评估局灶性和放射性体外冲击波治疗对髌骨肌腱病变疼痛和功能影响的系统评价和荟萃分析

IF 2 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation Pub Date : 2026-09-01 Epub Date: 2026-06-06 DOI:10.1016/j.arrct.2026.100657

Adam Friedman DO, MBS, Seth Spicer DO, Jared Garfinkle BS, Hassan Tahir DO

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引用次数: 0

摘要

目的通过系统回顾和荟萃分析，评价局灶性或放射状体外冲击波治疗（ESWT）改善髌骨肌腱病变（PT）患者疼痛和功能的有效性。数据来源在PubMed， Embase和Web of Science中进行了全面的文献检索，截止到2025年5月27日。搜索词与ESWT和PT相关。使用谷歌Scholar评估其他灰色文献。研究选择纳入使用聚焦或径向ESWT治疗PT并使用视觉模拟量表（VAS）和/或维多利亚体育评估研究所（VISA）报告治疗前后结果的研究。随机对照试验、前瞻性队列研究和回顾性图表评价均符合条件。13项研究（VAS =530, VISA =369）符合纳入标准。数据提取：两位作者独立提取VAS、VISA、SDs和样本量。当报告多个随访点时，优先考虑随访12- 16周的数据。对13项研究进行随机效应荟萃分析，共899名参与者（VAS为530人，VISA为369人）。ESWT显示VAS降低2.53（从5.24到2.71），VISA增加20.22（从54.65到74.86），均超过最小临床重要差异阈值（VAS: 1.2; VISA: 7.3）。效应量较大（VAS d= - 1.54; VISA d=1.76）。随机试验的偏倚风险一般较低；非随机研究有较高的偏倚，但对综合效应的影响很小。采用推荐评估、发展和评价分级法对证据的确定性进行评级：4项高质量研究、6项中等质量研究和3项低质量研究。异质性很高，但大多数ESWT组表现出一致的临床获益。结论seswt可显著减轻PT患者的疼痛并改善功能，其效应值超过临床有意义的阈值。它代表了一个可行的非侵入性治疗选择的个人没有反应保守护理。未来的研究应侧重于规范ESWT协议和随访时间间隔，以提高可重复性和临床转译性。

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Systematic Review and Meta-analysis Assessing the Effects of Focal and Radial Extracorporeal Shockwave Therapy on Pain and Function in Patellar Tendinopathy

Objective

To evaluate the effectiveness of focal or radial extracorporeal shockwave therapy (ESWT) in improving pain and function in individuals with patellar tendinopathy (PT) through a systematic review and meta-analysis.

Data Sources

A comprehensive literature search was conducted in PubMed, Embase, and Web of Science up to May 27, 2025. Search terms were related to ESWT and PT. Additional gray literature was assessed using Google Scholar.

Study Selection

Studies were included if they used focused or radial ESWT to treat PT and reported pre- and posttreatment outcomes using the visual analog scale (VAS) and/or the Victorian Institute of Sport Assessment (VISA). Randomized controlled trials, prospective cohort studies, and retrospective chart reviews were eligible. Thirteen studies (n=530 for VAS; n=369 for VISA) met the inclusion criteria.

Data Extraction

Two authors independently extracted VAS, VISA, SDs, and sample sizes. Data from 12- to 16-week follow-up were prioritized when multiple follow-up points were reported.

Data Synthesis

A random-effects meta-analysis was performed across 13 studies totaling 899 participants (530 for VAS, 369 for VISA). ESWT demonstrated a significant VAS reduction of 2.53 (from 5.24 to 2.71) and VISA increase of 20.22 (from 54.65 to 74.86), both exceeding minimal clinically important difference thresholds (VAS: 1.2; VISA: 7.3). Effect sizes were large (VAS d=−1.54; VISA d=1.76). Randomized trials generally had a low risk of bias; nonrandomized studies had higher bias but minimal influence on pooled effects. Certainty of evidence was rated using Grading of Recommendations Assessment, Development, and Evaluation: 4 high, 6 moderate, and 3 low-quality studies. Heterogeneity was high, but most ESWT arms showed consistent clinical benefit.

Conclusions

ESWT significantly reduces pain and improves function in patients with PT, with effect sizes exceeding clinically meaningful thresholds. It represents a viable noninvasive treatment option for individuals not responding to conservative care. Future research should focus on standardizing ESWT protocols and follow-up intervals to enhance reproducibility and clinical translation.

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