Feeney Kaylem M
Orthopaedics, Bon Secours Hospital Galway, Galway, IRL.
Cureus. 2022 Jul 18;14(7):e26960. doi: 10.7759/cureus.26960. eCollection 2022 Jul.
Achilles tendinopathy is one of the most common lower limb injuries in both athletes and the general population. Despite the plethora of conservative treatment options available for the management of Achilles tendinopathy, as many as one in four patients will go on to require surgery. Extracorporeal shockwave therapy (ESWT) has emerged as a promising treatment option and has been successful in the management of other common musculoskeletal injuries such as plantar fasciitis. However, the evidence for ESWT in the management of Achilles tendinopathy remains inconclusive. Therefore, the aim of this systematic review was to evaluate the current evidence for the use of ESWT in the management of midportion Achilles tendinopathy. A comprehensive literature search was conducted using the databases MEDLINE (Pubmed), AMED, EMBASE, CINAHL, and CENTRAL. The databases were searched from their inception to December 2021. This was conducted to identify randomised control trials (RCTs) evaluating the effectiveness of ESWT versus control treatment in the management of midportion Achilles tendinopathy. Following a comprehensive search of the literature, a total of 283 articles were identified. Following the screening of titles and abstracts, 236 articles were excluded. The main reasons for exclusion were the identification of duplicates, non-randomised studies, and the use of ESWT on other pathology. Following the exclusion of 236 articles, 47 articles were retrieved for full-text review. Of these 47 articles, 40 were excluded leaving a total of 7 RCTs eligible for inclusion in this review. There was consistent evidence from 4 RCTs that ESWT is effective in the management of midportion Achilles tendinopathy. This review suggests that ESWT is a safe and effective modality for treating midportion Achilles tendinopathy as it reduces pain and improves function. The best available evidence suggests that a combination of ESWT with eccentric exercises and stretching may be even more effective than ESWT alone. Further research is required to confirm this and to determine the optimum ESWT treatment protocol.
跟腱病是运动员和普通人群中最常见的下肢损伤之一。尽管有大量保守治疗方法可用于跟腱病的管理，但仍有多达四分之一的患者最终需要手术治疗。体外冲击波疗法（ESWT）已成为一种有前景的治疗选择，并且已成功用于治疗其他常见的肌肉骨骼损伤，如足底筋膜炎。然而，ESWT治疗跟腱病的证据仍然不确凿。因此，本系统评价的目的是评估目前使用ESWT治疗跟腱中部病变的证据。我们使用MEDLINE（PubMed）、AMED、EMBASE、CINAHL和CENTRAL数据库进行了全面的文献检索。这些数据库从创建到2021年12月都进行了检索。这样做是为了识别评估ESWT与对照治疗在跟腱中部病变管理中有效性的随机对照试验（RCT）。在全面检索文献后，共识别出283篇文章。在筛选标题和摘要后，排除了236篇文章。排除的主要原因是发现重复文章、非随机研究以及将ESWT用于其他病理情况。在排除236篇文章后，检索到47篇文章进行全文审查。在这47篇文章中，排除了40篇，最终共有7项RCT符合纳入本评价的标准。4项RCT提供了一致的证据，表明ESWT对跟腱中部病变的治疗有效。本评价表明，ESWT是治疗跟腱中部病变的一种安全有效的方法，因为它可以减轻疼痛并改善功能。现有最佳证据表明，ESWT与离心运动和拉伸相结合可能比单独使用ESWT更有效。需要进一步研究来证实这一点，并确定最佳的ESWT治疗方案。
