title: No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season: a randomized clinical trial.
abstract: BACKGROUND
  Patellar tendinopathy is a common overuse injury among jumping athletes. No evidence-based treatment guidelines exist. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment but its effectiveness has not been studied in athletes with patellar tendinopathy who have symptoms for 3 to 12 months and are still playing.
  
  
  OBJECTIVE
  The TOPGAME study was created to determine the effectiveness of ESWT on pain, symptoms, and function in athletes with early symptomatic patellar tendinopathy who are still in training and competition.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 1.
  
  
  METHODS
  Athletes playing volleyball, basketball, or handball with patellar tendinopathy for 3 to 12 months were randomized into the ESWT or placebo group during the first half of the season. The ESWT group received 3 ESWT treatments while the placebo group received sham ESWT. In-season follow-up measurements were 1, 12, and 22 weeks after treatment. The primary outcome was severity of patellar tendinopathy determined with the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire. Secondary outcome measures were pain during activities of daily living and sports and after functional knee-loading tests rated on a visual analog scale and subjective improvement. Multilevel analyses were performed to determine differences between groups over time.
  
  
  RESULTS
  Of the 127 symptomatic athletes invited to participate, 62 were eligible, gave consent, and were randomized into the ESWT (n = 31) or placebo group (n = 31). Mean VISA-P scores before and 1, 12, and 22 weeks after treatment were 59.4 (±11.7), 66.8 (±16.2), 66.7 (±17.5), and 70.5 (±18.9) for the ESWT group and 62.4 (±13.4), 66.3 (±19.0), 68.9 (±20.3), and 72.7 (±18.0) for the placebo group. For the VISA-P, there was a significant effect for time (P < .01) but no treatment × time interaction effect (P = .82). The same pattern was seen in visual analog scale pain scores. One week after final treatment, significantly more athletes in the ESWT group reported subjective improvement (65% vs 32%; χ(2) = 6.46, P = .01). This was the only difference noted between the 2 groups.
  
  
  CONCLUSIONS
  Extracorporeal shockwave therapy as a solitary treatment during the competitive season has no benefit over placebo treatment in the management of actively competing jumping athletes with patellar tendinopathy who have symptoms for less than 12 months.
authors.affiliation: University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands. j.zwerver@sport.umcg.nl
authors.forename: Johannes
authors.initials: J
authors.lastname: Zwerver
authors.forename: Fred
authors.initials: F
authors.lastname: Hartgens
authors.forename: Evert
authors.initials: E
authors.lastname: Verhagen
authors.forename: Henk
authors.initials: H
authors.lastname: van der Worp
authors.forename: Inge
authors.initials: I
authors.lastname: van den Akker-Scheek
authors.forename: Ron L
authors.initials: RL
authors.lastname: Diercks
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000628:therapy*; D001490:Basketball / Q000293:injuries; D012090:Cumulative Trauma Disorders / Q000628:therapy*; D005260:Female; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D007718:Knee Injuries / Q000628:therapy*; D008297:Male; D052256:Tendinopathy / Q000628:therapy*; D016896:Treatment Outcome; D054798:Volleyball / Q000293:injuries; D055815:Young Adult