A PEEK BEHIND THE STUDY … WITH PETER MALLIARAS

Malliaras P, Connell D, Boesen AP, et al. Efficacy of high-volume injections with and without corticosteroid compared with sham for Achilles tendinopathy: a protocol for a randomised controlled trial. 

The full protocol manuscript can be accessed here

 

Tell us more about yourself and the author team

I am a physiotherapist and researcher at Monash University in Melbourne. Our research team, the Monash Musculoskeletal Research Unit, is focused on developing and evaluating education, exercise and other interventions for common musculoskeletal conditions, with an emphasis on tendinopathy. We have a developing team of researchers, research assistants, higher degree students and collaborators. We have funding support from various external organizations including NHMRC, HCF, Arthritis Australia, Australian Physiotherapy Association, among others.

 

What is the story behind your study?

I worked for many years in London alongside some excellent clinicians, including Dr Otto Chan, Prof Dylan Morrissey and Prof Nicola Maffulli. Otto is a consultant radiologist. His group developed the high-volume injection (local anesthetic, steroid and saline [50mL in total)) to potentially have a mechanical effect on the ingrowth of blood and nerve vessels in tendinopathy. The thought was that being able to mechanically influence these tissues may have a positive impact on tendon pain. This may be via physically removing / breaking some of the ingrowing structures (that may have a role in tendon pain) or more likely by exerting some local trauma to these tissues. The entire team there in London were and still are an inspiration to me, particularly Otto Chan. They are the most welcoming and warm group of doctors and physios I have worked with. My experience with the high-volume injection in London led to an interest to test the efficacy further and hence the idea for the study was born.

 

In your own words, what did you find so far?

So far, we have recruited 126 out of 192 people with Achilles tendinopathy. I hope we will complete recruitment in the next 3-4 months and then complete data collection 12-months after the last person is recruited. It will be very interesting to see whether there is long-term efficacy for the high-volume injection compared to placebo. We are testing two-version of the high-volume injection, one with and one without inclusion of the steroid component. A recent by the group led by Robert-Jan de Vos showed there were no differences in pain and function outcomes at 6-months when comparing the high-volume injection without steroid to placebo (van der Vlist, A.C., et al., 2020. BMJ, 370.). The high-volume injection arm with steroid in out study is likely to be more beneficial than placebo in the short term, but whether there will be any additional benefits (or harms) at 12-months will be interesting to see.

 

What was the main challenge you faced in your study to date?

By far the biggest challenge has been navigating COVID-19 related-restrictions. We had to pause recruitment for 8 months during the extensive lockdowns and restrictions here in Melbourne. This also unfortunately meant that the research assistants that were initially trained to undertake the study resigned, and we had to recruit and find new staff once restrictions eased.

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