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

Abstract

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.

Nonoperative treatment of insertional Achilles tendinopathy: a systematic review

“…The search of PubMed, Embase, Web of Science database, and additional search finally yielded 470 records after duplicates were removed. The studies were screened by reviewing abstracts and full-texts according to the inclusion and exclusion criteria, and 23 studies [ 6 , 11 – 32 ] (containing 35 groups) were eligible for the final review, including 11 comparative studies (6 RCTs, 5 non-randomized comparative studies) and 12 non-comparative studies. The studies were published from 2003 to 2020.…”

“…Erroi et al demonstrated that both ESWT and PRP therapy were effective and safe, and there were no significant differences between two groups in VAS, VISA-A, or satisfaction rate [ 27 ]. Zhang et al showed that patients with IAT who had greater sports activity levels had better therapeutic responses to ESWT than nonsports-active patients after a 5-year follow-up [ 32 ].…”

“…One group received combined eccentric training and conventional physical therapy including gastrocnemius, soleus, hamstring stretches, and ice massage on the Achilles tendon twice a day. With regard to the outcome, a 10-point visual analog scale (VAS) or numerical pain scale was reported showed that patients with IAT who had greater sports activity levels had better therapeutic responses to ESWT than nonsports-active patients after a 5-year follow-up [32].…”

The clinical diagnosis of Achilles tendinopathy: a scoping review

“…Combined terminology 7 ( Chazan, 1998;Den Hartog, 2009;Fredericson, 1996;Nichols, 1989;Scott, Huisman & Khan, 2011;Wang et al, 2012) Tendinopathy location Insertional 21 (Aldridge, 2004;Benazzo, Todesca & Ceciliani, 1997;Benito, 2016;Cheng, Zhang & Cai, 2016;Chimenti et al, 2016;Chimenti et al, 2017;Den Hartog, 2009;Irwin, 2010;Maffulli et al, 2019;Mansur et al, 2019;Mansur et al, 2017;McCormack et al, 2015;Stenson et al, 2018;Thomas et al, 2010;Wei et al, 2017;Xu et al, 2019;Zellers et al, 2019;Zhang et al, 2020;…”

“…Of the included cohort studies, 21 were prospective cohort studies (Cheng, Zhang & Cai, 2016;Chester et al, 2008;Crill, Berlet & Hyer, 2014;Duthon et al, 2011;Jowett, Richmond & Bedi, 2018;Karjalainen et al, 2000;Khan et al, 2003;Knobloch et al, 2008;Mansur et al, 2019;McCormack et al, 2015;O'Neill et al, 2019;Oloff et al, 2015;Paavola et al, 2000;Silbernagel et al, 2007;Syvertson et al, 2017;Zhuang et al, 2019) and 10 were retrospective cohort studies (Alfredson & Spang, 2018;Barge-Caballero et al, 2008;Florit et al, 2019;Murawski et al, 2014;Stenson et al, 2018;Von Wehren et al, 2019; Wei et al, 2017;Zellers et al, 2019;Zhang et al, 2020). Midportion Achilles tendinopathy was investigated in 15 studies (Chester et al, 2008;Crill, Berlet & Hyer, 2014;Duthon et al, 2011;Jowett, Richmond & Bedi, 2018;Knobloch et al, 2008;Lakshmanan & O'Doherty, 2004;Murawski et al, 2014;O'Neill et al, 2019;Paavola et al, 2000;Silbernagel et al, 2007;Syvertson et al, 2017;Von Wehren et al, 2019), insertional tendinopathy was investigated in eight studies …”