Chronic Insertional Achilles Tendinopathy Research Articles

High-Energy Extracorporeal Shock Wave Therapy as a Treatment for Insertional Achilles Tendinopathy

Background Results of high-energy extracorporeal shock wave therapy for the treatment of insertional Achilles tendinopathy are not determined. It is unclear how local anesthesia alters the outcome of this procedure. Hypothesis Extracorporeal shock wave therapy is an effective treatment for insertional Achilles tendinopathy. Local anesthesia field block adversely affects outcome. Study Design Case control study; Level of evidence, 3. Methods Thirty-five patients with chronic insertional Achilles tendinopathy were treated with 1 dose of high-energy extracorporeal shock wave therapy (ESWT group; 3000 shocks; 0.21 mJ/mm2; total energy flux density, 604 mJ/mm2), and 33 were treated with nonoperative therapy (control group). All extracorporeal shock wave therapy procedures were performed using a local anesthesia field block (LA subgroup, 12 patients) or a nonlocal anesthesia (NLA subgroup, 23 patients). Evaluation was by visual analog score and by Roles and Maudsley score. Results One month, 3 months, and 12 months after treatment, the mean visual analog score for the control and ESWT groups were 8.2 and 4.2 (P < .001), 7.2 and 2.9 (P < .001), and 7.0 and 2.8 (P < .001), respectively. Twelve months after treatment, the number of patients with successful Roles and Maudsley scores was statistically greater in the ESWT group compared with the control group (P > .0002), with 83% of ESWT group patients having a successful result, and the mean improvement in visual analog score for the LA subgroup was significantly less than that in the NLA subgroup (F = 16.77 vs F = 53.95, P < .001). The percentage of patients with successful Roles and Maudsley scores did not differ among the LA and NLA subgroups. Conclusion Extracorporeal shock wave therapy is an effective treatment for chronic insertional Achilles tendinopathy. Local field block anesthesia may decrease the effectiveness of this procedure.

Extrakorporale Stoßwellentherapie zur Behandlung der Achillessehnentendinopathie

The purpose of this study was to determine the efficacy of extracorporeal shock wave therapy (ESWT) for the treatment of adults with chronic insertional Achilles tendinopathy. 68 patients with chronic insertional Achilles tendinopathy were enrolled in this study. A total of 35 patients were treated with a single dose of ESWT (3000 shocks of 0.20 mJ/mm(2), ESWT group), while 33 patients were treated with traditional non-operative measures (control group). At 3 months post treatment, the mean VAS for the control and ESWT groups were 2.9 and 7.2 respectively. Using the Roles and Maudsley scale, 39% of the control patients and 51% of the ESWT patients were assigned an excellent or good result. ESWT as applied is a safe and effective treatment for chronic insertional Achilles tendinopathy.