scispace - formally typeset
Search or ask a question
Journal ArticleDOI

Extracorporeal shockwave therapy for the treatment of Achilles tendinopathies: a prospective study.

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 ...

Content maybe subject to copyright    Report

Citations
More filters
Journal ArticleDOI
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

Journal ArticleDOI
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]....

    [...]

Journal ArticleDOI
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)....

    [...]

  • ...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....

    [...]

  • ...A few studies used suboptimal statistical tests; therefore, the results of these studies may not be accurate and indeed misleading.(7,29)...

    [...]

Journal ArticleDOI
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

Journal ArticleDOI
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....

    [...]

  • ...The shock waves were given in a single session of 2000 shocks with 21 kV (Fridman et al. 2008)....

    [...]

References
More filters
Journal ArticleDOI
TL;DR: The effects of extracorporeal shock waves (ESWT) on tendon healing were assessed by observing histological and biomechanical parameters in a rat model of injury to the tendo Achillis to suggest a basis for clinical trials using ESWT.
Abstract: The effects of extracorporeal shock waves (ESWT) on tendon healing were assessed by observing histological and biomechanical parameters in a rat model of injury to the tendo Achillis. The injury was created by inserting an 18-G needle through tendo Achillis in 48 adult Wistar albino rats. The animals were divided into three groups. The first group received radiation only after the operation. The second received no shock waves and the third had 500 15 KV shocks on the second post-operative day. All the rats were killed on the 21st day after surgery. Histopathological analysis showed an increase in the number of capillaries and less formation of adhesions in the study group compared with the control group (p = 0.03). A significantly greater force was required to rupture the tendon in the study group (p = 0.028). Our findings suggest a basis for clinical trials using ESWT.

65 citations

Journal ArticleDOI
TL;DR: The abstract should state that shock wave therapy as applied did not produce a clinically relevant effect over placebo, and the pilot trial by Costa et al is valuable by clarifying how not to treat patients with recalcitrant Achilles tendinopathy using ESWT.
Abstract: To the Editor: I read with great interest the article “Shock Wave Therapy for Chronic Achilles Tendon Pain” by Costa et al, in which the authors stated that the results of an earlier trial by Rompe et al using extracorporeal shock wave therapy (ESWT) for plantar fasciitis were used to determine their sample size. The technique used by Rompe et al for producing a placebo effect also was used by Costa et al in their study. However, “in the absence of evidence to guide the number and frequency of treatment,” the authors decided not to test the parameters given in the trial by Rompe et al (three applications of 1000 impulses of low-energy ESWT, weekly interval, and main outcome measurement 3 months after last application). Instead they relied “on the experience of the senior author.” However, they do not state the experiences of the senior author or what data justified changing the previous treatment protocol. Speed et al showed that repetitive low-energy shock wave treatment applied in monthly intervals had no relevant treatment effect within 4 weeks after the last ESWT. Why did Costa et al choose a treatment concept already proven ineffective under randomized controlled conditions? Why did they choose a main followup period of only 4 weeks after the last ESWT? In numerous studies published regarding use of ESWT for treatment of tendinopathy, the main followup has been 12–14 weeks after the last ESWT. Level I therapeutic studies have provided evidence for a distinct treatment effect of ESWT for lateral epicondylitis and plantar fasciitis under the following circumstances: (1) application of 1500–2000 shocks of low-energy flux density (0.08–0.15 mJ/mm); (2) application to the site of maximal discomfort (patient guidance); (3) no local anesthesia; (4) weekly intervals (3–4 applications); and (5) at least 3 months followup after the last application. Treatment success (reduction of pain by 50%) can be expected to be approximately 60% compared with approximately 30% after placebo treatment. Therefore, the abstract should state that shock wave therapy as applied did not produce a clinically relevant effect over placebo. The pilot trial by Costa et al is valuable by clarifying how not to treat patients with recalcitrant Achilles tendinopathy using ESWT. Sincerely,

36 citations

Journal ArticleDOI
J. P. Furia1
TL;DR: ESWT as applied is a safe and effective treatment for chronic insertional Achilles tendinopathy and is assigned an excellent or good result.
Abstract: Ziel der Studie war die Untersuchung der Effektivitat einer extrakorporalen Stoswellentherapie (ESWT) in der Behandlung erwachsener Patienten mit chronischer Ansatztendinopathie der Achillessehne. Zwischen Juni 2003 und Januar 2004 wurden 68 Patienten mit chronischer Achillessehnenansatztendinopathie in die Studie eingeschlossen. 35 Patienten wurden mit einmaliger ESWT behandelt, 33 Patienten wurden konservativ ohne ESWT therapiert. Jeder ESWT-Patient erhielt eine einmalige Behandlung mit 3000 Impulsen der Energieflussdichte 0,2 mJ/mm2. Im 3-Monats-Follow-up lagen die VAS-Werte bei 2,9 in ESWT-Gruppe vs. 7,2 in der Kontrollgruppe. Bei der Bewertung nach dem Roles-Maudsley-Score erreichten nach 3 Monaten 51% der ESWT-Patienten vs. 39% der Kontrollpatienten ein hervorragendes oder gutes Ergebniss. ESWT ist eine effektive und sichere Therapie zur Behandlung der chronischen Ansatztendinopathie der Achillessehne.

35 citations

Journal ArticleDOI
TL;DR: Clinical studies have shown that the application of low dose radiofrequency in chronic tendinosis of the Achilles tendon, lateral and medial epicondyle, and patellar tendon have yielded good to excellent results in 90% to 95% of the cases.
Abstract: ABSTRACT Tendinosis is a chronic degenerative condition that afflicts both professional and recreational athletes, as well as people that perform repetitive-type tasks in the workplace. Basic science research over the past 10 years has shown that tendinosis is a degenerative condition and not an inflammatory condition. Precursor studies have shown that radiofrequency stimulation, both in the heart and in the field of wound healing, has led to increased angiogenesis. Basic science studies at our institution have shown increased angiogenesis and growth factor acceleration after the application of bipolar radiofrequency. Early clinical studies have shown that the application of low dose radiofrequency in chronic tendinosis of the Achilles tendon, lateral and medial epicondyle, and patellar tendon have yielded good to excellent results in 90% to 95% of the cases. Further clinical studies have shown that the application of the technology through a minimally invasive procedure yielded similar results in the foot and ankle, specifically the Achilles tendon, plantar fascia, and peroneal and posterior tibial tendons. The technique is simple, minimally invasive, and has a rapid rehabilitation component. Results over 3 years have continued to show 90% to 95% good to excellent results.

22 citations