score of 100) compared to 67% (24 of 36 tendons) of patients treated with rehabilitation alone (p = 0.03 with Chi square analysis). Other outcome measures showed nonsignificant trends towards improvement in the glyceryl trinitrate group (pain scores p = 0.07, functional hop test p = 0.07, and return to sport p = 0.16). The mean estimated effect size for all outcome measures was 0.21.

CONCLUSIONS:

Topical glyceryl trinitrate treatment has demonstrated efficacy in treating chronic noninsertional Achilles tendinopathy, and the treatment benefits continue at 3 years. Significant differences in asymptomatic patient outcomes for the glyceryl trinitrate group continue at 3 years, and this is confirmed by the effect size estimate. This suggests that the mechanism of action of topical glyceryl trinitrate on chronic tendinopathies is more than an analgesic effect.

• Authors: Justin Alan Paoloni, George A C Murrell
• Journal: Foot & ankle international (Foot Ankle Int) Vol. 28 Issue 10 Pg. 1064-8 (Oct 2007) ISSN: 1071-1007 [Print] United States
• PMID: 17923056 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Vasodilator Agents
• Nitroglycerin

Topics

• Achilles Tendon (drug effects, pathology)
• Administration, Topical
• Adult
• Aged
• Chronic Disease
• Double-Blind Method
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Nitroglycerin (administration & dosage, therapeutic use)
• Tendinopathy (drug therapy)
• Time Factors
• Treatment Outcome
• Vasodilator Agents (administration & dosage, therapeutic use)