Rompe Jan D, Furia John, Maffulli Nicola
OrthoTrauma Evaluation Center, Oppenheimer Str 70, Mainz, Germany D-55130.
Am J Sports Med. 2009 Mar;37(3):463-70. doi: 10.1177/0363546508326983. Epub 2008 Dec 15.
Results of a previous randomized controlled trial have shown comparable effectiveness of a standardized eccentric loading training and of repetitive low-energy shock-wave treatment (SWT) in patients suffering from chronic midportion Achilles tendinopathy. No randomized controlled trials have tested whether a combined approach might lead to even better results.
To compare the effectiveness of 2 management strategies--group 1: eccentric loading and group 2: eccentric loading plus repetitive low-energy shock-wave therapy.
Randomized controlled trial; Level of evidence, 1.
Sixty-eight patients with a chronic recalcitrant (>6 months) noninsertional Achilles tendinopathy were enrolled in a randomized controlled study. All patients had received unsuccessful management for >3 months, including at least (1) peritendinous local injections, (2) nonsteroidal anti-inflammatory drugs, and (3) physiotherapy. A computerized random-number generator was used to draw up an allocation schedule. Analysis was on an intention-to-treat basis.
At 4 months from baseline, the VISA-A score increased in both groups, from 50 to 73 points in group 1 (eccentric loading) and from 51 to 87 points in group 2 (eccentric loading plus shock-wave treatment). Pain rating decreased in both groups, from 7 to 4 points in group 1 and from 7 to 2 points in group 2. Nineteen of 34 patients in group 1 (56%) and 28 of 34 patients in group 2 (82%) reported a Likert scale of 1 or 2 points ("completely recovered" or "much improved"). For all outcome measures, groups 1 and 2 differed significantly in favor of the combined approach at the 4-month follow-up. At 1 year from baseline, there was no difference any longer, with 15 failed patients of group 1 opting for having the combined therapy as cross-over and with 6 failed patients of group 2 having undergone surgery.
At 4-month follow-up, eccentric loading alone was less effective when compared with a combination of eccentric loading and repetitive low-energy shock-wave treatment.
一项先前的随机对照试验结果显示，标准化离心负荷训练与重复性低能量冲击波治疗（SWT）对慢性跟腱中部肌腱病患者的疗效相当。尚无随机对照试验检验联合治疗方法是否能带来更好的效果。
比较两种治疗策略的疗效——第1组：离心负荷训练；第2组：离心负荷训练加重复性低能量冲击波治疗。
随机对照试验；证据等级，1级。
68例患有慢性顽固性（>6个月）非止点性跟腱病的患者纳入一项随机对照研究。所有患者接受>3个月的治疗均未成功，包括至少（1）腱鞘周围局部注射、（2）非甾体类抗炎药和（3）物理治疗。使用计算机随机数字生成器制定分配方案。分析采用意向性分析。
从基线开始4个月时，两组的VISA-A评分均升高，第1组（离心负荷训练）从50分升至73分，第2组（离心负荷训练加冲击波治疗）从51分升至87分。两组的疼痛评分均降低，第1组从7分降至4分，第2组从7分降至2分。第1组34例患者中有19例（56%）、第2组34例患者中有28例（82%）报告Likert评分为1或2分（“完全恢复”或“明显改善”）。对于所有结局指标，在4个月随访时，第1组和第2组在联合治疗方法方面存在显著差异，联合治疗效果更佳。从基线开始1年时，不再有差异，第1组15例治疗失败的患者选择交叉接受联合治疗，第2组6例治疗失败的患者接受了手术。
在4个月随访时，与离心负荷训练和重复性低能量冲击波治疗联合相比，单纯离心负荷训练效果较差。
