ESWT compared with PRP injection in patellar tendinopathy summary of evidence
| Outcomes | Comparisons | Relative effect (95% CI) | Patients /studies (n) | Quality of evidence (GRADE) | Clinical significance | |
| Average estimate /assumed risk in the ESWT group | Average estimate /assumed risk in the control group | |||||
| VISA-P score Follow-up: 2 months | ESWT: mean±SD was 71.3±19.1 | PRP injection: mean±SD was 76.2±16.5 | MD −4.90 (−15.22 to 5.42) The difference was not clinically and statistically significant | 46/1 | ⊕ Very low1,2 | Very low level of evidence of no difference between ESWT compared with PRP injection in VISA-P |
| Follow-up: 6 months | ESWT: mean±SD was 73.7±19.9 | PRP injection: mean±SD was 86.7±14.2 | MD −13.00 (−22.99 to 3.01) The difference was statistically but not clinically significant | 46/1 | ⊕ Very low1,2 | Very low level of evidence of significant improvement in VISA-P scores in the PRP group compared with focused ESWT |
| Follow-up: 12 months | ESWT: mean±SD was 77.6±19.9 | PRP injection: mean±SD was 91.3±9.9 | MD −13.70 (−22.78 to 4.62) The difference was statistically but not clinically significant | 46/1 | ⊕ Very low1,2 | Very low level of evidence of significant improvement in VISA-P scores in the PRP group compared with focused ESWT |
| Self-perceived recovery Follow-up: 2 months | ESWT: 12 of 23 (52%) participants reported satisfactory recovery | PRP injection: 12 of 23 (52%) participants reported satisfactory recovery | OR 1.00 (0.31 to 3.18) The difference was not statistically significant | 46/1 | ⊕ Very low1,2 | Very low level of evidence of no significant difference between ESWT and PRP injection in patient-rated recovery |
| Follow-up: 6 months | ESWT: 13 of 23 (57%) participants reported satisfactory recovery | PRP injection: 19 of 23 (83%) participants reported satisfactory recovery | OR 0.27 (0.07 to 1.06) The difference was not statistically significant | 46/1 | ⊕ Very low1,2 | Very low level of evidence of no significant difference between ESWT and PRP injection in patient-rated recovery |
| Follow-up 12 months | ESWT: 15 of 23 (65%) participants reported satisfactory recovery | PRP injection: 21 of 23 (91%) participants reported satisfactory recovery | OR 0.18 (0.03 to 0.96) The difference was statistically significant | 46/1 | ⊕ Very low1,2 | Very low level of evidence in favour of PRP injection compared with focused ESWT in patient-rated recovery |
| VAS score* Follow-up: 2 months | ESWT: mean±SD was 3.9±1.9 | PRP injection: mean±SD was 3.2±1.8 | MD 0.70 (−0.37 to 1.77) The difference was not statistically significant | 46/1 | ⊕ Very low1,2 | Very low level of evidence of no difference between PRP injection and focused ESWT in pain scores |
| Follow-up: 6 months | ESWT: mean±SD was 3.9±2.3 | PRP injection: mean±SD was 2.4±1.9 | MD 1.50 (0.28 to 2.72) The difference was clinically and statistically significant | 46/1 | ⊕ Very low1,2 | Very low level of evidence in favour of PRP injection compared with focused ESWT in VAS pain reduction |
| Follow-up: 12 months | ESWT: mean±SD was 3.2±2.4 | PRP injection: mean±SD was 1.5±1.7 | MD 1.70 (0.50 to 2.90) The difference was clinically and statistically significant | 46/1 | ⊕ Very low1,2 | Very low level of evidence in favour of PRP injection compared with focused ESWT in VAS pain reduction |
| Patient-rated pain reduction** Follow-up: 2 months | ESWT: MD from baseline was 2.4 points | PRP: MD from baseline was 3.4 points | Not estimable | 46/1 | N/A | ESWT: minimal improvement PRP: much improved |
| Follow-up: 6 months | ESWT: MD from baseline was 2.4 points | PRP: MD from baseline was 4.2 points | Not estimable | 46/1 | N/A | ESWT: minimal improvement PRP: very much improved |
| Follow-up: 12 months | ESWT: MD from baseline was 3.1 points | PRP: MD from baseline was 5.6 points | Not estimable | 46/1 | N/A | ESWT: much improved PRP: very much improved |
*Pain scores are referred to load-induced pain.
**Cut-off points adjusted from Farrar et al.44
1 Only one randomised controlled trial included in analyses.
2 Decreased level of evidence due to indirect comparison (both groups received a standardised stretching and strengthening protocol for 2 weeks post treatment).
ESWT, extracorporeal shockwave therapy; GRADE, Grading of Recommendations Assessment, Development and Evaluation; MD, mean difference; N/A, not available; PRP, platelet-rich plasma; VAS, visual analogue scale.