HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Sign In to gain access to subscriptions and/or personal tools.

This Article Full Text Full Text (PDF) An erratum has been published All Versions of this Article: 35/3/374    most recent 0363546506295940v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Rompe, J. D. Articles by Maffulli, N. Search for Related Content PubMed PubMed Citation Articles by Rompe, J. D. Articles by Maffulli, N. Related Collections Achilles tendon Nonoperative

Eccentric Loading, Shock-Wave Treatment, or a Wait-and-See Policy for Tendinopathy of the Main Body of Tendo Achillis

A Randomized Controlled Trial

Jan D. Rompe, MD^,*, Bernhard Nafe, MD, John P. Furia, MD, PhD and Nicola Maffulli, MD, PhD, FRCS(Orth)^||

From the OrthoTrauma Clinic, Gruenstadt, Germany, Rüsselsheim-Bauschheim, Germany, the SUN Orthopaedic Group, Lewisburg, Pennsylvania, and the ^|| Department of Trauma and Orthopaedic Surgery, Keele, University School of Medicine, Staffordshire, England

^* Address correspondence to Jan D. Rompe, MD, Professor, Orthopaedic Surgery, OrthoTrauma Clinic, Kirchheimer Str. 60, 67269 Gruenstadt, Germany (e-mail: profrompe{at}web.de).

Background: Few randomized controlled trials compare different methods of management in chronic tendinopathy of the main body of tendo Achillis.

Purpose: To compare the effectiveness of 3 management strategies—group 1, eccentric loading; group 2, repetitive low-energy shock-wave therapy (SWT); and group 3, wait and see—in patients with chronic tendinopathy of the main body of tendo Achillis.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: Seventy-five patients with a chronic recalcitrant (>6 months) noninsertional Achilles tendinopathy were enrolled in a randomized controlled study. All patients had received unsuccessful management for >3 months, including at least (1) peritendinous local injections, (2) nonsteroidal anti-inflammatory drugs, and (3) physiotherapy. A computerized random-number generator was used to draw up an allocation schedule. Analysis was on intention-to-treat basis.

Results: At 4 months from baseline, the Victorian Institute of Sport Assessment (VISA)-A score increased in all groups, from 51 to 76 points in group 1 (eccentric loading), from 50 to 70 points in group 2 (repetitive low-energy SWT), and from 48 to 55 points in group 3 (wait and see). Pain rating decreased in all groups, from 7 to 4 points in group 1, from 7 to 4 points in group 2, and from 8 to 6 points in group 3. Fifteen of 25 patients in group 1 (60%), 13 of 25 patients in group 2 (52%), and 6 of 25 patients in Group 3 (24%) reported a Likert scale of 1 or 2 points ("completely recovered" or "much improved"). For all outcome measures, groups 1 and 2 did not differ significantly. For all outcome measures, groups 1 and 2 showed significantly better results than group 3.

Conclusion: At 4-month follow-up, eccentric loading and low-energy SWT showed comparable results. The wait-and-see strategy was ineffective for the management of chronic recalcitrant tendinopathy of the main body of the Achilles tendon.

Key Words: Achilles pain • tendinopathy • eccentric loading • shock wave therapy

This article has been cited by other articles:

				N. Maffulli and U. G. Longo Conservative management for tendinopathy: is there enough scientific evidence? Rheumatology, April 1, 2008; 47(4): 390 - 391. [Full Text] [PDF]

				J. P. Furia High-Energy Extracorporeal Shock Wave Therapy as a Treatment for Chronic Noninsertional Achilles Tendinopathy Am. J. Sports Med., March 1, 2008; 36(3): 502 - 508. [Abstract] [Full Text] [PDF]

				J. D. Rompe, J. Furia, and N. Maffulli Eccentric Loading Compared with Shock Wave Treatment for Chronic Insertional Achilles Tendinopathy. A Randomized, Controlled Trial J. Bone Joint Surg. Am., January 1, 2008; 90(1): 52 - 61. [Abstract] [Full Text] [PDF]