Jakub Katolický, Petra Poklopová, Gregory Bashford, Tereza Katolická, Kryštof Voleský, Stanislav Machač, Tomáš Nedělka
{"title":"ESWT is able to change macromorphological and micromorphological parameters in patellar tendinopathy: a prospective cohort study.","authors":"Jakub Katolický, Petra Poklopová, Gregory Bashford, Tereza Katolická, Kryštof Voleský, Stanislav Machač, Tomáš Nedělka","doi":"10.1097/JS9.0000000000002351","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the mid-term effects of focused extracorporeal shockwave therapy (ESWT) on clinical symptoms and tendon structure in patellar tendinopathy. Ultrasound (US) evaluation and an innovative in vivo analysis of intra-tendinous morphology using validated spatial frequency analysis (SFA) software were employed to quantify the organization and density of collagen fascicles.</p><p><strong>Methods: </strong>This prospective cohort study included 21 recreational athletes (mean age 29.9 ± 9.3 years) with chronic unilateral symptomatic patellar tendinopathy. ESWT was applied as monotherapy over four weekly sessions. Pain was assessed using the Numeric Rating Scale (NRS) and disease severity with the Victorian Institute of Sports Assessment - Patella (VISA-P) questionnaire. Morphological parameters, such as tendon diameter (TD), were assessed with US and analyzed using SFA software. The asymptomatic tendons served as controls. Follow-up assessments were conducted at the end of the treatment period and 3 months posttreatment.</p><p><strong>Results: </strong>Baseline evaluations revealed increased TD in proximal part of the tendon (P = 0.001) and decreased organization of collagen fascicles (P = 0.013) in symptomatic tendons compared to asymptomatic controls. At the 3-month follow-up, symptomatic tendons showed significant reductions in TD (P < 0.001) and improvements in both organization and density of collagen fascicles throughout various parameters - PSFR (P = 0.024), P6 (P = 0.05), Q6 (P = 0.016), PPP (P = 0.003). No significant morphological changes were observed in asymptomatic tendons. Clinical evaluations demonstrated significant reductions in NRS (P < 0.001) and increases in VISA-P scores (P < 0.001) at all time points.</p><p><strong>Conclusion: </strong>The study suggests that ESWT may have the potential to induce positive structural changes in patellar tendinopathy, including improved organization and density of collagen fascicles. These findings indicate that ESWT could be a promising noninvasive approach to managing patellar tendinopathy, with observed improvements in clinical symptoms and tendon structure. However, further high-quality research is needed to confirm these results and establish their long-term efficacy.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International journal of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JS9.0000000000002351","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: This study aimed to assess the mid-term effects of focused extracorporeal shockwave therapy (ESWT) on clinical symptoms and tendon structure in patellar tendinopathy. Ultrasound (US) evaluation and an innovative in vivo analysis of intra-tendinous morphology using validated spatial frequency analysis (SFA) software were employed to quantify the organization and density of collagen fascicles.
Methods: This prospective cohort study included 21 recreational athletes (mean age 29.9 ± 9.3 years) with chronic unilateral symptomatic patellar tendinopathy. ESWT was applied as monotherapy over four weekly sessions. Pain was assessed using the Numeric Rating Scale (NRS) and disease severity with the Victorian Institute of Sports Assessment - Patella (VISA-P) questionnaire. Morphological parameters, such as tendon diameter (TD), were assessed with US and analyzed using SFA software. The asymptomatic tendons served as controls. Follow-up assessments were conducted at the end of the treatment period and 3 months posttreatment.
Results: Baseline evaluations revealed increased TD in proximal part of the tendon (P = 0.001) and decreased organization of collagen fascicles (P = 0.013) in symptomatic tendons compared to asymptomatic controls. At the 3-month follow-up, symptomatic tendons showed significant reductions in TD (P < 0.001) and improvements in both organization and density of collagen fascicles throughout various parameters - PSFR (P = 0.024), P6 (P = 0.05), Q6 (P = 0.016), PPP (P = 0.003). No significant morphological changes were observed in asymptomatic tendons. Clinical evaluations demonstrated significant reductions in NRS (P < 0.001) and increases in VISA-P scores (P < 0.001) at all time points.
Conclusion: The study suggests that ESWT may have the potential to induce positive structural changes in patellar tendinopathy, including improved organization and density of collagen fascicles. These findings indicate that ESWT could be a promising noninvasive approach to managing patellar tendinopathy, with observed improvements in clinical symptoms and tendon structure. However, further high-quality research is needed to confirm these results and establish their long-term efficacy.
期刊介绍:
The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.