HVIGI

HVIGI (High-Volume Image-Guided Injection) is a minimally invasive therapeutic procedure developed and studied by Erasmus Medical Center for the treatment of chronic midportion Achilles tendinopathy. The intervention involves the ultrasound-guided injection of a high volume (typically 40-50 mL) of a solution containing a local anesthetic (such as bupivacaine or lidocaine) and normal saline into the space between the Achilles tendon and Kager's fat pad. The primary mechanism of action is the mechanical disruption of neovascularization and associated sensory nerve ingrowth into the tendon, which are thought to be key drivers of chronic pain. This procedure is often used in patients who have failed conservative management, such as eccentric exercise or shockwave therapy, and is typically administered alongside a progressive loading exercise program. Clinical trials at Erasmus MC, such as the HAT study, have evaluated its efficacy in randomized, double-blind, placebo-controlled settings.

Other names

High-Volume Image-Guided InjectionHATHVIGI in Chronic Achilles Tendinopathy