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Background: Extracorporeal shockwave therapy (ESWT) is a noninvasive treatment modality that is used in the treatment of chronic Achilles tendinopathy (AT). Purposes: To (1) retrospectively assess outcomes after ESWT for both noninsertional AT (NAT) and insertional AT (IAT) at >1-year follow-up and (2) identify potential predictors of outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Chart review was conducted to identify patients who underwent ESWT for AT with a minimum of 1-year follow-up. Data collected and assessed included patient demographic characteristics, pathological characteristics including the location of AT (NAT or IAT), presence of a Haglund deformity, and severity of tendon degeneration on magnetic resonance imaging (MRI), in addition to treatment characteristics including number of sessions and intensity of ESWT. The Victorian Institute of Sports Assessment–Achilles (VISA-A) and visual analog scale (VAS) pain scores were obtained before ESWT, 6 months after ESWT, and at final follow-up. Failures were also recorded, which were defined as no improvement in VISA-A or VAS scores or need for surgical intervention. Linear regression was performed to identify potential predictors of inferior subjective clinical outcomes and failures. Survival analysis was conducted using Kaplan-Meier curves. Results: The study included 52 patients with IAT and 34 patients with NAT. The mean follow-up in the NAT cohort was 22.3 ± 10.2 months and the mean follow-up in the IAT cohort was 26.8 ± 15.8 months. Improvements in VISA-A and VAS scores were observed in the NAT cohort at 6-month follow-up and at final follow-up (P <.05). Improvements in VISA-A and VAS scores were recorded in the IAT cohort at 6-month follow-up, which subsequently deteriorated at final follow-up. In the NAT cohort, the failure rate at 6-month follow-up was 11.8%, which increased to 29.4% at final follow-up. In the IAT cohort, the failure rate at 6-month follow-up was 32.7%, which increased to 59.6% at final follow-up. Predictors of inferior subjective clinical outcomes and failures in the NAT cohort included pre-ESWT subjective clinical score, male sex, presence of a cardiovascular risk factor, and more severe MRI grading of tendinopathy. Predictors of inferior subjective clinical outcomes and failures in the IAT cohort included pre-ESWT subjective clinical score and more severe MRI grading of tendinopathy. Conclusion: Superior subjective clinical outcomes together with a lower failure rate were maintained for >1 year in the NAT cohort compared with the IAT cohort, calling into question the long-term benefit of ESWT for patients with IAT. [ABSTRACT FROM AUTHOR]

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment modality that is utilized in the treatment of chronic Achilles tendinopathy (AT). The purpose of this study was to retrospectively assess outcomes following ESWT for both NAT and IAT at greater than 1-year follow-up, and to identify potential predictors of outcomes. Methods: Chart review was conducted to identify patients who underwent ESWT for AT with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, Victorian Institute of Sports Assessment-Achilles (VISA-A) and visual analog scale (VAS) scores and failures. Linear regression was performed to identify potential predictors of outcomes. Survival analysis was conducted using Kaplan Meier curves. Fifty-two cases of IAT and 34 cases of NAT were included. The mean follow-up in the NAT cohort was 22.3±10.2 months and the mean follow-up time in the IAT cohort was 26.8±15.8 months. Results: Improvements in VISA-A and VAS scores were observed in the NAT cohort at 6 months follow-up and at final follow-up (p < 0.01). Improvements in VISA-A scores and VAS scores were recorded in the IAT cohort at 6 months follow-up which subsequently deteriorated at final follow-up. In the NAT cohort, the failure rate at 6 months follow-up was 11.8% which increased to 29.4% at final follow-up. In the IAT cohort, the failure rate at 6 months follow-up was 32.7% which increased to 59.6% at final follow-up. Predictors of poor outcomes in the NAT cohort included pre-ESWT subjective clinical score, male, presence of cardiovascular risk factor, and increasing MRI severity. Predictors of poor outcomes in the IAT cohort included pre-ESWT subjective clinical score and increasing MRI severity. Conclusion: This study found that superior subjective clinical outcomes together with a lower failure rate maintained over 1 year in the NAT cohort compared to the IAT cohort. This may implicate ESWT as a temporising treatment in IAT and a longer term solution in patients with NAT. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this retrospective clinical study was to evaluate outcomes following extracorporeal shockwave therapy (ESWT) for the treatment of Achilles tendinopathy. Subgroup analysis was conducted to identify predictors of poor outcomes. Methods: This retrospective cohort study included existing clinical data from 74 patients from a single academic institution. Patients greater than 16 years of old who underwent ESWT for Achilles tendinopathy in the office setting between 3/3/2017 to 8/2/2022 were included. Data collected included: patient demographics, co-morbidities, treatment characteristics, Victorian institute of sports assessment - Achilles (VISA-A) scoring tool, visual analog scale (VAS), magnetic resonance imaging data, return to play (RTP) data and failures were recorded. Failure was defined as no improvement in VISA-A nor VAS scores or surgical intervention. For these data, mean and standard deviation were calculated, and paired samples T-tests and Welch's T-tests were performed on clinical outcome scores. Results: In total, 74 patients (91 heels) with a mean age of 54.1 ± 14.0 years and BMI of 27.3 ± 4.5 kg/m2 underwent ESWT for Achilles tendinopathy at a mean follow-up of 25.7 ± 15.0 months. Eighteen patients were in the non-insertional Achilles tendinopathy (NAT) cohort and 56 patients were in the insertional Achilles tendinopathy (IAT) cohort. Both NAT and IAT cohorts had a similar improvement in VISA-A score (p=0.365) and VAS scores (p=0.65). A shorter return to play time was found in the NAT cohort (1.1 ± 0.9 months) compared to the IAT cohort (2.6 ± 5.7 months) but this was not statistically significant (p=0.34). There was a higher failure rate in the the IAT cohort (50.0%) than the NAT cohort (38.9%). Patients who received platelet-rich plasma (PRP) had a higher failure rate (61.2%) than those who did not receive PRP (39.6%). In the NAT cohort, the failure rate in females was 0.0%. In the IAT cohort, the failure rate in females was 61.9%. Linear regression analysis found that elevated BMI and MRI severity were associated with worse post-ESWT outcomes. Conclusions: This retrospective study demonstrated a high failure rate at short-term follow-up in patients who underwent ESWT for Achilles tendinopathy. Higher failure rates were found in patients with IAT and those who received intratendinous PRP. Predictors of poor outcomes included elevated BMI and MRI severity. Further studies with larger patient cohorts and a longer follow-up are necessary to determine the role of ESWT in the treatment of Achilles tendinopathy. [ABSTRACT FROM AUTHOR]