Efficacy and cost effectiveness of high volume injections with and without corticosteroid compared with sham for midportion Achilles tendinopathy (Inject trial): randomised controlled trial.

In adults with midportion Achilles tendinopathy, high volume injections with or without corticosteroid did not improve VISA-A pain/disability versus sham at 52 weeks.

• Why it matters: The trial addresses whether adding high volume injection and/or corticosteroid to standard exercise and education provides meaningful long-term symptom relief and value for money.
• What they did: In a single-centre, participant- and assessor-masked three-arm RCT (n=192), participants received sham or high volume bupivacaine injections with or without 25 mg hydrocortisone, alongside the same exercise programme; VISA-A was assessed to 12 months and costs were evaluated as cost per quality-adjusted life-year.
• The result: At 12 months (VISA-A data from 181/192), differences versus sham were -3.5 (98.33% CI -12.0 to 5.0) with corticosteroid and 4.0 (-4.2 to 12.3) without; corticosteroid showed short-term benefit at six weeks (9.2 (1.5 to 16.9)) but worse outcomes at 26 weeks (-8.6 (-16.4 to -0.7)). Cost-effectiveness favored corticosteroid over sham with similar effectiveness (>0.90 probability at AUD50,000 and AUD100,000), but routine use is not supported due to worse longer-term clinical outcomes.

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