Injectables in the Therapy of Mid-Portion Achilles Tendinopathy, a Descriptive Review.

Achilles mid-portion tendinopathy is defined as a painful thickening of the tendon, identified also on different imagistic examinations, occurring in sport people as well in inactively middle-aged individuals. The chronic and/or relapsing evolution interfere with daily living and alter the quality of life. Eccentric physical exercise is a cornerstone in her management and several injectable agents are used in clinical settings to reduce pain and improve function. According to the presumed pathogenic mechanisms, many classes of agents are in use: corticosteroids, protease inhibitors, sclerosing agents, pro-inflammatory agents, autologous products. The modalities of administration, either intra- or peritendon, the timing and number of sessions are displayed. Practical approach of chronic mid-portion Achilles tendinopathy consists of rest, tendon protection, eccentric exercise and therapeutical injections. The clinicians must choose between a spectrum of agents active on different pathogenic mechanisms, with benefits in the short and medium term. Future research may be focused on comparison between the different agents and on long term evolution.