Effectiveness of Extracorporeal Shockwave Therapy in Active Athletes with Patellar Tendinopathy; a Randomized Controlled Trial

Abstract

Patellar tendinopathy (PT) is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment in patients with chronic PT. Its effectiveness has not been studied in athletes who keep on playing sports despite having mild patellar tendon pain. PURPOSE: To determine the effectiveness of ESWT in athletes with PT who keep on playing sports. METHODS: The TOPGAME-study is a multicenter two armed randomized controlled trial with blinded participants and outcome assessors. Volleyball, handball and basketball players with mild symptoms of PT for 3 to 12 months were included. They were randomly allocated to either an ESWT or placebo group. The ESWT group received 3 patient guided piezoelectric focused medium energy density (mean 0.31 mJ/mm2) ESWT treatments without local anesthesia at a weekly interval in the first half of the competition. The placebo group received sham ESWT treatment using the same equipment and procedure. Follow-up measurements took place 1, 12 and 22 weeks after (sham) ESWT treatment, when athletes were still in competition. Primary outcome measure was the VISA-P questionnaire. RESULTS: Out of 113 athletes who volunteered, 62 met the inclusion criteria and were randomized to either the ESWT (n = 31) or placebo group (n = 31). Duration of symptoms was comparable in both groups, 7.3 ± 3.6 and 8.1 ± 3.8 months respectively. Mean VISA-P scores before and at 1, 12 and 22 weeks after treatment are summarized in table 1. There was a significant effect for time (p<0.01) but no effect for treatment × time (p=0.73).Table 1: Mean VISA-P scores before and at 1, 12 and 22 weeks follow-upCONCLUSION: Early intervention with ESWT in active players with PT does not lead to faster recovery than usual care with sham ESWT treatment.