Extracorporeal Shock Wave Therapy for Achilles and Patellar Tendinopathy: Meta-Analysis and a Systematic Review of the Literature

Background: Sports related injuries such as lower limb tendinopathies can result in long-standing impairment of athletic performance. In recent years, treatment interventions like eccentric exercises, Platelet Rich Plasma (PRP) injections and Extracorporeal Shockwave Therapy (ESWT) have gained popularity among Physiotherapists and sports clinicians, but the evidence of their effectiveness is very limited. Purpose: To investigate the effectiveness of ESWT on Achilles and Patellar tendinopathy. Methods: A systematic review and meta-analysis was conducted using MEDLINE, EMBASE, AMED, CINAHL, PEDro and Cochrane databases and bibliographic searches from inception until April 2013 to identify randomized control trials comparing ESWT with other treatment methods. Results: Of 306 titles screened, 9 papers, including 487 patients were included in this review. Meta-analysis showed no significant differences between the intervention and control group on the pooled VISA-A scores (p=0.59, 95% CI-15.02, 26.51) or load-induced pain (p=0.51, 95% CI-3.15, 1.56) for Achilles tendinopathy and no significant differences between the pooled VISA-P scores for patellar tendinopathy (p=0.27, CI-7.86, 27.87). Conclusions: The meta-analysis did not demonstrate a statistically significant improvement in symptoms or load induced pain for ESWT compared to other treatments or control. Adequately powered, high quality studies with longer follow-ups are required