Line- and Point-Focused Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Placebo-Controlled RCT Study.
Achilles tendinopathy
ESWT
elastography
ultrasound
ultrasound tissue characterization (UTC)
Journal
Sports health
ISSN: 1941-0921
Titre abrégé: Sports Health
Pays: United States
ID NLM: 101518422
Informations de publication
Date de publication:
Historique:
pubmed:
16
2
2021
medline:
9
9
2021
entrez:
15
2
2021
Statut:
ppublish
Résumé
Extracorporeal shock wave therapy (ESWT) is a widely considered treatment option for Achilles tendinopathy. Line-focused ESWT is a novel technique treating a larger tendon area than point-focused ESWT. Monitoring capacities of clinical symptoms with ultrasound under ESWT treatment are unknown. Point- and line-focused ESWT have a superior outcome than placebo ESWT. ESWT leads to morphological tendon changes detectable with ultrasound. Single-blinded placebo-controlled randomized contolled trial. Level 1. The study was conducted in 3 cohorts, namely ESWT point (n = 21), ESWT line (n = 24), and ESWT placebo (n = 21). Victorian Institute of Sports Assessment-Achilles (VISA-A) score was measured before the intervention (T0), after 6 weeks (T1), and after 24 weeks (T2). All cohorts performed daily physiotherapy for 24 weeks and received 4 sessions of point-focused, line-focused, or placebo ESWT in the first 6 weeks. Ultrasound was performed with B-mode, power Doppler, shear wave elastography (SWE) at T0 and T2 and with ultrasound tissue characterization (UTC) at T0, T1, and T2. Data were analyzed with a mixed analysis of variance and There was a significant VISA-A improvement over time for all groups ( There is a significant VISA-A score improvement for all study groups without a statistically significant benefit for ESWT point or ESWT line compared with ESWT placebo. Tendon adaptation could only be detected with SWE for ESWT point. The present study could not detect any statistically relevant effect of ESWT compared to placebo. SWE is able to demonstrate tendon adaptation.
Sections du résumé
BACKGROUND
BACKGROUND
Extracorporeal shock wave therapy (ESWT) is a widely considered treatment option for Achilles tendinopathy. Line-focused ESWT is a novel technique treating a larger tendon area than point-focused ESWT. Monitoring capacities of clinical symptoms with ultrasound under ESWT treatment are unknown.
HYPOTHESIS
OBJECTIVE
Point- and line-focused ESWT have a superior outcome than placebo ESWT. ESWT leads to morphological tendon changes detectable with ultrasound.
STUDY DESIGN
METHODS
Single-blinded placebo-controlled randomized contolled trial.
LEVEL OF EVIDENCE
METHODS
Level 1.
METHODS
METHODS
The study was conducted in 3 cohorts, namely ESWT point (n = 21), ESWT line (n = 24), and ESWT placebo (n = 21). Victorian Institute of Sports Assessment-Achilles (VISA-A) score was measured before the intervention (T0), after 6 weeks (T1), and after 24 weeks (T2). All cohorts performed daily physiotherapy for 24 weeks and received 4 sessions of point-focused, line-focused, or placebo ESWT in the first 6 weeks. Ultrasound was performed with B-mode, power Doppler, shear wave elastography (SWE) at T0 and T2 and with ultrasound tissue characterization (UTC) at T0, T1, and T2. Data were analyzed with a mixed analysis of variance and
RESULTS
RESULTS
There was a significant VISA-A improvement over time for all groups (
CONCLUSION
CONCLUSIONS
There is a significant VISA-A score improvement for all study groups without a statistically significant benefit for ESWT point or ESWT line compared with ESWT placebo. Tendon adaptation could only be detected with SWE for ESWT point.
CLINICAL RELEVANCE
CONCLUSIONS
The present study could not detect any statistically relevant effect of ESWT compared to placebo. SWE is able to demonstrate tendon adaptation.
Identifiants
pubmed: 33586526
doi: 10.1177/1941738121991791
pmc: PMC8404720
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
511-518Références
Arch Orthop Trauma Surg. 2014 Sep;134(9):1205-10
pubmed: 25012530
J Orthop Translat. 2018 Jul 04;15:9-20
pubmed: 30258782
Knee Surg Sports Traumatol Arthrosc. 2001 Jul;9(4):233-8
pubmed: 11522081
Int J Surg. 2015 Dec;24(Pt B):154-9
pubmed: 26327530
Int J Sports Phys Ther. 2018 Apr;13(2):283-292
pubmed: 30090686
Acad Radiol. 2018 Mar;25(3):265-272
pubmed: 29153963
Med Sci Monit. 2016 Apr 09;22:1186-91
pubmed: 27072885
Br J Sports Med. 2018 Mar;52(6):387-407
pubmed: 28954794
Sex Med. 2018 Mar;6(1):1-7
pubmed: 29275957
Sports Health. 2020 Jul/Aug;12(4):373-381
pubmed: 32003647
J Musculoskelet Neuronal Interact. 2005 Mar;5(1):22-34
pubmed: 15788868
Br J Sports Med. 2010 Dec;44(16):1153-9
pubmed: 19666626
Clin J Sport Med. 2021 May 1;31(3):e161-e175
pubmed: 31241489
Int J Sports Phys Ther. 2012 Feb;7(1):76-84
pubmed: 22319681
Acta Orthop. 2008 Apr;79(2):249-56
pubmed: 18484252
Equine Vet J. 2007 May;39(3):226-31
pubmed: 17520973
Biomed Res Int. 2019 Dec 26;2019:3086910
pubmed: 31950037
J Mech Behav Biomed Mater. 2015 Dec;52:85-94
pubmed: 25958330
PeerJ. 2017 Jul 19;5:e3592
pubmed: 28740756
Ann Rehabil Med. 2014 Aug;38(4):534-40
pubmed: 25229032
J Sports Med Phys Fitness. 2020 Nov;60(11):1462-1469
pubmed: 32586084
BMC Musculoskelet Disord. 2009 Oct 30;10:134
pubmed: 19878572
Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):2051-2058
pubmed: 29079961
Br J Sports Med. 2014 Mar;48(6):469-75
pubmed: 24100290
Am J Phys Med Rehabil. 2019 Sep;98(9):806-810
pubmed: 31021822
Am J Sports Med. 2009 Mar;37(3):463-70
pubmed: 19088057
Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2124-32
pubmed: 25539686
Foot Ankle Surg. 2013 Jun;19(2):112-7
pubmed: 23548453
Trials. 2010 Mar 24;11:32
pubmed: 20334632
Muscles Ligaments Tendons J. 2017 May 10;7(1):88-97
pubmed: 28717616
Int J Sports Phys Ther. 2015 Oct;10(5):639-44
pubmed: 26491614
Clin Orthop Relat Res. 2005 Nov;440:199-204
pubmed: 16239807
Foot Ankle Int. 2020 Apr;41(4):403-410
pubmed: 31924120
Br J Sports Med. 2016 Oct;50(19):1187-91
pubmed: 27127294
Equine Vet J. 2010 Jul;42(5):407-11
pubmed: 20636776
Eur J Phys Rehabil Med. 2019 Dec;55(6):761-771
pubmed: 31615195
Biomed Res Int. 2016;2016:2580969
pubmed: 28004000
Br J Sports Med. 2015 Aug;49(15):995-9
pubmed: 25586910