Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: a...

Area of Science:

• Orthopedics
• Sports Medicine
• Regenerative Medicine

Background:

• Chronic midportion Achilles tendinopathy is a debilitating condition.
• Previous research indicated comparable effectiveness between eccentric loading and shock-wave therapy (SWT).
• The potential benefit of combining these treatments remained unexplored in randomized controlled trials.

Purpose of the Study:

• To compare the effectiveness of eccentric loading versus a combination of eccentric loading and repetitive low-energy SWT.
• To evaluate treatment outcomes for chronic recalcitrant noninsertional Achilles tendinopathy.

Main Methods:

• A randomized controlled trial (Level of evidence, 1) involving 68 patients.
• Patients had chronic Achilles tendinopathy unresponsive to >3 months of standard treatments.
• Treatments compared: eccentric loading (group 1) vs. eccentric loading + SWT (group 2).
• Intention-to-treat analysis was performed.

Main Results:

• At 4 months, the combined therapy group (group 2) showed significantly greater improvement in VISA-A scores and pain reduction compared to eccentric loading alone (group 1).
• Patient-reported recovery (Likert scale 1 or 2) was higher in group 2 (82%) than in group 1 (56%) at 4 months.
• By 1 year, the significant difference between groups disappeared, with some patients in group 1 crossing over to combined therapy and some in group 2 undergoing surgery.

Conclusions:

• Eccentric loading combined with repetitive low-energy SWT is more effective than eccentric loading alone at the 4-month follow-up for chronic Achilles tendinopathy.
• The long-term superiority of the combined approach was not sustained at 1 year.
• Further investigation into optimal treatment durations and patient selection for combined therapies is warranted.