Introduction
Method
Search strategy
Inclusion and exclusion criteria
Study selection and data extraction
Quality assessment
Statistical analyses
Results
Literature search
No. | Study | Year | LOE | Study design | Country | No. of patients (tendons) | Activity level | Age (year) | Duration of symptoms (month) | Diagnosis |
---|---|---|---|---|---|---|---|---|---|---|
1 | Fahlström et al. | 2003 | 4 | Prospective | Sweden | 30 (31) | Recreational | 37.9 | 32 | CE, US, MRI, X-ray |
2 | Öhberg et al. | 2003 | 4 | Pilot study | Sweden | 11 (11) | Mixed | 44 | 29 | CE, US |
3 | Costantino et al. | 2005 | 3 | Retrospective | Italy | Group A 5 (5) | Professional | 32.7 | ≥ 2 | CE, US |
Group B 5 (5) | Professional | 32.7 | ≥ 2 | |||||||
Group C 5 (5) | Professional | 32.7 | ≥ 2 | |||||||
4 | Furia et al. | 2006 | 3 | Retrospective | USA | Group A 35 (35) | Mixed | 50 | 19.9 | CE, MRI, X-ray |
Group B 33 (33) | Mixed | 52.6 | 16.8 | |||||||
5 | Knobloch et al. | 2007 | 4 | Prospective | Germany | 10 (10) | Recreational | NR | ≥ 3 | CE, US |
6 | Rompe et al. | 2008 | 1 | RCT | Germany | 25 (30) | Mixed | 39.2 | 24.8 | CE, US, X-ray |
25 (31) | Mixed | 40.4 | 26.3 | |||||||
7 | Jonsson et al. | 2008 | 4 | Pilot study | Sweden | 27 (34) | Recreational | 53.4 | 26.5 | CE, US |
8 | Ryan et al. | 2010 | 4 | Case series | Canada | NR (22) | NR | NR | ≥ 6 | CE, US |
9 | Verrall et al. | 2011 | 4 | Retrospective | Australia | 14 (14) | Professional | NR | 4.5 | CE |
10 | Saxena et al. | 2011 | 2 | Prospective | USA | NR (19) | NR | 54.3 | NR | CE, MRI, X-ray |
11 | Notarnicola et al. | 2012 | 1 | RCT | Italy | Group A 32 (32) | NR | NR | 6 | CE, US, MRI, X-ray |
Group B 32 (32) | NR | NR | 6 | |||||||
12 | Notarnicola et al. | 2013 | 2 | RCT | Italy | Group A 30 (30) | NR | 57.5 | ≥ 6 | CE, US, MRI, X-ray |
Group B 30 (30) | NR | 59.5 | ≥ 6 | |||||||
13 | Kedia et al. | 2014 | 2 | RCT | USA | Group A 16 (19) | Mixed | 51.7 | 18.5 | CE |
Group B 20 (20) | Mixed | 55.3 | 18.3 | |||||||
14 | McCormack et al. | 2016 | 2 | RCT | USA | Group A 6 (6) | NR | 53.3 | 21.9 | CE |
Group B 6 (6) | NR | 53.9 | 20.8 | |||||||
15 | Taylor et al. | 2016 | 4 | Prospective | UK | 12 (12) | NR | 54 | 42 | CE, US |
16 | Pavone et al. | 2016 | 4 | Case series | Italy | 40 (40) | NR | 41 | ≥ 3 | CE, X-ray |
17 | Wu et al. | 2016 | 3 | Retrospective | China | Group A 37 (37) | NR | 37.6 | ≥ 6 | CE, X-ray |
Group B 30 (30) | NR | 35.8 | ≥ 6 | |||||||
18 | Erroi et al. | 2017 | 3 | Retrospective | Italy | Group A 24 (24) | Mixed | 53.2 | 13.7 | CE, US |
Group B 21 (21) | Mixed | 47.7 | 14.3 | |||||||
19 | Maffulli et al. | 2018 | 4 | Case series | UK | 80 (80) | NR | 53.4 | NR | CE |
20 | Wheeler et al. | 2019 | 4 | Case series | UK | 30 (30) | NR | 55.4 | 21 | CE |
21 | Mansur et al. | 2019 | 3 | Prospective | Brazil | 19 (19) | NR | 51 | NR | CE, US, X-ray |
22 | Pinitkwamdee et al. | 2020 | 1 | RCT | Thailand | Group A 16 (22) | Mixed | 61.4 | 7.5 | CE,X-ray |
Group B 15 (16) | Mixed | 56.5 | 12 | |||||||
23 | Zhang et al. | 2020 | 3 | Retrospective | China | Group A 16 (16) | Sports-active | 31 | ≥ 3 | CE, US, MRI |
Group B 17 (17) | Nonsports-active | 37 | ≥ 3 |
Population characteristics
Quality assessment
Studies | Study design | MINORS |
---|---|---|
Fahlström et al. 2003 [6] | Non-comparative | 12 |
Öhberg et al. 2003 [11] | Non-comparative | 11 |
Costantino et al. 2005 [12] | Comparative | 18 |
Furia et al. 2006 [13] | Comparative | 20 |
Knobloch et al. 2007 [14] | Non-comparative | 12 |
Jonsson et al. 2008 [16] | Non-comparative | 12 |
Ryan et al. 2010 [17] | Non-comparative | 12 |
Verrall et al. 2011 [18] | Non-comparative | 10 |
Saxena et al. 2011 [19] | Non-comparative | 12 |
Taylor et al. 2016 [24] | Non-comparative | 10 |
Pavone et al. 2016 [25] | Non-comparative | 12 |
Wu et al. 2016 [26] | Comparative | 22 |
Erroi et al. 2017 [27] | Comparative | 18 |
Maffulli et al. 2018 [28] | Non-comparative | 12 |
Wheeler et al. 2019 [29] | Non-comparative | 12 |
Mansur et al. 2019 [30] | Non-comparative | 12 |
Zhang et al. 2020 [32] | Comparative | 15 |
Studies | Random sequence generation (selection bias) | Allocation concealment (selection bias) | Blinding of participants (performance bias) | Blinding of outcome assessment (detection bias) | Incomplete outcome (attrition bias) | Selective reporting (reporting bias) | Other bias |
---|---|---|---|---|---|---|---|
Rompe et al. 2008 [15] | Low | Low | Unclear | Low | Low | Unclear | High |
Notarnicola et al. 2012 [20] | Low | Unclear | Low | Low | Low | Unclear | High |
Notarnicola et al. 2013 | Unclear | Unclear | Low | Unclear | Low | Unclear | Unclear |
Kedia et al. 2014 [22] | Low | Low | Unclear | Low | Low | Unclear | High |
McCormack et al. 2016 [23] | Low | Low | Unclear | Unclear | Low | Unclear | Unclear |
Pinitkwamdee et al. 2020 [31] | Low | Low | Low | Low | Low | Unclear | High |
Eccentric training
Study | Year | Intervention | LOE | Previous treatment | Follow-up (month) | Evaluation and outcome | Significance | Overall |
---|---|---|---|---|---|---|---|---|
Fahlström | 2003 | ECC training (full range): 12 weeks | 4 | Failed | 3 | VAS: 7.6 to 5.5 | n.s. | VAS: − 2.83 VISA-A: 50.6 to 64 Satisfaction: 45.6% (47/103) |
Satisfaction: 32.2% | ||||||||
Knobloch | 2007 | ECC training (full range): 12 weeks | 4 | None | 3 | VAS: 6 to 3.2 | * | |
Rompe | 2008 | ECC training (full range): 12 weeks | 1 | Failed | 4 | VAS: 6.8 to 5.0 | * | |
VISA-A: 52.7 to 63.4 | * | |||||||
Satisfaction: 28% | ||||||||
Jonsson | 2008 | ECC training (floor level): 12 weeks | 4 | NR | 4 | VAS: 7.2 to 3.3 | * | |
Satisfaction: 66.7% | ||||||||
Verrall | 2011 | ECC training (full range): 6 weeks | 4 | NR | 3 | VAS: 7.3 to 3.0 | * | |
Satisfaction: 50% | ||||||||
Kedia | 2014 | ECC (full range)+strengthening training: 12 weeks | 2 | NR | 3 | VAS: − 2.19 | * | |
SF-36 (bodily pain): 16.22 | * | |||||||
SF-36: 9.78 | n.s. | |||||||
FAOQ: − 0.73 | * | |||||||
McCormack | 2016 | ECC training (floor level): 12 weeks | 2 | None | 13 | VAS: 5.4 to 1 | * | |
VISA-A: 40.2 to 67 | * | |||||||
Satisfaction: 83.3% |
Extracorporeal shockwave therapy
Study | Year | Intervention | LOE | Previous treatment | Follow-up (month) | Evaluation and outcome | Significance | Overall |
---|---|---|---|---|---|---|---|---|
Furia | 2006 | ESWT (high energy) | 3 | Failed | 12 | VAS: 7.9 to 2.8 | * | VAS: − 4.49 VISA-A: 47.5 to 76.2 Satisfaction: 73.7% (101/137) AOFAS: 68.2 to 84.5 |
Satisfaction: 82.9% | ||||||||
Rompe | 2008 | ESWT (low energy) | 1 | Failed | 12 | VAS: 7.0 to 3.0 | * | |
VISA-A: 53.2 to 79.4 | * | |||||||
Satisfaction: 64% | ||||||||
Saxena | 2011 | ESWT (low energy) | 2 | None | 12-24 | Satisfaction: 82.4% | ||
Notarnicola | 2012 | ESWT (low energy)+dietary | 1 | None | 6 | VAS: 7.1 to 2.0 | * | |
AOFAS: 70.6 to 92.4 | * | |||||||
Oximetry: 75.4% to 60.2% | * | |||||||
Satisfaction: 93.8% | ||||||||
Notarnicola | 2012 | ESWT (low energy)+placebo | 1 | None | 6 | VAS: 7.1 to 2.9 | * | |
AOFAS: 65.8 to 76.5 | * | |||||||
Oximetry: 73.0% to 66.0% | * | |||||||
Satisfaction: 38.5% | ||||||||
Taylor | 2016 | ESWT (low energy) | 4 | Failed | 24 | VAS: 6.7 to 2.8 | * | |
VISA-A: 43 to 70 | * | |||||||
Wu | 2016 | ESWT (low energy) | 3 | Failed | 14.5 | VISA-A: 49.6 to 83.9 | * | |
Likert: 3.92 to 1.57 | * | |||||||
Wu | 2016 | ESWT (low energy) (with Haglund’s deformity) | 3 | Failed | 15.3 | VISA-A: 48.7 to 67.8 | * | |
Likert: 4.0 to 2.37 | * | |||||||
Maffulli | 2018 | ESWT (low energy) | 4 | Failed | 24 | VAS: 5.9 to 1.8 | * | |
VISA-A: 42.0 to 72.3 | * | |||||||
EQ-5D (anxiety): 1.36 to 1.1 | n.s. | |||||||
EQ-5D (mobility): 1.71 to 1.35 | * | |||||||
EQ-5D (pain): 2.0 to 1.52 | * | |||||||
EQ-5D (usual activity): 1.8 to 1.35 | * | |||||||
EQ-5D (self-care): 1.11 to 1.0 | n.s. | |||||||
EQ-5D (thermometer): 65.3 to 77.3 | n.s. | |||||||
Pinitkwamdee | 2020 | ESWT (low energy)+conservative (without ECC) | 1 | Failed | 6 | VAS: 6.0 to 2.8 | * | |
VAS-FA: 64.8 to 77.2 | n.s. | |||||||
Pain: 54.4 to 70.1 | n.s. | |||||||
Function: 60.1 to 76.0 | n.s. | |||||||
Other complaints: 80.0 to 85.8 | n.s. | |||||||
Zhang | 2020 | ESWT (low energy) | 3 | None | 60 | VAS: 7.0 to 0.3 | * | |
VISA-A: 56 to 90 | * | |||||||
Zhang | 2020 | ESWT (low energy) | 3 | None | 60 | VAS:7.0 to 1.6 | * | |
VISA-A: 51 to 78 | * |
ESWT combined with eccentric training
Study | Year | Intervention | LOE | Previous treatment | Follow-up (month) | Evaluation and outcome | Significance | Overall |
---|---|---|---|---|---|---|---|---|
Notarnicola | 2013 | ESWT (low energy)+ECC | 2 | None | 6 | VAS: 7.0 to 3.3 | * | VAS: − 4.42VISA-A: 47.9 to 69.4 Satisfaction: 74.3%(84/113) AOFAS: 68.3 to 93.4 |
AOFAS: 67.0 to 76.9 | * | |||||||
Pavone | 2016 | ESWT (low energy)+ECC | 4 | Failed | 12 | VAS: 7.6 to 1.9 | * | |
AOFAS: 71.4 to 91.3 | * | |||||||
Satisfaction: 65% | ||||||||
Erroi | 2017 | ESWT (low energy)+exercise (include ECC) | 3 | Failed | 6 | VAS: 6.4 to 1.5 | * | |
VISA-A: 50.6 to 86.5 | * | |||||||
Satisfaction: 87.5% | ||||||||
Wheeler | 2019 | ESWT (high energy)+exercise (include ECC) | 4 | NR | 6 | VAS: 6.5 to 2.0 | * | |
VISA-A: 28 to 60 | * | |||||||
Satisfaction: 80% | ||||||||
Self-reported worst pain: 8.0 to 5.0 | * | |||||||
Self-reported stiffness: 6.0 to 3.0 | * | |||||||
FAAM-ADL: 57% to 85% | * | |||||||
pD: 15 to 9.5 | * | |||||||
EQ-5D(health): 70% to 85% | n.s. | |||||||
HADS (anxiety): 5.0 to 3.0 | n.s. | |||||||
HADS (depression): 3.0 to 2.0 | n.s. | |||||||
Mansur | 2019 | ESWT (high energy)+ECC | 3 | NR | 6 | VAS: 5.3 to 3.2 | * | |
VISA-A: 49.1 to 62.6 | * | |||||||
AOFAS: 63.6 to 77.2 | * | |||||||
Satisfaction: 68.4% |
Other nonoperative treatments
Study | Year | Intervention | LOE | Previous treatment | Follow-up (month) | Evaluation and outcome | Significance |
---|---|---|---|---|---|---|---|
Öhberg | 2003 | Sclerosing therapy | 4 | Failed | 8 | VAS: 8.3 to 2.8 | * |
Satisfaction: 72.7% | |||||||
Costantino | 2005 | Cryoultrasound therapy | 3 | NR | 8 | VAS: 9 to 1.8 | * |
Costantino | 2005 | Laser CO2 | 3 | NR | 8 | VAS: 9 to 2.8 | * |
Costantino | 2005 | t.e.ca.r. therapy | 3 | NR | 8 | VAS: 9 to 2.0 | * |
Furia | 2006 | Conservative (without ECC) | 3 | Failed | 12 | VAS: 8.6 to 7.0 | n.s. |
Satisfaction: 39.4% | |||||||
Ryan | 2010 | Dextrose injections | 4 | Failed | 28.6 | VAS at rest: 3.3 to 0.3 | * |
VAS with activity: 5.1 to 1.0 | * | ||||||
VAS during sports: 7.0 to 1.8 | * | ||||||
Notarnicola | 2013 | CHELT+ECC | 2 | None | 6 | VAS: 7.0 to 1.7 | * |
AOFAS: 62.5 to 83.0 | * | ||||||
Kedia | 2014 | Strengthening training: 12 weeks | 2 | NR | 3 | VAS: -2.08 | * |
SF-36(bodily pain): 16.4 | * | ||||||
SF-36: 10.27 | * | ||||||
FAOQ: -0.758 | * | ||||||
McCormack | 2016 | ECC training+Astym: 12 weeks | 2 | None | 13 | VISA-A: 36.6 to 90.7 | * |
NPRS: 4.6 to 0.67 | * | ||||||
Satisfaction: 100% | |||||||
Erroi | 2017 | PRP+exercise (include ECC) | 3 | Failed | 6 | VAS: 5.9 to 2.6 | * |
VISA-A: 52.8 to 82.0 | * | ||||||
Satisfaction: 71.4% | |||||||
Pinitkwamdee | 2020 | Conservative (without ECC) | 1 | Failed | 6 | VAS: 5.2 to 2.0 | * |
VAS-FA: 65.3 to 82.7 | n.s. | ||||||
Pain: 47.3 to 77.8 | * | ||||||
Function: 66.6 to 82.5 | n.s. | ||||||
Other complaints: 83.9 to 87.9 | n.s. |
Comparative studies
Study | Year | Intervention | LOE | Previous treatment | Follow-up (month) | Evaluation and outcome | Significance |
---|---|---|---|---|---|---|---|
Costantino | 2005 | Cryoultrasound therapy vs. laser CO2 vs. t.e.ca.r. therapy | 3 | NR | 8 | VAS: 1.8 vs. 2.8 vs. 2.0 | n.s. |
Furia | 2006 | ESWT (high energy) vs. conservative (without ECC) | 3 | Failed | 12 | VAS: 2.8 vs. 7.0 | * |
Satisfaction: 82.9% vs. 39.4% | * | ||||||
Rompe | 2008 | ESWT (low energy) vs. ECC training (full range) | 1 | Failed | 12 | VAS: 3.0 vs. 5.0 | * |
VISA-A: 79.4 vs. 63.4 | * | ||||||
Satisfaction: 64% vs. 28% | * | ||||||
Notarnicola | 2012 | ESWT (low energy)+dietary vs. ESWT (low energy)+placebo | 1 | NR | 6 | VAS: 2.0 vs. 2.9 | n.s. |
AOFAS: 92.4 vs. 76.5 | * | ||||||
Oximetry: 60.2% vs. 66.0% | * | ||||||
Satisfaction: 93.8% vs.38.5% | * | ||||||
Notarnicola | 2013 | CHELT+ECC vs. ESWT (low energy)+ECC | 2 | None | 6 | VAS: 1.7 vs. 3.3 | * |
AOFAS: 83.0 vs. 76.9 | n.s. | ||||||
Kedia | 2014 | ECC (full range)+strengthening training vs. strengthening training | 2 | NR | 3 | VAS: − 2.19 vs. − 2.08 | n.s. |
SF-36 (bodily pain): 16.22 vs. 16.4 | n.s. | ||||||
SF-36: 9.78 vs. 10.27 | n.s. | ||||||
FAOQ: − 0.73 vs. − 0.758 | n.s. | ||||||
McCormack | 2016 | ECC training+Astym vs. ECC training | 2 | None | 3 | VISA-A: 67.0 vs. 90.7 | * |
NPRS: 1.0 vs. 0.67 | n.s. | ||||||
Satisfaction: 83.3% vs. 100% | n.s. | ||||||
Wu | 2016 | ESWT (low energy) vs. ESWT (low energy) (with Haglund’s deformity) | 3 | Failed | 14.5 | VISA-A: 83.9 vs. 67.8 | * |
Likert: 1.57 vs. 2.37 | n.s. | ||||||
Erroi | 2017 | ESWT (low energy)+exercise (include ECC) vs. PRP+exercise (include ECC) | 3 | Failed | 6 | VAS: 1.5 vs. 2.6 | n.s. |
VISA-A: 86.5 vs. 82.0 | n.s. | ||||||
Satisfaction: 87.5% vs. 71.4% | n.s. | ||||||
Pinitkwamdee | 2020 | ESWT (low energy)+conservative (without ECC) vs. conservative (without ECC) | 1 | Failed | 6 | VAS: 2.8 vs. 2.0 | n.s. |
VAS-FA: 77.2 vs. 82.7 | n.s. | ||||||
Pain: 70.1 vs. 77.8 | n.s. | ||||||
Function: 76.0 vs. 82.5 | n.s. | ||||||
Other complaints: 85.8 vs. 87.9 | n.s. | ||||||
Zhang | 2020 | ESWT (low energy) (sports-active) vs. ESWT (low energy) (nonsports-active) | 3 | None | 60 | VAS: 0.3 to 1.6 | * |
VISA-A: 90 to 78 | * |