Patellar Tip Syndrome/Patellofemoral Ağrı Sendromu
Title:Treatment of patellar tendinopathy with extracorporeal shock wave therapy
Author: Jack Taunton, MD K.M. Taunton, BSc K.M. Khan, MD, PhD
Abstract
Objective: To determine the effectiveness of extracorporeal shock wave therapy (ESWT) on patellar tendinopathy.
Method: This was a single-centre, randomized controlled trial, with 20 male and female subjects ranging from age 23 to 52. Treatment subjects received three to five sessions of ESWT and the control subjects received three to five sessions with the use of an energy-absorbing pad. The effects of the shock wave therapy were measured using the Victorian Institute of Sport Assessment (VISA) test and a vertical jump test. Pretreatment ultrasound was used to determine which subjects had neovascularization in the area of the patellar tendon.
Results: ESWT resulted in a significant improvement in the VISA score for questions 1, 3, and 6; for the VISA total score; and for the vertical jump score. Additionally, anecdotal evidence suggested an overall decrease in pain and an increase in function.
Conclusions: Extracorporeal shock wave therapy appears to be a useful adjunct to the eccentric drop-squat strength protocol in the treatment of chronic patellar tendinopathy. Future studies need to include a larger subject pool, a long-term follow-up, and a reliable objective measure of the microscopic and macroscopic improvement of the patellar tendon.
Keywords: patellar tendinopathy
Title: Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials
Authors: Chun-De Liao,#1,2 Guo-Min Xie,#3 Jau-Yih Tsauo,1 Hung-Chou Chen,2,4,6 and Tsan-Hon Lioucorresponding author2,5,6
Abstract:
Background
Extracorporeal shock-wave therapy (ESWT), which can be divided into radial shock-wave therapy (RaSWT) and focused shock-wave therapy (FoSWT), has been widely used in clinical practice for managing orthopedic conditions. The aim of this study was to determine the clinical efficacy of ESWT for knee soft tissue disorders (KSTDs) and compare the efficacy of different shock-wave types, energy levels, and intervention durations.
Methods
We performed a comprehensive search of online databases and search engines without restrictions on the publication year or language. We selected randomized controlled trials (RCTs) reporting the efficacy of ESWT for KSTDs and included them in a meta-analysis and risk of bias assessment. The pooled effect sizes of ESWT were estimated by computing odds ratios (ORs) with 95% confidence intervals (CIs) for the treatment success rate (TSR) and standardized mean differences (SMDs) with 95% CIs for pain reduction (i.e., the difference in pain relief, which was the change in pain from baseline to the end of RCTs between treatment and control groups) and for restoration of knee range of motion (ROM).
Results
We included 19 RCTs, all of which were of high or medium methodological quality and had a Physiotherapy Evidence Database score of ≥5/10. In general, ESWT had overall significant effects on the TSR (OR: 3.36, 95% CI: 1.84–6.12, P < 0.0001), pain reduction (SMD: − 1.49, 95% CI: − 2.11 to − 0.87, P < 0.00001), and ROM restoration (SMD: 1.76, 95% CI: 1.43–2.09, P < 0.00001). Subgroup analyses revealed that FoSWT and RaSWT applied for a long period (≥1 month) had significant effects on pain reduction, with the corresponding SMDs being − 3.13 (95% CI: − 5.70 to − 0.56; P = 0.02) and − 1.80 (95% CI: − 2.52 to − 1.08; P < 0.00001), respectively. Low-energy FoSWT may have greater efficacy for the TSR than high-energy FoSWT, whereas the inverse result was observed for RaSWT.
Conclusions
The ESWT exerts an overall effect on the TSR, pain reduction, and ROM restoration in patients with KSTDs. Shock-wave types and application levels have different contributions to treatment efficacy for KSTDs, which must be investigated further for optimizing these treatments in clinical practice.
Electronic supplementary material
The online version of this article (10.1186/s12891-018-2204-6) contains supplementary material, which is available to authorized users.
Keywords: Extracorporeal shock wave therapy, Knee, Musculoskeletal disorders, Physical therapy
Title: Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database
Authors: Christoph Schmitz,* Nikolaus B. M. Császár, Stefan Milz, Matthias Schieker, Nicola Maffulli, Jan-Dirk Rompe,|| and John P. Furia
Abstract
Background
Extracorporeal shock wave therapy (ESWT) is an effective and safe non-invasive treatment option for tendon and other pathologies of the musculoskeletal system.
Sources of data
This systematic review used data derived from the Physiotherapy Evidence Database (PEDro; www.pedro.org.au, 23 October 2015, date last accessed).
Areas of agreement
ESWT is effective and safe. An optimum treatment protocol for ESWT appears to be three treatment sessions at 1-week intervals, with 2000 impulses per session and the highest energy flux density the patient can tolerate.
Areas of controversy
The distinction between radial ESWT as ‘low-energy ESWT’ and focused ESWT as ‘high-energy ESWT’ is not correct and should be abandoned.
Growing points
There is no scientific evidence in favour of either radial ESWT or focused ESWT with respect to treatment outcome.
Areas timely for developing research
Future randomized controlled trials should primarily address systematic tests of the aforementioned optimum treatment protocol and direct comparisons between radial and focused ESWT.
Keywords: ESWT, RSWT, PEDRo, musculoskeletal system
