Extracorporeal shockwave therapy for the treatment of Achilles tendinopathies: a prospective study.
01 Nov 2008-Journal of the American Podiatric Medical Association (J Am Podiatr Med Assoc)-Vol. 98, Iss: 6, pp 466-468
TL;DR: High-power extracorporeal shockwave therapy is safe, noninvasive, and effective, and it has a role in the treatment of chronic Achilles tendinopathy.
Abstract: Background: Extracorporeal shockwave therapy has been shown to be effective in the treatment of chronic tendon pathology in the elbow, shoulder, and plantar fascia. This prospective study examines ...
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TL;DR: This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.
Abstract: Heel pain, whether plantar or posterior, is predominantly a mechanical pathology although an array of diverse pathologies including neurologic, arthritic, traumatic, neoplastic, infectious, or vascular etiologies must be considered. This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.
355 citations
TL;DR: Implantation of BMMC in rotator cuff sutures appears to be a safe and promising alternative to other biological approaches currently used to enhance tissue quality in affected tendons.
Abstract: Purpose
To investigate the behavior of rotator cuff tears treated with conventional repair technique with the aid of autologous bone marrow mononuclear cells (BMMC).
208 citations
Cites background from "Extracorporeal shockwave therapy fo..."
...In these diseases, new treatments have gained ground trying to stimulate tendon regeneration, including shockwave therapy [13], microtenotomy, and thermal stimulation [5, 39]....
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TL;DR: Extracorporeal shock wave therapy is an effective intervention and should be considered for GTPS, PT, and AT particularly when other nonoperative treatments have failed.
Abstract: Background:There is accumulating evidence for the effectiveness of extracorporeal shock wave therapy (ESWT) when treating lower limb tendinopathies including greater trochanteric pain syndrome (GTPS), patellar tendinopathy (PT), and Achilles tendinopathy (AT).Purpose:To evaluate the effectiveness of ESWT for lower limb tendinopathies.Study Design:Systematic review and meta-analysis.Methods:PubMed (Medline), Embase, Web of Knowledge, Cochrane, and CINAHL were searched from inception to February 2013 for studies of any design investigating the effectiveness of ESWT in GTPS, PT, and AT. Citation tracking was performed using PubMed and Google Scholar. Animal and non–English language studies were excluded. A quality assessment was performed by 2 independent reviewers, and effect size calculations were computed when sufficient data were provided.Results:A total of 20 studies were identified, with 13 providing sufficient data to compute effect size calculations. The energy level, number of impulses, number of se...
150 citations
Cites background or result from "Extracorporeal shockwave therapy fo..."
...yy Four studies concerned patients with midportion tendinopathy,(8,13,21,23) 2 concerned patients with insertional tendinopathy,(9,20) and 5 included both.(5,7,18,25,31) Seven studies(5,8,9,18,20,21,23) compared the effectiveness of ESWT to an alternative intervention (Figure 4)....
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...The 6 studies looking at long-term ESWT effects included 2 retrospective(8,9) and 4 prospective studies.(7,13,25,31) Furia(8,9) showed that the differences in pain and functional outcomes between the patient groups receiving ESWT and other nonoperative therapies were similar at 3 months....
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...A few studies used suboptimal statistical tests; therefore, the results of these studies may not be accurate and indeed misleading.(7,29)...
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TL;DR: Low level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.
Abstract: Objective To evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT) Design Systematic review Eligibility criteria Randomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included Risk of bias and quality of studies were evaluated Results Moderate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT Regarding the rest of the results, there was only very low or no level of evidence 13 studies showed high risk of bias largely due to methodology, blinding and reporting Conclusion Low level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation
120 citations
TL;DR: The aim of the present review is to investigate differences in outcome in select orthopaedic applications using focused and unfocused shock waves.
Abstract: For the past decade extracorporeal shock wave therapy has been applied to a wide range of musculoskeletal disorders. The many promising results and the introduction of shock wave generators that are less expensive and easier to handle has added to the growing interest. Based on their nature of propagation, shock waves can be divided into two types: focused and unfocused. Although several physical differences between these different types of shock waves have been described, very little is known about the clinical outcome using these different modalities. The aim of the present review is to investigate differences in outcome in select orthopaedic applications using focused and unfocused shock waves.
53 citations
Cites background or methods from "Extracorporeal shockwave therapy fo..."
...Off-label use of ESW therapy has been described for a wide range of indications including Achilles tendinopathy (Furia 2006; Rompe et al. 2007b; Fridman et al. 2008; Furia 2008; Rasmussen et al. 2008; Rompe et al. 2008; Rompe et al. 2009a; Saxena et al. 2011), pseudarthrosis and fracture nonunion (Cacchio et al....
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...The shock waves were given in a single session of 2000 shocks with 21 kV (Fridman et al. 2008)....
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References
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TL;DR: There is "Platinum"level evidence that shock wave therapy provides little or no benefit in terms of pain and function in lateral elbow pain and there is "Silver" level evidence based upon one trial involving 93 participants that steroid injection may be more effective than ESWT.
Abstract: Background This review is one in a series of reviews of interventions for lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common condition causing pain in the elbow and forearm and lack of strength and function of the elbow and wrist. Shock wave therapy (ESWT) involves the application of single pulsed acoustic wave. Since the 1990's reports of benefit of ESWT in the treatment of tendon disorders have been appearing in the literature. A systematic review published in the German language appeared in 2000 (Boddeker 2000) Objectives To determine the effectiveness and safety of ESWT in the treatment of adults with lateral elbow pain. Search strategy Comprehensive electronic searches of MEDLINE, CINAHL, EMBASE and SCISEARCH were combined with searches of the Cochrane Clinical Trails Registrar and the Musculoskeletal Review Group's specialist trial database. Identified keywords and authors were searched again in an effort to identify as many trials as possible. Selection criteria Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were evaluated for inclusion in the review provided they described individuals with lateral elbow pain and were comparing the use of ESWT as a treatment strategy. Data collection and analysis For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference. Weighted mean difference using a random effects model was selected when outcomes were measured on standard scales. A fixed effects model was used to interpret results and assess heterogeneity. For binary data numbers of events and total population were analysed and interpreted as relative risk. Main results Two trials of ESWT versus placebo are included in this review (~~Rompe 1996~~, ~~Haake 2001~~). Both trials included similar study populations consisting of participants with chronic symptoms who had failed other conservative treatment. The frequency of ESWT application and the doses and techniques used were similar in both trials. The first trial demonstrated highly significant differences in favour of ESWT whereas the second trial found no benefits of ESWT over placebo. When the data from the two trials were pooled, the benefits observed in the first trial were no longer statistically significant. The relative risk for treatment failure (defined as Roles-Maudsley score of 4) of ESWT over placebo was 0.40 (95% CI, 0.08 to 1.91) at six weeks and 0.44 (95% CI, 0.09 to 2.17) at one year. After 6 weeks, there was no statistically significant improvement in pain at rest [WMD pain out of 100 = - 11.40 (95% CI, -26.10 to 3.30)], pain with resisted wrist extension [WMD pain out of 100 = -16.20 (95% CI, -47.75 to 15.36)] or pain with resisted middle finger extension [WMD pain out of 100 = -20.51(95% CI, -56.57 to 15.56)]. Results after 12 or 24 weeks were similar. Reviewer's conclusions The two trials included in this review yielded conflicting results. Further trials are needed to clarify the value of ESWT for lateral elbow pain.
179 citations
TL;DR: The results provide no support for the use of shock wave therapy for treatment of patients with chronic Achilles tendon pain, but the confidence intervals include the potential for a clinically relevant treatment effect.
Abstract: Shock wave therapy has been used for treatment of several soft tissue disorders that are characterized by chronic pain. We sought to determine if shock wave therapy reduces chronic Achilles tendon pain. Forty-nine patients were enrolled in a double-blind randomized placebo-controlled trial. Each pat
121 citations
TL;DR: Extracorporeal shock wave therapy is an effective treatment, which significantly reduces the symptoms associated with chronic plantar fasciitis and compares favorably to the results achieved with surgical intervention in the form of a percutaneous plantarfasciotomy.
Abstract: A review of the history, mechanism of action, and application of extracorporeal shock wave therapy for chronic plantar fasciitis is presented. The results of 40 feet treated with this modality are reviewed after a mean follow-up time of 8.4 months. All procedures were performed under intravenous sedation and local infiltrative anesthesia. An electrohydraulic shock wave with a mean of 20.6 kV combined with a mean of 2,506 pulses was used. The results of a similar demographic class of patients having undergone a percutaneous plantar fasciotomy at our institution were compared to the results of this cohort of shock wave patients. Eighty-two percent of the patients treated with extracorporeal shock wave therapy were successfully treated as compared to 83% with a percutaneous plantar fasciotomy. The mean score on the 11-point visual analog scale for satisfied patients was 7.9 preoperatively and 2.95 within 7 days postoperatively. After 3 months, the mean visual analog score was 4.2 or 50% of the preoperative value after a mean of 8.4 months following treatment. Eighty-three percent of the patients treated stated that shock wave therapy improved their symptoms. There were no complications encountered in any patient in this study. Extracorporeal shock wave therapy is an effective treatment, which significantly reduces the symptoms associated with chronic plantar fasciitis and compares favorably to the results achieved with surgical intervention in the form of a percutaneous plantar fasciotomy.
109 citations
TL;DR: The anatomy of Achilles insertional tendinopathy is discussed from the anatomy of to its management, and overuse and poor training habits are considered to be the main etiology of Achilles Insertional Tendinopathy.
Abstract: There has been significant progress in our understanding of Achilles insertional tendinopathy since Clain and Baxter divided Achilles tendon disorders into noninsertional and insertional tendinopathy in 1992. In this article we specifically concentrate on Achilles insertional tendinopathy. Classically, overuse and poor training habits are considered to be the main etiology of Achilles insertional tendinopathy. This article discusses Achilles insertional tendinopathy from the anatomy of to its management.
83 citations
TL;DR: 4 to 6 months of nonsurgical therapy is appropriate for middle aged patients or athletes with chronic Achilles tenosynovitis and those that fail this treatment will improve with a limited debridement of diseased tissue without excessive soft tissue dissection of the tendon.
Abstract: We reviewed our results of nonoperative and operative treatment of chronic Achilles tenosynovitis to further define outcomes and treatment parameters. Forty-one patients presented with an average of 14 weeks of Achilles tendon symptoms. All patients received nonsurgical treatment initially, and 21 patients (51%) recovered after an average of 18 weeks of therapy. Three additional patients improved after brisement of the tendon/peritenon interspace. Seventeen of 41 patients eventually underwent soft tissue tenolysis and/or excision of degenerative tendon cysts.Those patients who responded to nonoperative therapy tended to be younger (average age, 33 years) than those who had degenerative tendon changes requiring surgery (average age, 48 years). All surgical patients were able to return to unrestricted activity after 31 weeks (range, 27–48 weeks). We believe 4 to 6 months of nonsurgical therapy is appropriate for middle aged patients or athletes with chronic Achilles tenosynovitis. Those that fail this treat...
73 citations