High-energy extracorporeal shock wave therapy as a treatment for chronic noninsertional Achilles tendinopathy.
BACKGROUND
High-energy extracorporeal shock wave therapy has been shown to be an effective treatment for chronic insertional Achilles tendinopathy. The results of high-energy shock wave therapy for chronic noninsertional Achilles tendinopathy have not been determined.


OBJECTIVE
Shock wave therapy is an effective treatment for noninsertional Achilles tendinopathy.


METHODS
Case control study; Level of evidence, 3.


METHODS
Thirty-four patients with chronic noninsertional Achilles tendinopathy were treated with a single dose of high-energy shock wave therapy (shock wave therapy group; 3000 shocks; 0.21 mJ/mm(2); total energy flux density, 604 mJ/mm(2)). Thirty-four patients with chronic noninsertional Achilles tendinopathy were treated not with shock wave therapy but with additional forms of nonoperative therapy (control group). All shock wave therapy procedures were performed using regional anesthesia. Evaluation was by change in visual analog score and by Roles and Maudsley score.


RESULTS
One month, 3 months, and 12 months after treatment, the mean visual analog scores for the control and shock wave therapy groups were 8.4 and 4.4 (P < .001), 6.5 and 2.9 (P < .001), and 5.6 and 2.2 (P < .001), respectively. At final follow-up, the number of excellent, good, fair, and poor results for the shock wave therapy and control groups were 12 and 0 (P < .001), 17 and 9 (P < .001), 5 and 17 (P < .001), and 0 and 8 (P < .001), respectively. A chi(2) analysis revealed that the percentage of patients with excellent ("1") or good ("2") Roles and Maudsley scores, that is, successful results, 12 months after treatment was statistically greater in the shock wave therapy group than in the control group (P < .001).


CONCLUSIONS
Shock wave therapy is an effective treatment for chronic noninsertional Achilles tendinopathy.
Furia
John P
JP
SUN Orthopedics and Sports Medicine, 900 Buffalo Road, Lewisburg, PA 17837, USA. jfuria@ptd.net
D000125:Achilles Tendon / Q000528:radiation effects*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D019220:High-Energy Shock Waves / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000528:radiation effects*; D052256:Tendinopathy / Q000628:therapy*