Table 2 Summary of studies on ESWT and patellar tendinopathy
AuthorPublication yearVara F et al242000 AbstractLohrer H et al252002Peers KHE et al62003Peers KHE252003Taunton KM et al272003Wang CJ et al132007Vulpiani MC et al142007
Study designRandomised clinical trial, single-blindNon-randomised, prospective pilot studyRetrospective cross-sectional analysisRandomised clinical trialRandomised clinical trialRandomised clinical trialNon-randomised, prospective cohort study
Outcome measuresVAS score, pressure pain, functional improvementPain at rest, pain during exercise and pressure pain (all VAS scores), and pain-free running time (min)VISA score, VAS score and R&M classificationVISA score, VAS score, R&M classification and functional improvementVISA score and vertical jump testVISA score, VAS score, R&M classification, functional improvement and echo image of patellar tendonVAS score, subjective clinical evaluation range
Follow-up period in months2412243336>24
Number of patients (total/study group)27/1445/45, all athletes27/14 (28/15 tendons), all athletes41/21, all athletes20/10, all athletes50/27 (54/30 tendons), all athletes73/73 (83/83 tendons), 15 athletes
Duration of symptoms in months⩾613.923⩾316.2⩾3
Severity before ESWTVAS 1.6VAS 5VISA 54.4VAS 6.0VAS 7.1
VAS 5.5 (pressure pain), VAS 5.5 (during exercise), pain-free running time 10.4 minVISA 46.5VISA 42.57
Previous treatment before ESWTTwo of the following treatments: NSAIDs, physical therapy, steroid injections, patellar bracing, acupuncture or immobilisationTwo of the following treatments: NSAIDs, physical therapy or steroid injectionsNSAIDs, physical therapy, steroid injections or patellar tapingNSAIDsSteroid injectionsNSAIDs or physiotherapy
ESWT typeDolorclastSiemens SonocurSonocur Plus SiemensSiemens SonocurOssaTronSTORZ
RadialFocusedFocusedFocusedFocusedMedica Focused
Energy level (mJ/mm2)0.105–0.437 (medium)0.06–0.18 (low-medium)0.08 (medium)0.2 (medium)0.17 (medium)0.18 (medium)0.08–0.44 (low-high)
Number of treatments1–53–5 (2000 imp)3 (1000 imp)3 (1000 imp)3–5 (2000 imp)1 (1500 imp)3–5 (1500–2500 imp)
Local anaestheticnonenonenonenonenonenone
Method of localisationpatient-guided feedbackimage guidingimage guidingpalpationpalpation, control by imaging
Additional treatment after ESWTnonenoneEccentric training, single leg decline squatnonenonenone
Mean VAS and VISA after ESWT (improvement)VAS 0.3* (1.3)VAS 1VAS 3 (2.0)VISA 61.4*(7.0)VAS 0.59*(5.41)VAS 1.35* (5.75)
VAS 1.7* pressure pain (31.8)VISA 83.9VISA 74.74*(28.24)VISA 92.0* (44.43)
VAS 1.9* during exercise (3.6)
painfree running time 70.3 min (59.9)
Improved patients (%)74% (11/14) improved, good and satisfactory64.4% (29/45) improved, pain-free or less pain66% (10/15) improved, excellent and good61.9% (13/21) improved, excellent and good70% (7/10) improved, less pain, function improved90.1% (27/30) improved, excellent and good79.9% (66/83) improved and satisfied
Significant differences in advantage of ESWT treatmentYesYesNo significant difference between ESWT treatment and surgical treatmentYes, except for VAS score and R&M classificationYesYes, except for diameter and appearance of patellar tendonYes
Delphi score3237462
ConclusionGood results in favour of the group that received ESWT treatment with an energy level of 0.105–0.437 mJ/mm2ESWT does have a therapeutic effect on patellar tendinopathyESWT treatment is a good alternative for surgical treatment when conservative treatment fails for chronic patellar tendinopathyESWT positively contributed to the improvement of pain and function in the short-term treatment of patellar tendinopathyESWT treatment could be of value as an additional treatment to other conservative treatments, like eccentric trainingESWT was more effective and safer than conservative treatment in patients with chronic patellar tendinopathyESWT seems to be encouraging in light of the long-lasting improvement of the pain symptomatology

  • Imp, impulses; R&M Classification, Roles & Maudsley classification ; VAS, Visual Analog Score, an index of severity of pain where patients with no pain have a score of 0 points; VISA, Victorian Institute of Sport Assessment questionnaire, an index of severity of patellar tendinopathy where asymptomatic, fully performing individuals have a maximal score of 100 points.34

  • For Delphi score see figure 2.23

  • *significant difference at p<0.05.