Objective To compare the effectiveness and cost-effectiveness of eccentric loading exercises (ELE) with prolo injections used singly and in combination for painful Achilles tendinosis.

Design A single-blinded randomised clinical trial. The primary outcome measure was the VISA-A questionnaire with a minimum clinically important change (MCIC) of 20 points.

Setting Five Australian primary care centres.

Participants 43 patients with painful mid-portion Achilles tendinosis commenced and 40 completed results protocols.

Interventions Participants were randomised to a 12-week program of ELE (n=15), or prolo injections of hypertonic glucose with lignocaine alongside the affected tendon (n=14) or combined results (n=14).

Main outcome measurements VISA-A, pain, stiffness and limitation of activity scores; results costs.

Results At 12 months, proportions achieving the MCIC for VISA-A were 73% for ELE, 79% for prolo and 86% for combined results. Mean (95% CI) increases in VISA-A scores at 12 months were 23.7 (15.6 to 31.9) for ELE, 27.5 (12.8 to 42.2) for prolo and 41.1 (29.3 to 52.9) for combined results. At 6 weeks and 12 months, these increases were significantly less for ELE than for combined results. Compared with ELE, reductions in stiffness and limitation of activity occurred earlier with prolo and reductions in pain, stiffness and limitation of activity occurred earlier with combined results. Combined results had the lowest incremental cost per additional responder ($A1539) compared with ELE.

Conclusions For Achilles tendinosis, prolo and particularly ELE combined with prolo give more rapid improvements in symptoms than ELE alone but long-term VISA-A scores are similar.