Line- and Point-Focused Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Placebo-Controlled RCT Study

被引:22
作者
Gatz, Matthias [1 ]
Schweda, Sebastian [1 ]
Betsch, Marcel [1 ]
Dirrichs, Timm [2 ]
de la Fuente, Matias [3 ]
Reinhardt, Nina [3 ]
Quack, Valentin [1 ]
机构
[1] RWTH Aachen Univ Clin, Dept Orthopaed Surg, Pauwelsstr 30, D-52074 Aachen, Germany
[2] RWTH Aachen Univ Clin, Dept Radiol, Aachen, Germany
[3] Rhein Westfal TH Aachen, Chair Med Engn, Aachen, Germany
来源
SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH | 2021年 / 13卷 / 05期
关键词
ESWT; Achilles tendinopathy; ultrasound; ultrasound tissue characterization (UTC); elastography; FOLLOW-UP; VISA-A; TENDON; STIFFNESS; PAIN;
D O I
10.1177/1941738121991791
中图分类号
G8 [体育];
学科分类号
04 ; 0403 ;
摘要
Background: Extracorporeal shock wave therapy (ESWT) is a widely considered treatment option for Achilles tendinopathy. Line-focused ESWT is a novel technique treating a larger tendon area than point-focused ESWT. Monitoring capacities of clinical symptoms with ultrasound under ESWT treatment are unknown. Hypothesis: Point- and line-focused ESWT have a superior outcome than placebo ESWT. ESWT leads to morphological tendon changes detectable with ultrasound. Study Design: Single-blinded placebo-controlled randomized contolled trial. Methods: The study was conducted in 3 cohorts, namely ESWT point (n = 21), ESWT line (n = 24), and ESWT placebo (n = 21). Victorian Institute of Sports Assessment-Achilles (VISA-A) score was measured before the intervention (T0), after 6 weeks (T1), and after 24 weeks (T2). All cohorts performed daily physiotherapy for 24 weeks and received 4 sessions of point-focused, line-focused, or placebo ESWT in the first 6 weeks. Ultrasound was performed with B-mode, power Doppler, shear wave elastography (SWE) at T0 and T2 and with ultrasound tissue characterization (UTC) at T0, T1, and T2. Data were analyzed with a mixed analysis of variance and t test. Results: There was a significant VISA-A improvement over time for all groups (P < 0.001). ESWT point had the strongest VISA-A score improvement +23 (ESWT line: +18; ESWT placebo: +15), but there was no significant interaction between time and any of the groups: F(4, 116) = 1.393; P = 0.24. UTC, power Doppler, and B-mode could not show significant alterations over time. SWE revealed a significant increase of elastic properties for ESWT point in the insertion (t = -3.113, P = 0.03) and midportion (t = -2.627, P = 0.02) over time. Conclusion: There is a significant VISA-A score improvement for all study groups without a statistically significant benefit for ESWT point or ESWT line compared with ESWT placebo. Tendon adaptation could only be detected with SWE for ESWT point.
引用
收藏
页码:511 / 518
页数:8
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