Eccentric Loading, Shock-Wave Treatment, or a Wait- and-See Policy for Tendinopathy of the Main Body of Tendo Achillis

TLDR

Chronic non‑insertional Achilles tendinopathy lacks robust comparative trials for treatment options. This study aimed to compare the effectiveness of eccentric loading, low‑energy shock‑wave therapy, and a wait‑and‑see approach. A randomized controlled trial enrolled 75 patients with >6‑month recalcitrant tendinopathy who had failed prior injections, NSAIDs, and physiotherapy, and allocated them via computer‑generated random numbers. At four months, both eccentric loading and shock‑wave therapy produced similar improvements in VISA‑A scores and pain, with recovery rates of 60 % and 52 % versus 24 % for wait‑and‑see, and both active treatments were significantly better than the wait‑and‑see strategy.

Abstract

Few randomized controlled trials compare different methods of management in chronic tendinopathy of the main body of tendo Achillis.To compare the effectiveness of 3 management strategies-group 1, eccentric loading; group 2, repetitive low-energy shock-wave therapy (SWT); and group 3, wait and see-in patients with chronic tendinopathy of the main body of tendo Achillis.Randomized controlled trial; Level of evidence, 1.Seventy-five patients with a chronic recalcitrant (>6 months) noninsertional Achilles tendinopathy were enrolled in a randomized controlled study. All patients had received unsuccessful management for >3 months, including at least (1) peritendinous local injections, (2) nonsteroidal anti-inflammatory drugs, and (3) physiotherapy. A computerized random-number generator was used to draw up an allocation schedule. Analysis was on intention-to-treat basis.At 4 months from baseline, the Victorian Institute of Sport Assessment (VISA)-A score increased in all groups, from 51 to 76 points in group 1 (eccentric loading), from 50 to 70 points in group 2 (repetitive low-energy SWT), and from 48 to 55 points in group 3 (wait and see). Pain rating decreased in all groups, from 7 to 4 points in group 1, from 7 to 4 points in group 2, and from 8 to 6 points in group 3. Fifteen of 25 patients in group 1 (60%), 13 of 25 patients in group 2 (52%), and 6 of 25 patients in Group 3 (24%) reported a Likert scale of 1 or 2 points ("completely recovered" or "much improved"). For all outcome measures, groups 1 and 2 did not differ significantly. For all outcome measures, groups 1 and 2 showed significantly better results than group 3.At 4-month follow-up, eccentric loading and low-energy SWT showed comparable results. The wait-and-see strategy was ineffective for the management of chronic recalcitrant tendinopathy of the main body of the Achilles tendon.