Conservative treatment for Insertional Achilles Tendinopathy: platelet-rich plasma and focused shock waves. A retrospective study

Erroi, Davide; Sigona, Matilde; Suarez, Tania; Trischitta, Donatella; Pavan, Antonio; Vulpiani, Maria Chiara; Vetrano, Mario

doi:10.11138/mltj/2017.7.1.098

Cited by 60 publications

(16 citation statements)

References 48 publications

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“…All of these changes lead to synthesis of proteins, nitric oxide (NO), and specific growth factors (GF) which activate several biological processes 7 . Erroi et al 20 . demonstrated that both ESWT and platelet-rich plasma (PRP) injections are effective in the treatment of insertional Achilles tendinopathy in people who participate in sports.…”

Section: Discussionmentioning

confidence: 99%

ESWT and nutraceutical supplementation (Tendisulfur Forte) vs ESWT-only in the treatment of lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy: a comparative study

Vitali

Rodriguez

Pironti

et al. 2019

Journal of Drug Assessment

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Objective: The purpose of this study was to determine the efficacy of Extracorporeal Shock Wave Therapy (ESWT) in combination with the dietary supplement Tendisulfur Forte in the treatment of shoulder tendinopathy, lateral epicondylitis, and Achilles tendinopathy. Methods: Patients were sub-divided for each pathology into two equal sized groups of 15: one treated with ESWT supplemented with Tendisulfur Forte, and the other treated with ESWT only. Shoulder functionality was measured through the UCLA shoulder score. Treatment of epicondylitis was assessed with the Mayo elbow score. Achilles tendinopathy was measured with the VISA-A score. Pain through the various groups of the study was measures with the Visual Analog Scale (VAS). Results: Patients in the Tendisulfur Forte group had overall better functional and VAS scale scores for shoulder tendinopathy, elbow epicondylitis, and Achilles tendinopathy. UCLA scores for shoulder tendinopathy showed significant results at 60 days in the Tendisulfur Forte group ( p = 0.0002). Mayo scores in the treatment of lateral epicondylitis was significant at 60 days in the study group ( p < 0.0001). Achilles tendinopathy was improved in the study group at 30 days ( p < 0.0001). VAS scales were significant for each pathology at 60 days ( p < 0.0001). In addition, NSAIDs consumption was greatly reduced and, in most cases, stopped in the Tendisulfur Forte Groups. Conclusion: Concerning the results obtained, this paper underlines the effectiveness of combined treatment of ESWT plus Tendisulfur Forte, in the absence of side-effects. Indeed, oral supplementation lead to a faster recovery and better outcomes with a significant reduction in NSAIDs consumption.

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Section: Discussionmentioning

confidence: 99%

ESWT and nutraceutical supplementation (Tendisulfur Forte) vs ESWT-only in the treatment of lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy: a comparative study

Vitali

Rodriguez

Pironti

et al. 2019

Journal of Drug Assessment

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“…Many studies compared the effect of ESWT to Sham ESWT, where they found significant improvement of pain and function in ESWT group [10]; others compared local injections such as corticosteroids [43] where they concluded the pain improves in short-term followup and sodium hyaluronate would be better in the intermediate and long-term follow-up, as mentioned in a study done by Lynen et al [44], where they found that the usage of two injections of hyaluronan gives a greater improvement of pain than ESWT in cases of Achilles tendinopathy [45]. Platelet-rich plasma was also used in comparison to ESWT in a study done by Erroi et al [30] where they stated that both modalities are effective for pain and function improvement in a follow-up time of 6 months. In our work, we compared ESWT to local mesotherapy injection (MT), with a clinically significant improvement of pain and tendon function all through the study till the 12th week, as well as significant objective improvement of tendon thickness and heterogenicity and decreased Doppler signs, but in comparison to the group treated with ESWT, no change in calcifications was noticed; however, an old study conducted by Capone et al [15] using MT (disodium EDTA) to treat patients with calcific shoulder tendinitis found good effect after 24 months' follow-up, as well as another randomized double-blind study of 80 patients with calcific tendinitis of the shoulder, who were treated with mesotherapy one session per week for 1 year, and placebo for controls showed a disappearance of calcifications completely in 62% and partially in 25% of patients treated with MT and 15% in the control group [16].…”

Section: Discussionmentioning

confidence: 99%

“…However, other authors stated that ESWT is effective in patients with non-calcified insertional Achilles tendinopathy while other cases with insertional tendinopathy who are not improving on conservative therapy will need removal of the degenerated part of the calcified tendon [25]. The protocols for ESWT are variably in different studies, ranging from either single session [9], 3-4 sessions [26], weekly or twice weekly [27,28], with either focused [7,23,26,27,[29][30][31] or radial applications [9,10,28,32,33]. The number of pulses usually ranges from 1500 to 3000 [28,31,32]; our study protocol for ESWT consisted of four weekly sessions of high energy both focused and radial technique, which was similar to other authors [10].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

El-Mallah

Elattar

2020

Egypt Rheumatol Rehabil

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Background Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. Results Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness. Conclusion ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

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“…It has been reported that ESWT yields better clinical outcomes over eccentric exercises 20 and relatively similar results compared with PRP injections in physically active patients. 6 Despite the reported efficacy of ESWT for chronic Achilles tendinopathy, some patients do not respond to treatment and still have residual symptoms. Therefore, it is important to know which patients are more amenable to ESWT.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Response of Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy Between Sports-Active and Nonsports-Active Patients With 5-Year Follow-up

Zhang

Yao

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain. Extracorporeal shock wave therapy (ESWT) has proven to be an effective treatment, but the relationship between therapeutic responses and sports activity levels has not been studied. Purpose: To compare the clinical outcomes of ESWT used to treat IATs between sports-active and nonsports-active patients over 5 years. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was conducted on 33 patients with IAT who received ESWT from October 2012 to September 2013. Patients were classified into 2 groups according to their preinjury Tegner activity level: a sports-active group, defined as patients who self-reported to be regular joggers (SA group; Tegner activity level >3; n = 16), and a nonsports-active group (control group; Tegner activity level ≤3; n = 17). The mean age was 31 ± 7 years for the SA group and 37 ± 10 years for the control group. The Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire scores and visual analog scale (VAS) pain scores were used to evaluate the clinical outcomes before treatment, immediately after treatment, and 5 years after treatment. Ultrasonography was also used to assess the insertional Achilles tendon quality. Results: Before treatment, there were no significant differences between the groups with regard to VAS scores, while the VISA-A score in the SA group was higher than that in the control group. After ESWT, both groups had increased VISA-A scores and decreased VAS scores, indicating improvement. At 5-year follow-up, the SA group had a significantly lower mean VAS score (0.3 ± 0.8 vs 1.6 ± 1.3; P = .001) and a significantly higher mean VISA-A score (90 ± 4 vs 78 ± 7; P < .001) compared with the control group. There was no significant difference between the groups regarding the calcification and neovascularization of the Achilles tendon based on ultrasonography. Conclusion: ESWT can improve the symptoms of Achilles tendinopathy, and patients with IAT who had greater sports activity levels had better therapeutic responses than nonsports-active patients after 5-year follow-up.

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Conservative treatment for Insertional Achilles Tendinopathy: platelet-rich plasma and focused shock waves. A retrospective study

Cited by 60 publications

References 48 publications

ESWT and nutraceutical supplementation (Tendisulfur Forte) vs ESWT-only in the treatment of lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy: a comparative study

ESWT and nutraceutical supplementation (Tendisulfur Forte) vs ESWT-only in the treatment of lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy: a comparative study

Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

Therapeutic Response of Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy Between Sports-Active and Nonsports-Active Patients With 5-Year Follow-up

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