Efficacy of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Meta-analysis.

BACKGROUND

Achilles tendinopathy is a frequent sports injury, and extracorporeal shock wave therapy (ESWT) has been proposed as a treatment.

PURPOSE

To compare outcomes between ESWT and other nonsurgical intervention (including sham shock wave therapy) in Achilles tendinopathy patients.

STUDY DESIGN

Systematic review; Level of evidence, 2.

METHODS

We included 5 randomized controlled trials and 3 case-control studies published between 2005 and 2018. We analyzed pain scores and other outcomes that were reported in more than 3 of the 8 studies.

RESULTS

ESWT was associated with significantly better scores than comparison therapy on the visual analog scale for pain ( < .01), American Orthopaedic Foot & Ankle Society scale ( = .01), Likert scale for satisfaction ( = .03), Roles and Maudsley scale ( < .01), Victorian Institute of Sports Assessment-Achilles questionnaire ( < .01), and numerical rating scale ( = .02). The 2 patient groups did not differ significantly in tenderness ( = .34) or pain threshold ( = .24). Subgroup analysis showed that ESWT led to better VAS pain scores than comparison treatments at both low-energy level (0.06-0.11 mJ/mm) and medium-energy level (0.12-0.25 mJ/mm) and at both shorter (<6 months) and longer (≥6 months) follow-up.

CONCLUSION

ESWT improves pain and functional outcomes in patients with Achilles tendinopathy. Further research is needed to determine the optimal energy level.