Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

Abstract

Background Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. Results Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness. Conclusion ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review

“…In an RCT of athletes with high risk of bias comparing ESWT with mesotherapy in Achilles tendinopathy (insertional and non-insertional), both four sessions of ESWT and mesotherapy (microinjections with a mixture composed of betamethasone, normal saline and lidocaine along the tendon) improved VAS and AOFAS hindfoot scores at 4 and 12 weeks without between-group difference. ESWT group showed further improvement in tendon thickness, heterogeneity and calcifications at 12 weeks while mesotherapy reporting improvement limited to tendon thickness 68. In another RCT with high risk of bias including recreationally active individuals with non-insertional Achilles tendinopathy, three sessions of R-SWT resulted in greater reduction in activity-related pain compared with ultrasound therapy or placebo ultrasound (VAS mean and SD 1.42±1.32, 2.85±2.03 and 4.23±1.5, respectively) 69…”

“…In plantar fasciitis, a prospective study found that surgery resulted in better VAS and Roles and Maudsley scores although return to activities tended to be faster with ESWT 55. ESWT appeared to have similar efficacy with mesotherapy when added with exercise programme in Achilles tendinopathy68 but allowed better activity-related pain relief than ultrasound therapy in non-insertional Achilles tendinopathy based on the RCTs 69. In IT band syndrome, ESWT and manual therapy seemed to have comparable outcomes in terms of pain relief and return to activity level when added with an exercise programme 76.…”

Staying in the Game: Interventions for Managing Achilles Tendinopathy in the In-Season Athlete

“…In an RCT that included both midportion and insertional AT, El-Mallah et al found similar improvements in mean Visual Analog Scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores at 4- and 12-wk follow-up between athletes receiving four weekly sessions of combined focused and radial high-energy ESWT ( n = 20) and those receiving weekly mesotherapy injections ( n = 20) (17). In this study, mesotherapy injections were described as 10 to 15 intradermal microinjections of 2 mL of 5-mg betamethasone diproprionate and 2-mg betamethasone sodium phosphate, 2 mL of 0.9% normal saline, and 1 mL of 2% lidocaine.…”

“…Compared to mesotherapy, ESWT significantly decreased tendon thickness and improved heterogenicity, Doppler activity, and calcifications at 12-wk (17). Another RCT found no significant difference between sham ( n = 27) and ESWT ( n = 22) for treatment of insertional or midportion AT (18).…”

ICON 2020—International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy

“…Structure was reported in 19% (58/307) of the studies, with neovascularization being the most frequently reported measurement instrument (20 studies) (Table 2; Fig. 2) [20,24,78,82,87,99,135,147,148,170,184,185,191,192,207,287,308,312]. Structure was reported using 21 various outcome measures of tendon morphological, vascular and mechanical properties using diagnostic ultrasound, MRI and other imaging technologies.…”