Zhang Shurong, Li Hong, Yao Wei, Hua Yinghui, Li Yunxia
Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
Orthop J Sports Med. 2020 Jan 22;8(1):2325967119898118. doi: 10.1177/2325967119898118. eCollection 2020 Jan.
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.
To compare the clinical outcomes of ESWT used to treat IATs between sports-active and nonsports-active patients over 5 years.
Cohort study; Level of evidence, 3.
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.
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; = .001) and a significantly higher mean VISA-A score (90 ± 4 vs 78 ± 7; < .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.
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.
插入性跟腱病（IAT）是足跟后部疼痛的常见原因。体外冲击波疗法（ESWT）已被证明是一种有效的治疗方法，但治疗反应与运动活动水平之间的关系尚未得到研究。
比较5年间运动活跃和非运动活跃患者接受ESWT治疗IAT的临床结果。
队列研究；证据等级，3级。
对2012年10月至2013年9月接受ESWT治疗的33例IAT患者进行回顾性研究。根据伤前Tegner活动水平将患者分为2组：运动活跃组，定义为自我报告为经常慢跑的患者（SA组；Tegner活动水平>3；n = 16），和非运动活跃组（对照组；Tegner活动水平≤3；n = 17）。SA组的平均年龄为31±7岁，对照组为37±10岁。使用维多利亚运动评估-跟腱（VISA-A）问卷评分和视觉模拟量表（VAS）疼痛评分来评估治疗前、治疗后即刻和治疗后5年的临床结果。还使用超声检查来评估跟腱插入部的质量。
治疗前，两组VAS评分无显著差异，而SA组的VISA-A评分高于对照组。ESWT治疗后，两组的VISA-A评分均升高，VAS评分均降低，表明病情有所改善。在5年随访时，与对照组相比，SA组的平均VAS评分显著更低（0.3±0.8 vs 1.6±1.3；P = 0.001），平均VISA-A评分显著更高（90±4 vs 78±7；P < 0.001）。基于超声检查，两组在跟腱钙化和新生血管形成方面无显著差异。
ESWT可改善跟腱病症状，5年随访后，运动活动水平较高的IAT患者比非运动活跃患者的治疗反应更好。
