Resident, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA.
Assistant Professor, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA; Associate Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA.
J Foot Ankle Surg. 2022 Jan-Feb;61(1):99-103. doi: 10.1053/j.jfas.2021.06.014. Epub 2021 Jun 24.
Achilles tendinopathy is a common condition and many patients have functional limitations after initial conservative treatment. Shockwave therapy has been shown to improve function within patients; however, comparative outcomes for different forms of shockwave are poorly described. In this retrospective cohort study, we describe findings from a quality improvement initiative evaluating safety and functional outcomes after treatment with radial shockwave therapy (n = 58) or combined radial and focused shockwave therapy (n = 29) for patients with Achilles tendinopathy refractory to exercise therapy. All patients were prescribed an eccentric exercise program. We hypothesized both groups would see improvements in function quantified using the Victorian Institute of Sports Assessment-Achilles with similar safety outcomes. Overall, the minimal clinically important difference (defined at 7 for insertional and 12 for noninsertional Achilles tendinopathy) was met in a greater proportion of patients treated with combined shockwave compared to radial shockwave (26 [89.7%] vs 37 [63.8%], p = .022). The change in Victorian Institute of Sports Assessment-Achilles from baseline to final treatment was not different between combined and radial-only groups (23.3 ± 12.6 vs 19.9 ± 18.7, p = .2). Within group differences from baseline to final follow-up measures (mean duration 17.9 ± 14.8 weeks) demonstrated overall functional improvement for both groups (both p < .0001). No serious adverse effects were observed. Our findings suggest combined radial and focused shockwave therapy may provide more predictable functional gains for treatment of Achilles tendinopathy compared to radial shockwave therapy.
跟腱病是一种常见病症，许多患者在初始保守治疗后仍存在功能受限。冲击波治疗已被证明可改善患者的功能；然而，不同形式的冲击波治疗的比较结果描述得很差。在这项回顾性队列研究中，我们描述了一项质量改进计划的结果，该计划评估了对经运动疗法治疗无效的跟腱病患者使用径向冲击波治疗（n=58）或径向联合聚焦冲击波治疗（n=29）后的安全性和功能结果。所有患者均被开具了离心运动方案。我们假设两组在使用维多利亚运动评估-跟腱（VISA-A）量化的功能改善方面都会有改善，且安全性结果相似。总体而言，与接受单纯径向冲击波治疗的患者相比，接受联合冲击波治疗的患者在插入性和非插入性跟腱病中达到最小临床重要差异（定义为 7 分和 12 分）的比例更大（26 [89.7%] 比 37 [63.8%]，p=0.022）。从基线到最终治疗的维多利亚运动评估-跟腱的变化在联合组和单纯径向组之间没有差异（23.3 ± 12.6 比 19.9 ± 18.7，p=0.2）。两组从基线到最终随访测量（平均随访时间 17.9 ± 14.8 周）的组内差异均显示出整体功能改善（两组均 p<0.0001）。未观察到严重不良事件。我们的研究结果表明，与单纯径向冲击波治疗相比，径向联合聚焦冲击波治疗可能为跟腱病的治疗提供更可预测的功能改善。
