Katolický Jakub, Poklopová Petra, Bashford Gregory, Katolická Tereza, Voleský Kryštof, Machač Stanislav, Nedělka Tomáš
Second Faculty of Medicine, Department of Rehabilitation and Sports Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
Faculty of Biomedical Engineering, Department of Health Care and Population Protection, Czech Technical University, Prague, Czech Republic.
Int J Surg. 2025 May 1;111(5):3169-3177. doi: 10.1097/JS9.0000000000002351.
This study aimed to assess the mid-term effects of focused extracorporeal shockwave therapy (ESWT) on clinical symptoms and tendon structure in patellar tendinopathy. Ultrasound (US) evaluation and an innovative in vivo analysis of intra-tendinous morphology using validated spatial frequency analysis (SFA) software were employed to quantify the organization and density of collagen fascicles.
This prospective cohort study included 21 recreational athletes (mean age 29.9 ± 9.3 years) with chronic unilateral symptomatic patellar tendinopathy. ESWT was applied as monotherapy over four weekly sessions. Pain was assessed using the Numeric Rating Scale (NRS) and disease severity with the Victorian Institute of Sports Assessment - Patella (VISA-P) questionnaire. Morphological parameters, such as tendon diameter (TD), were assessed with US and analyzed using SFA software. The asymptomatic tendons served as controls. Follow-up assessments were conducted at the end of the treatment period and 3 months posttreatment.
Baseline evaluations revealed increased TD in proximal part of the tendon ( P = 0.001) and decreased organization of collagen fascicles ( P = 0.013) in symptomatic tendons compared to asymptomatic controls. At the 3-month follow-up, symptomatic tendons showed significant reductions in TD ( P < 0.001) and improvements in both organization and density of collagen fascicles throughout various parameters - peak spatial frequency radius (PSFR) ( P = 0.024), P6 ( P = 0.05), Q6 ( P = 0.016), PPP ( P = 0.003). No significant morphological changes were observed in asymptomatic tendons. Clinical evaluations demonstrated significant reductions in NRS ( P < 0.001) and increases in Victorian Institute of Sports Assessment - Patella (VISA-P) scores ( P < 0.001) at all time points.
The study suggests that ESWT may have the potential to induce positive structural changes in patellar tendinopathy, including improved organization and density of collagen fascicles. These findings indicate that ESWT could be a promising noninvasive approach to managing patellar tendinopathy, with observed improvements in clinical symptoms and tendon structure. However, further high-quality research is needed to confirm these results and establish their long-term efficacy.
本研究旨在评估聚焦式体外冲击波疗法（ESWT）对髌腱病临床症状和肌腱结构的中期影响。采用超声（US）评估以及使用经过验证的空间频率分析（SFA）软件对肌腱内形态进行的创新性体内分析，来量化胶原束的排列和密度。
这项前瞻性队列研究纳入了21名患有慢性单侧症状性髌腱病的休闲运动员（平均年龄29.9±9.3岁）。ESWT作为单一疗法，每周进行一次，共治疗四周。使用数字评分量表（NRS）评估疼痛，并通过维多利亚运动评估 - 髌骨（VISA - P）问卷评估疾病严重程度。使用超声评估诸如肌腱直径（TD）等形态学参数，并使用SFA软件进行分析。将无症状的肌腱作为对照。在治疗期结束时和治疗后3个月进行随访评估。
基线评估显示，与无症状对照相比，有症状肌腱的肌腱近端TD增加（P = 0.001），胶原束排列减少（P = 0.013）。在3个月的随访中，有症状肌腱的TD显著降低（P < 0.001），并且在整个各种参数中，胶原束的排列和密度均有所改善 - 峰值空间频率半径（PSFR）（P = 0.024）、P6（P = 0.05）、Q6（P = 0.016）、PPP（P = 0.003）。无症状肌腱未观察到明显的形态学变化。临床评估显示，在所有时间点，NRS均显著降低（P < 0.001），维多利亚运动评估 - 髌骨（VISA - P）评分均升高（P < 0.001）。
该研究表明，ESWT可能有潜力在髌腱病中诱导积极的结构变化，包括改善胶原束的排列和密度。这些发现表明，ESWT可能是一种有前景的非侵入性治疗髌腱病的方法，观察到临床症状和肌腱结构均有改善。然而，需要进一步的高质量研究来证实这些结果并确定其长期疗效。
