Radial Extracorporeal Shockwave Therapy (rESWT) is not superior to “minimal-dose” rESWT for patients with chronic patella tendinopathy; a double-blinded randomised controlled trial

Objectives

Investigating outcomes for patients with chronic patella tendinopathy following radial extra-corporeal shockwave therapy (rESWT).

Methods

22 patients with chronic patella tendinopathy were recruited for this DB-RCT from a single NHS Sports Medicine clinic. Participants were randomized equally to either 3 sessions of “therapeutic-dose” or “minimal-dose” rESWT respectively, alongside a structured and progressive home exercise program. Participants: 86% male, mean age 36.1±12.5 years, symptom duration: 30.4±32.7 months. Maximum 6-month follow-up, with interim data at 6-weeks, and 3-months.

Results

Improvements were seen in both groups, with an improvement of pain by about 35% across all time periods; these within-group improvements were seen at the interim (6-week, 3-month) and final (6-month) study period. However, no differences were seen between-groups at any time period, suggesting non-superiority of “therapeutic” over “minimal-dose” ESWT. There were no changes seen in markers of general health or levels of recorded physical activity.

Conclusion

Small sample sizes limit firm conclusions, but this study has failed to show any superiority of rESWT compared to “minimal-dose” rESWT in patients with chronic patella tendinopathy, when performed alongside a structured home exercise program (progressive loading, flexibility, and balance components). The findings from this study do not support the current recommendations, that of three sessions of radial-ESWT performed at weekly intervals at the “maximally comfortably-tolerated dose”.