Ann Rehabil Med.  2017 Feb;41(1):42-50. 10.5535/arm.2017.41.1.42.

Long-Term Outcome and Factors Affecting Prognosis of Extracorporeal Shockwave Therapy for Chronic Refractory Achilles Tendinopathy

• Lee JY
• Yoon K
• Yi Y
• Park CH
• Lee JS
• Seo KH
• Park YS
• Lee YT

• KMID: 2383676
• DOI: http://doi.org/10.5535/arm.2017.41.1.42

Abstract

OBJECTIVE
To investigate the factors affecting prognosis of extracorporeal shockwave therapy (ESWT) for chronic refractory Achilles tendinopathy (AT).
METHODS
Thirty-six patients (48 consecutive feet) with chronic AT (>6 months) and who underwent ESWT for "˜poor' or "˜fair' grade in Roles-Maudsley Score (RMS) after unsuccessful conservative treatment were included in the present study. A maximum of 12 sessions of ESWT were conducted until treatment success: RMS reached "˜good' or "˜excellent'. Termination of ESWT for no response, or "˜poor' or "˜fair' grade was regarded as treatment failure. Immediate outcome, long-term outcome (telephone interview after mean 26 months), and factors affecting treatment success were analyzed.
RESULTS
Numeric Rating Scale was significantly decreased at immediate and long-term follow-up. Success rate was 71.1% and 90.3%, respectively. Univariate logistic regression identified that immediate treatment success was associated with retrocalcaneal enthesophyte on X-ray (odds ratio [OR], 0.06; 95% confidence interval [CI], 0.01-0.28), pretreatment abnormal ultrasonography echogenicity within Achilles tendon (OR, 18.89; 95% CI, 2.08-171.96), mean duration of "˜post-treatment soreness' (OR, 0.55; 95% CI, 0.33-0.94), and duration of "˜post-treatment soreness after first ESWT' (OR, 0.06; 95% CI, 0.01-0.34). The duration of "˜post-treatment soreness after first ESWT' was found to be the only factor associated with long-term success (OR, 0.32; 95% CI, 0.10-0.99).
CONCLUSION
ESWT appears to be effective in achieving long-term success in chronic refractory AT. Immediate success was associated with absence of retrocalcaneal enthesophyte on X-ray, presence of pretreatment abnormal ultrasonography echogenicity, shorter mean duration of "˜post-treatment soreness', and shorter duration of "˜post-treatment soreness after first ESWT'. The shorter duration of "˜post-treatment soreness after first ESWT' was identified as the only positive prognostic parameter in achieving long-term success.

Keyword

Tendinopathy; Ultrasonic shockwave; Treatment outcome; Prognosis

MeSH Terms

Achilles Tendon
Follow-Up Studies
High-Energy Shock Waves
Humans
Logistic Models
Prognosis*
Tendinopathy*
Treatment Failure
Treatment Outcome
Ultrasonography

Figure

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  Fig. 1 Ultrasonography abnormality was defined as (A) maximum anteroposterior thickness of tendon >6 mm, (B) hypoechoic area or heterogeneous appearance of fibrillar pattern, or (C) hypervascularity.

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  Fig. 2 In 31 patients (43 feet) who were available for long-term follow-up telephone interview, subjective pain was significantly decreased at immediate and long-term follow-up, respectively (*p<0.05). ESWT, extracorporeal shockwave therapy.

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