NCT03077009

Brief Summary

This is a study to assess the benefit of sodium hyaluronate (Ostenil) injection for plantaris friction syndrome (PFS) associated with midportion Achilles tendinopathy. Functional outcome scores will be recorded prior to treatment and at regular intervals up to 2 years. Changes in tendon structure will be assessed using ultrasonographic tissue characterisation (UTC). UTC will be performed prior to treatment and also at regular intervals up to 6 months following injection.

Trial Health

43
At Risk

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Trial has exceeded expected completion date
Enrollment
33

participants targeted

Target at below P25 for phase_4

Timeline
Completed

Started Mar 2017

Typical duration for phase_4

Geographic Reach
1 country

2 active sites

Status
unknown

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

First Submitted

Initial submission to the registry

February 12, 2017

Completed
26 days until next milestone

First Posted

Study publicly available on registry

March 10, 2017

Completed
10 days until next milestone

Study Start

First participant enrolled

March 20, 2017

Completed
3 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

March 20, 2020

Completed
Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

March 20, 2020

Completed
Last Updated

March 10, 2017

Status Verified

February 1, 2017

Enrollment Period

3 years

First QC Date

February 12, 2017

Last Update Submit

March 6, 2017

Conditions

Outcome Measures

Primary Outcomes (1)

  • Ultrasound Tissue Characterisation (UTC)

    Structural assessment of the Achilles tendon using ultrasound

    up to 6 months post intervention

Secondary Outcomes (2)

  • Foot and Ankle Outcome Score (FAOS) Functional outcome

    up to 2 years post intervention

  • Victorian Institute of Sports Assessment-Achilles (VISA-A)

    up to 2 years post intervention

Study Arms (1)

Treatment arm

EXPERIMENTAL

Patients with confirmed plantaris friction syndrome will be offered hyaluronic acid injection into the space between the Plantaris and Achilles tendons

Drug: Hyaluronic Acid

Interventions

Ultrasound guided injection for plantaris friction syndrome

Also known as: Ostenil
Treatment arm

Eligibility Criteria

Age18 Years - 75 Years
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • Patients aged 18-75 years
  • Able to provide informed consent
  • Diagnosis of PFS requiring sodium hyaluronate injection
  • Able to follow physiotherapy instructions

You may not qualify if:

  • Previous Achilles tendon surgery
  • Previous injection therapy for Achilles midportion tendinopathy
  • Age \< 18 \>75 years
  • Active local infection
  • Active bleeding disorder or anticoagulant therapy
  • Allergies to lignocaine or sodium hyaluronate
  • Active deep vein thrombosis

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (2)

Fortius Clinic

London, W1H 6EQ, United Kingdom

RECRUITING

Fortius Clinic

London, United Kingdom

RECRUITING

Related Publications (31)

  • St Onge R, Weiss C, Denlinger JL, Balazs EA. A preliminary assessment of Na-hyaluronate injection into "no man's land" for primary flexor tendon repair. Clin Orthop Relat Res. 1980 Jan-Feb;(146):269-75.

    PMID: 6768485BACKGROUND
  • Chen WY, Abatangelo G. Functions of hyaluronan in wound repair. Wound Repair Regen. 1999 Mar-Apr;7(2):79-89. doi: 10.1046/j.1524-475x.1999.00079.x.

    PMID: 10231509BACKGROUND
  • Yagishita K, Sekiya I, Sakaguchi Y, Shinomiya K, Muneta T. The effect of hyaluronan on tendon healing in rabbits. Arthroscopy. 2005 Nov;21(11):1330-6. doi: 10.1016/j.arthro.2005.08.020.

    PMID: 16325083BACKGROUND
  • Akasaka T, Nishida J, Imaeda T, Shimamura T, Amadio PC, An KN. Effect of hyaluronic acid on the excursion resistance of tendon graft: a biomechanical in vitro study in a modified human model. Clin Biomech (Bristol). 2006 Oct;21(8):810-5. doi: 10.1016/j.clinbiomech.2006.04.007. Epub 2006 Jun 9.

    PMID: 16762465BACKGROUND
  • Akasaka T, Nishida J, Araki S, Shimamura T, Amadio PC, An KN. Hyaluronic acid diminishes the resistance to excursion after flexor tendon repair: an in vitro biomechanical study. J Biomech. 2005 Mar;38(3):503-7. doi: 10.1016/j.jbiomech.2004.04.021.

    PMID: 15652548BACKGROUND
  • Nishida J, Araki S, Akasaka T, Toba T, Shimamura T, Amadio PC, An KN. Effect of hyaluronic acid on the excursion resistance of tendon grafts. A biomechanical study in a canine model in vitro. J Bone Joint Surg Br. 2004 Aug;86(6):918-24. doi: 10.1302/0301-620x.86b6.14329.

    PMID: 15330037BACKGROUND
  • Hagberg L, Gerdin B. Sodium hyaluronate as an adjunct in adhesion prevention after flexor tendon surgery in rabbits. J Hand Surg Am. 1992 Sep;17(5):935-41. doi: 10.1016/0363-5023(92)90474-4.

    PMID: 1401812BACKGROUND
  • Bedi HS, Jowett C, Ristanis S, Docking S, Cook J. Plantaris Excision and Ventral Paratendinous Scraping for Achilles Tendinopathy in an Athletic Population. Foot Ankle Int. 2016 Apr;37(4):386-93. doi: 10.1177/1071100715619989. Epub 2015 Dec 4.

    PMID: 26637273BACKGROUND
  • van Schie HT, de Vos RJ, de Jonge S, Bakker EM, Heijboer MP, Verhaar JA, Tol JL, Weinans H. Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach. Br J Sports Med. 2010 Dec;44(16):1153-9. doi: 10.1136/bjsm.2009.061010. Epub 2009 Aug 6.

    PMID: 19666626BACKGROUND
  • Docking SI, Rosengarten SD, Cook J. Achilles tendon structure improves on UTC imaging over a 5-month pre-season in elite Australian football players. Scand J Med Sci Sports. 2016 May;26(5):557-63. doi: 10.1111/sms.12469. Epub 2015 May 5.

    PMID: 25943892BACKGROUND
  • Docking SI, Rosengarten SD, Daffy J, Cook J. Structural integrity is decreased in both Achilles tendons in people with unilateral Achilles tendinopathy. J Sci Med Sport. 2015 Jul;18(4):383-7. doi: 10.1016/j.jsams.2014.06.004. Epub 2014 Jun 20.

    PMID: 25024134BACKGROUND
  • Rosengarten SD, Cook JL, Bryant AL, Cordy JT, Daffy J, Docking SI. Australian football players' Achilles tendons respond to game loads within 2 days: an ultrasound tissue characterisation (UTC) study. Br J Sports Med. 2015 Feb;49(3):183-7. doi: 10.1136/bjsports-2013-092713. Epub 2014 Apr 15.

    PMID: 24735840BACKGROUND
  • Pearce CJ, Carmichael J, Calder JD. Achilles tendinoscopy and plantaris tendon release and division in the treatment of non-insertional Achilles tendinopathy. Foot Ankle Surg. 2012 Jun;18(2):124-7. doi: 10.1016/j.fas.2011.04.008. Epub 2011 May 26.

    PMID: 22444000BACKGROUND
  • Weinberg EP, Adams MJ, Hollenberg GM. Color Doppler sonography of patellar tendinosis. AJR Am J Roentgenol. 1998 Sep;171(3):743-4. doi: 10.2214/ajr.171.3.9725308. No abstract available.

    PMID: 9725308BACKGROUND
  • Alfredson H. Midportion Achilles tendinosis and the plantaris tendon. Br J Sports Med. 2011 Oct;45(13):1023-5. doi: 10.1136/bjsports-2011-090217. Epub 2011 May 31.

    PMID: 21628352BACKGROUND
  • Calder JD, Freeman R, Pollock N. Plantaris excision in the treatment of non-insertional Achilles tendinopathy in elite athletes. Br J Sports Med. 2015 Dec;49(23):1532-4. doi: 10.1136/bjsports-2014-093827. Epub 2014 Nov 13.

    PMID: 25394422BACKGROUND
  • Masci L, Spang C, van Schie HT, Alfredson H. Achilles tendinopathy-do plantaris tendon removal and Achilles tendon scraping improve tendon structure? A prospective study using ultrasound tissue characterisation. BMJ Open Sport Exerc Med. 2015 May 2;1(1):e000005. doi: 10.1136/bmjsem-2015-000005. eCollection 2015.

    PMID: 27900118BACKGROUND
  • Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, Taunton JE, Khan KM; Victorian Institute Of Sport Tendon Study Group. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med. 2001 Oct;35(5):335-41. doi: 10.1136/bjsm.35.5.335.

    PMID: 11579069BACKGROUND
  • Lintz F, Higgs A, Millett M, Barton T, Raghuvanshi M, Adams MA, Winson IG. The role of Plantaris Longus in Achilles tendinopathy: a biomechanical study. Foot Ankle Surg. 2011 Dec;17(4):252-5. doi: 10.1016/j.fas.2010.08.004. Epub 2010 Sep 15.

    PMID: 22017896BACKGROUND
  • Khan KM, Forster BB, Robinson J, Cheong Y, Louis L, Maclean L, Taunton JE. Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study. Br J Sports Med. 2003 Apr;37(2):149-53. doi: 10.1136/bjsm.37.2.149.

    PMID: 12663358BACKGROUND
  • Astrom M, Gentz CF, Nilsson P, Rausing A, Sjoberg S, Westlin N. Imaging in chronic achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases. Skeletal Radiol. 1996 Oct;25(7):615-20. doi: 10.1007/s002560050146.

    PMID: 8915043BACKGROUND
  • McAuliffe S, McCreesh K, Culloty F, Purtill H, O'Sullivan K. Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis. Br J Sports Med. 2016 Dec;50(24):1516-1523. doi: 10.1136/bjsports-2016-096288. Epub 2016 Sep 15.

    PMID: 27633025BACKGROUND
  • de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010 Jan 13;303(2):144-9. doi: 10.1001/jama.2009.1986.

    PMID: 20068208BACKGROUND
  • Alfredson H, Ohberg L. Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2005 May;13(4):338-44. doi: 10.1007/s00167-004-0585-6. Epub 2005 Feb 2.

    PMID: 15688235BACKGROUND
  • Chan O, O'Dowd D, Padhiar N, Morrissey D, King J, Jalan R, Maffulli N, Crisp T. High volume image guided injections in chronic Achilles tendinopathy. Disabil Rehabil. 2008;30(20-22):1697-708. doi: 10.1080/09638280701788225.

    PMID: 18608362BACKGROUND
  • Wheeler PC, Mahadevan D, Bhatt R, Bhatia M. A Comparison of Two Different High-Volume Image-Guided Injection Procedures for Patients With Chronic Noninsertional Achilles Tendinopathy: A Pragmatic Retrospective Cohort Study. J Foot Ankle Surg. 2016 Sep-Oct;55(5):976-9. doi: 10.1053/j.jfas.2016.04.017. Epub 2016 Jun 7.

    PMID: 27286927BACKGROUND
  • Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998 May-Jun;26(3):360-6. doi: 10.1177/03635465980260030301.

    PMID: 9617396BACKGROUND
  • Roche AJ, Calder JD. Achilles tendinopathy: A review of the current concepts of treatment. Bone Joint J. 2013 Oct;95-B(10):1299-307. doi: 10.1302/0301-620X.95B10.31881.

    PMID: 24078523BACKGROUND
  • Saxena A, Ramdath S Jr, O'Halloran P, Gerdesmeyer L, Gollwitzer H. Extra-corporeal pulsed-activated therapy ("EPAT" sound wave) for Achilles tendinopathy: a prospective study. J Foot Ankle Surg. 2011 May-Jun;50(3):315-9. doi: 10.1053/j.jfas.2011.01.003. Epub 2011 Mar 15.

    PMID: 21406328BACKGROUND
  • Lynen N, De Vroey T, Spiegel I, Van Ongeval F, Hendrickx NJ, Stassijns G. Comparison of Peritendinous Hyaluronan Injections Versus Extracorporeal Shock Wave Therapy in the Treatment of Painful Achilles' Tendinopathy: A Randomized Clinical Efficacy and Safety Study. Arch Phys Med Rehabil. 2017 Jan;98(1):64-71. doi: 10.1016/j.apmr.2016.08.470. Epub 2016 Sep 14.

    PMID: 27639439BACKGROUND
  • Daseler EH, Anson BJ. The Plantaris muscle an anatomical study of 750 specimens. J Bone Joint Surg [Am] 1943;25-A:822-827.

    RESULT

MeSH Terms

Interventions

Hyaluronic Acid

Intervention Hierarchy (Ancestors)

GlycosaminoglycansPolysaccharidesCarbohydrates

Study Officials

  • James Calder, MD FRCS

    Fortius Clinic, London

    PRINCIPAL INVESTIGATOR

Central Study Contacts

Study Design

Study Type
interventional
Phase
phase 4
Allocation
NA
Masking
NONE
Purpose
TREATMENT
Intervention Model
SINGLE GROUP
Sponsor Type
OTHER
Responsible Party
SPONSOR

Study Record Dates

First Submitted

February 12, 2017

First Posted

March 10, 2017

Study Start

March 20, 2017

Primary Completion

March 20, 2020

Study Completion

March 20, 2020

Last Updated

March 10, 2017

Record last verified: 2017-02

Data Sharing

IPD Sharing
Will not share

Locations