van der Vlist AC, Winters M, Weir A, et al
British Journal of Sports Medicine 2021;55:249-256.
Abstract
Objective To provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy.
Design Living systematic review and network meta-analysis.
Data sources Multiple databases including grey literature sources were searched up to February 2019.
Study eligibility criteria Randomised controlled trials examining the effectiveness of any treatment in patients with both insertional and/or midportion Achilles tendinopathy. We excluded trials with 10 or fewer participants per treatment arm or trials investigating tendon ruptures.
Data extraction and synthesis Reviewers independently extracted data and assessed the risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation to appraise the certainty of evidence.
Primary outcome measure The validated patient-reported Victorian Institute of Sport Assessment-Achilles questionnaire.
Results 29 trials investigating 42 different treatments were included. 22 trials (76%) were at high risk of bias and 7 (24%) had some concerns. Most trials included patients with midportion tendinopathy (86%). Any treatment class seemed superior to wait-and-see for midportion Achilles tendinopathy at 3 months (very low to low certainty of evidence). At 12 months, exercise therapy, exercise+injection therapy and exercise+night splint therapy were all comparable with injection therapy for midportion tendinopathy (very low to low certainty). No network meta-analysis could be performed for insertional Achilles tendinopathy.
Summary/conclusion In our living network meta-analysis no trials were at low risk of bias and there was large uncertainty in the comparative estimates. For midportion Achilles tendinopathy, wait-and-see is not recommended as all active treatments seemed superior at 3-month follow-up. There seems to be no clinically relevant difference in effectiveness between different active treatments at either 3-month or 12-month follow-up. As exercise therapy is easy to prescribe, can be of low cost and has few harms, clinicians could consider starting treatment with a calf-muscle exercise programme.
From: Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018
Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association
Journal of Orthopaedic & Sports Physical Therapy
Published Online:April 30, 2018Volume48Issue5PagesA1-A38
https://www.jospt.org/doi/10.2519/jospt.2018.0302
“Clinicians should use mechanical loading, which can be either in the form of eccentric exercise, or a heavy-load, slow-speed (concentric/eccentric) exercise program, to decrease pain and improve function for patients with midportion Achilles tendinopathy without presumed frailty of the tendon structure.”