Eccentric loading compared with shock wave treatment for chronic insertional achilles tendinopathy. A randomized,...

Area of Science:

• Orthopedics
• Sports Medicine
• Regenerative Medicine

Background:

• Chronic tendinopathy of the Achilles tendon insertion is challenging to manage nonoperatively.
• Previous studies showed success with eccentric loading and shock wave therapy for midsubstance Achilles tendinopathy.
• This study specifically investigated these treatments for insertional Achilles tendinopathy.

Purpose of the Study:

• To compare the effectiveness of eccentric loading versus repetitive low-energy shock wave therapy for chronic insertional Achilles tendinopathy.
• To evaluate pain, function, and activity levels using the VISA-A questionnaire.

Main Methods:

• A randomized controlled trial involving 50 patients with chronic recalcitrant insertional Achilles tendinopathy.
• Patients were randomized into two groups: eccentric loading (n=25) or low-energy shock wave therapy (n=25).
• Outcomes were assessed at 4 months and 1 year using the VISA-A questionnaire.

Main Results:

• Shock wave therapy group showed significantly greater improvement in VISA-A scores (53 to 80) compared to eccentric loading (53 to 63) at 4 months.
• Mean pain ratings decreased more in the shock wave therapy group (7 to 3) than the eccentric loading group (7 to 5).
• Higher recovery rates were observed in the shock wave therapy group (64%) versus the eccentric loading group (28%) at 4 months.

Conclusions:

• Low-energy shock wave therapy demonstrated superior outcomes compared to eccentric loading for chronic insertional Achilles tendinopathy at 4-month follow-up.
• The positive effects of shock wave therapy were sustained at the 1-year follow-up.
• Further research is needed to define optimal indications for eccentric loading in this patient population.