Efficacy of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Meta-analysis

Abstract

Background: Achilles tendinopathy is a frequent sports injury, and extracorporeal shock wave therapy (ESWT) has been proposed as a treatment. Purpose: To compare outcomes between ESWT and other nonsurgical intervention (including sham shock wave therapy) in Achilles tendinopathy patients. Study Design: Systematic review; Level of evidence, 2. Methods: We included 5 randomized controlled trials and 3 case-control studies published between 2005 and 2018. We analyzed pain scores and other outcomes that were reported in more than 3 of the 8 studies. Results: ESWT was associated with significantly better scores than comparison therapy on the visual analog scale for pain ( P < .01), American Orthopaedic Foot & Ankle Society scale ( P = .01), Likert scale for satisfaction ( P = .03), Roles and Maudsley scale ( P < .01), Victorian Institute of Sports Assessment–Achilles questionnaire ( P < .01), and numerical rating scale ( P = .02). The 2 patient groups did not differ significantly in tenderness ( P = .34) or pain threshold ( P = .24). Subgroup analysis showed that ESWT led to better VAS pain scores than comparison treatments at both low-energy level (0.06-0.11 mJ/mm2) and medium-energy level (0.12-0.25 mJ/mm2) and at both shorter (<6 months) and longer (≥6 months) follow-up. Conclusion: ESWT improves pain and functional outcomes in patients with Achilles tendinopathy. Further research is needed to determine the optimal energy level.

Short- and Intermediate-Term Results of Extracorporeal Shockwave Therapy for Noninsertional Achilles Tendinopathy

“…These results conform to the results of studies, reviews, and meta-analyses that suggested that the combination of ESWT and exercises is an effective treatment for AT. 1,13,35,38,39 One cannot miss the line of thought portrayed by RCTs reporting the effects of ESWT in AT (Table 4). Initially, RCTs compared shockwave therapy only to placebo, 9 the wait-and-see policy, and eccentric exercises.…”

“…The only RCTs in literature that included a "long-term" follow-up reported either combined data for both the study and control groups 9 or a global "general assessment" of patients (on a 6-point Likert scale), 38,39 indicating that the treatment was either successful or failed with no exact outcome scores or statistical comparison. Fan et al 13 conducted a systematic review with meta-analysis to investigate the efficacy of ESWT compared to other nonsurgical treatments (including sham ESWT). They reported that VAS pain scores were not significantly different for follow-ups shorter or longer than 6 months.…”

“…8,41,47 Low-energy extracorporeal shockwave therapy (ESWT) is a safe and well-tolerated modality, which could be used as an alternative to or in combination with exercises. Moreover, satisfactory evidence (RCTs, 9,35,38,39,45 systematic reviews, and meta-analyses 1,13,17,42,43 ) exists to support its effectiveness for treating chronic noninsertional AT. Costa et al 9 have reported no alleviation of pain during rest or walking (only pain during sports was alleviated) when ESWT was compared to placebo.…”

A comparative study of single-vs. double-row technique in surgical treatment of insertional Achilles tendinopathy

“…Studies show that the initial treatment for insertional tendinopathy should be conservative (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) . Surgery should be considered only when conservative treatment (a maximum of six months) has failed or in cases of persistent pain and limitations in daily and sports activities (1,14,16) .…”

Response to “Letter Regarding: Effectiveness of Extracorporeal Shockwave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy”

“…These studies did not discuss reducing the extent of calcification. 3 Therefore, ESWT in the treatment of chronic IAT would theoretically treat the pathology with the aim of relieving pain and promoting tendon tissue remodeling, 4 not to treat the calcification.…”