Abstract
BackgroundAchilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments.The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment.ResultsForty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness.ConclusionESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.
Highlights
Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes
We started our study with sixty adult athletic patients who were chosen from the period of February 2017 till December 2018 diagnosed with chronic Achilles tendinopathy; only forty completed the study till the end
On clinical examination of patients, the pain of ankle and Achilles tendon was reported in all patients (100%), as well as diffuse swelling of Achilles tendon (43%) while localized (57%), tenderness over tendon especially in insertional tendinopathy (60%), limited dorsi and plantar flexion (80%), and disturbed antalgic gait (95%) of patients
Summary
Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. It is a common pathology that occurs mainly in athletes as well as non-athletes, where the cause is usually trauma, overuse injury, or Tendinopathy could be either insertional or noninsertional (3–4 cm proximal to the calcaneal insertion). In subacute and chronic cases, inflammation seems to play a minor role and complex pathophysiological manifestations such as structural degeneration of the collagen matrix, partial rupture, intra-
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