Efficacy of Extracorporeal Shock Wave Therapy in the Treatment of Achilles Tendinopathy: Clinical and Functional Outcomes

Yıl 2019, Cilt: 24 Sayı: 1, 22 - 25, 30.01.2019

Yalçın Turhan , Mehmet Arıcan , Zekeriya Okan Karaduman

https://doi.org/10.21673/anadoluklin.452068

Öz

Aim: Chronic Achilles tendinopathy (AT) is one of the most common tendon pathologies, and conservative treatment often fails to produce satisfactory results. This study aimed to investigate the efficacy of extracorporeal shock wave therapy (ESWT) in chronic and refractory AT.

Materials and Methods: A total of 195 patients who had undergone ESWT for AT refractory to standard conservative treatment were assessed retrospectively, and 64 patients (64 feet) who met our eligibility criteria were included. The patients underwent three sessions of ESWT, each with 2000 pulses at a dose of 0.06–0.12 mJ/mm2 (low-dose). Pain levels and clinical/functional scores were measured before the treatment (BT) and at the 3rd and 12th weeks of the last session, by using the Visual Analogue Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scoring system.

Results: Of the 64 patients included, 48 were female and 16 were male. The mean patient age was 47.9 years. There was improvement in pain, the mean VAS scores changing from 7.4 (5–10) BT to 4 (2–7) at week 3 (p<0.001) and 1.5 (0–6) at week 12 (p<0.001). The mean AOFAS scores were also improved, changing from 60 (48–75) BT to 74.8 (62–90) at week 3 (p<0.001) and 86.6 (62–100) at week 12 (p<0.001). There was no statistically significant difference between male and female patients with respect to the improvement recorded in the VAS scores (p=0.163).

Discussion and Conclusion: Low-dose ESWT can produce successful clinical results in the treatment of chronic AT refractory to standard conservative treatment.

Anahtar Kelimeler

Achilles tendon, Tendinopathy, ESWT, VAS, AOFAS

Aşil Tendinopatisinin Tedavisinde Ekstrakorporeal Şok Dalga Tedavisinin Etkililiği: Klinik ve Fonksiyonel Sonuçlar

Öz

Amaç: Kronik Aşil tendinopatisi (AT) en sık görülen tendon patolojilerindendir ve konservatif tedavi çoğunlukla tatmin edici sonuçlar vermez. Bu çalışmada ekstrakorporeal şok dalga tedavisinin (ESWT) kronik ve refrakter AT’deki etkililiğini araştırmak amaçlanmıştır.

Gereç ve Yöntemler: Standart konservatif tedaviye refrakter AT nedeniyle ESWT uygulanmış olan 195 hasta geriye dönük olarak incelendi ve uygunluk kriterlerimize uyan 64 hasta (64 ayak) çalışmaya dahil edildi. Hastalara, her seansta 0,06–0, 12 mJ/mm2 (düşük doz) dozunda 2000 atım olacak şekilde, 3 seans ESWT uygulandı. Ağrı düzeyleri ve klinik/fonksiyonel skorlar Görsel Analog Skalası (VAS) ve Amerikan Ortopedik Ayak ve Ayak Bileği Birliği (AOFAS) skorlama sistemi kullanılarak tedavi öncesinde (TÖ) ve son seansın 3. ve 12. haftasında ölçüldü.

Bulgular: Çalışmaya alınan 64 hastanın 48’i kadın, 16’sı erkekti ve ortalama hasta yaşı 47,9 yıl idi. Ağrıda iyileşme söz konusuydu; ortalama VAS skorlarının TÖ 7,4’ten (5–10) 3. haftada 4’e (2–7) (p<0,001) ve 12. haftada ise 1,5’e (0–6) (p<0,001) gerilediği gözlendi. Ortalama AOFAS skorları da TÖ 60’tan (48–75) 3. haftada 74,8’e (62–90) (p<0,001) ve 12. haftada ise 86,6’ya (62–100) (p<0,001) yükselmişti. Kadın ve erkek hastalar arasında VAS skorlarında kaydedilen iyileşme bakımından istatistiksel olarak anlamlı fark yoktu (p=0,163).

Tartışma ve Sonuç: Düşük doz ESWT, kronik ve standart konservatif tedaviye refrakter AT tedavisinde başarılı klinik sonuçlar sağlayabilir.

Anahtar Kelimeler

AOFAS, Aşil tendonu, ESWT, tendinopati, VAS

Kaynakça

• 1. Magnan B, Bondi M, Pierantoni S, Samaila E. The pathogenesis of Achillestendinopathy: a systematic review. Foot Ankle Surg. 2014;20(3): 154-9.
• 2. Arner O, Lindholm A, Orell SR. Histologic changes in subcutaneous rupture of the Achilles tendon. Acta Chir Scand. 1958;116(5-6): 484-90.
• 3. Jarvinen TA, Kannus P, Paavola M, Jarvinen TL, Jozsa L, Jarvinen M. Achilles tendon injuries. Curr Opin Rheumatol. 2001;13(2): 150-5.
• 4. Leach RE, James S, Wasilewski S. Achilles tendinitis. Am J Sports Med. 1981;9(2):93–8.
• 5. Maffulli N, Sharma P, Luscombe KL. Achilles tendinopathy: etiology and management. J R Soc Med. 2004;97(10): 472-6.
• 6. Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric load-ing plus shock-wave treatment for midportion Achilles tendinopathy:a randomized controlled trial. Am J Sports Med. 2009;37(3): 463-70.
• 7. Chung B, Wiley JP. Extracorporeal shockwave therapy: a review. Sports Med. 2002;32(13): 851-65.
• 8. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994; 15(7): 349-53.
• 9. Wilson M, Stacy J. Shock wave therapy for Achilles tendinopathy. Current reviews in musculoskeletal medicine. 2011;4(1): 6-10.
• 10. Van Dijk CN, van Sterkenberg MN, Wiegerinck JI, Karlsson J, Maffulli N. Terminology for Achilles tendon related disorders. Knee Surg Sports TraumatolArthrosc. 2011;19(5): 835-41.
• 11. Joseph MF, Lillie KR, Bergeron DJ, Cota KC, Yoon J, Kraemer WJ, Denegar CR. Achilles tendon biomechanics in response to acute intense exercise. J Strength Cond Res. 2014;28(5): 1181-6.
• 12. Alfredson H, Lorentzon R. Chronic Achilles tendino¬sis: recommendations for treatment and prevention. Sports Med. 2000;29(2): 135-46.
• 13. Den Hartog BD. Insertional Achilles tendino¬sis: pathogenesis and treatment. Foot Ankle Clin. 2009;14(4): 639-50.
• 14. Vulpiani MC, Guzzini M, Ferretti A. Operative treatment of chronic Achillestendinopathy. Int Orthop. 2003;27(5):307-10.
• 15. Paavola M, Kannus P, Orava S, Pasanen M, Jarvinen M. Surgical treatment forchronic Achilles tendinopathy: a prospective seven month follow up study. BrJ Sports Med. 2002;36(3): 178-82.
• 16. Furia JP. High-energy extracorporeal shock wave ther¬apy as a treatment for insertional Achilles tendinopa¬thy. Am J Sports Med. 2006;34(5): 733-40.
• 17. Lakshmanan P, O’Doherty DP. Chronic Achilles tendi¬nopathy: treatment with extracorporeal shock waves. Foot Ankle Surg. 2004;10(3): 125-30.
• 18. Mani-Babu S, Morrissey D, Waugh C, Screen H, Bar¬ton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic re¬view. Am J Sports Med. 2015;43(3): 752-61.
• 19. Al-Abbad H, Simon JV. The effectiveness of extra¬corporeal shock wave therapy on chronic achilles tendinopathy: a systematic review. Foot Ankle Int. 2013;34(1): 33-41.
• 20. Haake M, Deike B, Thon A, Schmitt J. Value of exact focusing of extracorporeal shock waves (ESWT) in therapy of tendonitis calcarea. A prospective randomized study. Biomed Tech. 2001;46(3): 69-74.
• 21. Ogden JA, Alvarez R, Levitt R, Cross GL, Marlow M. Shock wave therapy for chronic proximal plantar faciitis. Clin Orthop. 2001;387: 47-59.
• 22. Perlick L, Schiffmann R, Kraft CN, Wallny T, Diedrich O. Extracorporal shock wave treatment of the achilles tendonitis: Experimental and preliminary clinical results. Z Orthop Ihre Grenzgeb. 2002;140(3): 275-80.
• 23. Furia JP. Extracorporeal shockwave therapy in the treatment of chronic insertional Achilles tendinopathy. Orthopade. 2005;34(6): 571-8.
• 24. Speed CA. Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions. J Bone Joint Surg Br. 2004;86(2): 165-71.
• 25. Rompe JD, Kirkpatrick CJ, Küllmer K, Schwitalle M, Krischek O. Dose-related effects of shock waves on rabbit tendon Achillis: A sonographic and histological study. J Bone Joint Surg Br. 1998;80(3): 546-52.
• 26. Sobhani S, Dekker R, Postema K, Dijkstra PU. Epi¬demiology of ankle and foot overuse injuries in sports: a systematic review. Scand J Med Sci Sports. 2013;23(6): 669-86.