Achilles tendinopathy affecting the mid-portion of the tendon, is a common condition that can significantly impair mobility and athletic performance. The NEAT trial, a single-site randomised double-blind placebo-controlled study conducted by Kirwan et al. (2024), sought to evaluate the efficacy of topical glyceryl trinitrate (GTN) ointment combined with an eccentric exercise regimen against a placebo treatment. This investigation is interesting because the use of GTN ointment or patches for achilles tendinopathy has become more common in recent years.
The trial involved 76 patients with chronic mid-portion Achilles tendinopathy, who were randomised to receive either 24 weeks of daily GTN ointment or placebo ointment. All participants also underwent a standardised 12-week eccentric exercise program, a well-documented intervention recognised for its benefits in tendinopathy rehabilitation. The primary outcome measure utilised was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire, which assesses critical domains including pain, function, and activity levels. Secondary outcomes encompassed various metrics such as pain severity, self-reported physical function, calf muscle function, pressure pain thresholds, and ultrasound evaluations.
Results indicated that significant improvements in VISA-A scores were observed in both groups at 6-week, 12-week, and 24-week follow-ups. However, the increase in scores was statistically comparable between the GTN and placebo groups, underscoring that the addition of GTN ointment did not yield any clinically meaningful benefits. The adjusted mean differences from baseline to the respective weeks suggested a lack of efficacy for the GTN treatment, with no statistically significant variation in secondary outcomes.
The findings from the NEAT trial lead to critical insights regarding the management of chronic mid-portion Achilles tendinopathy. While the study demonstrated improvements in patient-reported outcomes across both treatment groups, the lack of significant differences between GTN and placebo suggests that the use of topical GTN does not provide additional value in conjunction with eccentric exercises. Thus, it appears that the eccentric exercise program alone may be sufficient for eliciting improvements in function and reducing pain for these patients.
In conclusion, while the application of GTN ointment may have been anticipated to enhance recovery, the evidence from Kirwan et al. effectively negates this hypothesis. Clinicians managing Achilles tendinopathy can draw from this study when considering treatment options, reaffirming the utility of eccentric exercises as a standalone intervention while discarding the adjunct treatment of GTN ointment for this specific condition.
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