Outcomes following extracorporeal shockwave therapy for the treatment of insertional and non-insertional Achilles tendinopathy at 2 year follow-up: a retrospective review
J. Butler, D. Zheng, B. DeClouette, C. Walls, G. Jejelava, M. Azam, J. Kennedy
1NYU Langone Health, Orthopaedics, New York, United States
2John Peter Smith, Fort Worth, United States
Introduction: The purpose of this retrospective clinical study was to evaluate outcomes following extracorporeal shockwave therapy (ESWT) for the treatment of Achilles tendinopathy.
Methods: This retrospective cohort study included clinical data from 95 patients who underwent ESWT for insertional (IAT) or non-insertional (NAT) Achilles tendinopathy between 3/3/2017 to 2/8/2022 with a minimum of 1 year follow-up. Data regarding patient demographics, subjective clinical outcomes, radiographic outcomes, treatment characteristics, complications and failures were recorded. Failure was defined as no improvement in VISA-A nor VAS scores and/ or surgical intervention. Subgroup analysis was conducted to identify predictors of poor outcomes. Paired student’s t-tests and Welch’s t-tests were calculated. Regression analysis was carried out to identify predictors of poor outcomes.
Results: In total, 95 patients (109 ankles) with a mean age of 54.1 ± 14.0 years underwent ESWT for Achilles tendinopathy at a mean follow-up of 25.7 ± 15.0 months. Thirty-nine patients were in the NAT cohort and 56 patients were in the IAT cohort. Both NAT and IAT cohorts had a similar improvement in VISA-A score (p=0.365), VAS scores (p=0.65) and demonstrated a similar return to play time (p=0.34). There was a higher failure rate in the IAT cohort (51.8%) than the NAT cohort (23.1%). Patients who received platelet-rich plasma (PRP) had a higher failure rate (71.4%) than those who did not receive PRP (19.6%). Regression models found that treatment with PRP, MRI severity and female sex were associated with worse outcomes.
Conclusion: This retrospective study demonstrated a high failure rate at short-term follow-up in patients who underwent ESWT for insertional Achilles tendinopathy. Predictors of poor outcomes included treatment with PRP, MRI severity and female sex. Further studies with larger patient cohorts and longer follow-up are necessary to determine the role of ESWT in the treatment of Achilles tendinopathy.
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