Nitroglycerin patch won't help Achilles injury

NewsBot · Jun 27, 2008

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Nitroglycerin patch won't help Achilles injury

Patches that deliver nitroglycerin through the skin do nothing to help speed healing from a common type of injury to the Achilles tendon, UK researchers have found.

Noninsertional Achilles tendinopathy is a tear in the tendon above the point where it inserts into the heel bone. The cause of the condition hasn't been established, although overuse may be a factor in some cases, Dr. Timothy P.C. Kane, of North Hampshire Hospital in Basingstoke, and colleagues write in the American Journal of Sports Medicine.

There is little scientific evidence to support the many different approaches to treating the condition, the researchers add, although a previous study found that topical glyceryl trinitrate (GTN), in the form of the Nitroderm patch made by Schering-Plough, improved outcomes.

The authors of that study suggested that the patches -- which are normally used to treat chest pain called angina -- may have aided Achilles tendon injuries by increasing the formation of collagen and stimulating the activity of fibroblasts, the cells responsible for making connective tissue.

To investigate further, Kane and his team randomly assigned 40 patients with noninsertional Achilles tendinopathy to receive either standard physical therapy or standard physical therapy plus a daily GTN patch for six months. Patients who didn't improve underwent surgery, at which time the researchers sampled tissue from the tendon.

There was no difference in pain or disability scores between the two groups after six months, the researchers found. And examination of tissue in those who underwent surgery found no difference in new blood vessel growth, collagen synthesis or fibroblast activity.

The findings, according to Kane's team, suggest that the nitroglycerin patch will not help people with noninsertional Achilles tendinopathy heal any faster.
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NewsBot · Jun 27, 2008

Topical Glyceryl Trinitrate and Noninsertional Achilles Tendinopathy
A Clinical and Cellular Investigation
Timothy P. C. Kane, Muhammad Ismail and James D. F. Calder
The American Journal of Sports Medicine 36:1160-1163 (2008)

Background: Topical glyceryl trinitrate (GTN) therapy has been advocated in the treatment of Achilles tendinopathy. The mechanism of action is unknown but may be related to modulation of local nitric oxide levels.

Hypothesis: Topical GTN therapy for noninsertional Achilles tendinopathy will significantly enhance clinical improvement and will be associated with increased collagen synthesis within the tendon.

Study Design: Randomized controlled clinical trial; Level of evidence, 1.

Methods: Forty patients were recruited. Twenty underwent standard nonoperative physical therapy, and 20 underwent physical therapy and topical GTN daily. Clinical outcome was assessed using the Ankle Osteoarthritis Scale (AOS) visual analog score. Patients who failed to improve with conservative measures and who underwent surgical decompression had histological and immunohistochemical examination of samples from the Achilles tendon.

Results: Glyceryl trinitrate did not offer any additional clinical benefit over standard nonoperative treatment for noninsertional Achilles tendinopathy. After 6 months of treatment, there was no significant difference in scores between the groups for pain (3.0 vs 3.1, P = .42) or disability (2.15 vs 2.25, P = .38). Histological examination did not show any difference in neovascularization, collagen synthesis, or stimulated fibroblasts between the 2 groups. There was no evidence of modulation of nitric oxide synthase, a marker of nitric oxide production, in those tendons treated with GTN.

Conclusion and Clinical Relevance: This study has failed to support the clinical benefit of GTN patches previously described in the literature. In the available tissue samples, there did not appear to be any histological or immunohistochemical change in Achilles tendinopathy treated with GTN compared with those undergoing standard nonoperative therapy.
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NewsBot · Oct 9, 2018

Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review
Dimitris Challoumas et al
Br J Sports Med: 09 October 2018

Objective To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies.

Design A systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy.

Data sources MEDLINE, Embase, Scopus and CINAHL from database inception to January 2018.

Methods We examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulder et al.

Results A total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. For all tendinopathies, improvements in pain were significant when comparing GTN versus placebo in the short term (<8 weeks; poor evidence). Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following: patient satisfaction (strong evidence); chances of being asymptomatic with activities of daily living (strong evidence); range of movement (moderate evidence); strength (moderate evidence); pain (at night and with activity; poor evidence) and local tenderness (poor evidence). Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo (moderate evidence).

Conclusions and relevance Treatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions.
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NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

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