Shockwave therapy helps some tendinopathies, not patellar

Design

Systematic review and network meta-analysis of randomised trials, GRADE-rated

Population

3,921 patients across lateral epicondylitis, Achilles, rotator cuff, greater trochanteric and patellar tendinopathy

Primary outcome

Pain and function versus placebo and other conservative treatments

Effect

Pain reduced vs placebo in lateral epicondylitis, Achilles and rotator cuff; no effect in patellar tendinopathy

A network meta-analysis of 65 randomised trials and 3,921 patients compared extracorporeal shockwave therapy with other conservative treatments across five tendinopathies.

Against placebo, shockwave therapy reduced pain in lateral epicondylitis (standardised mean difference -0.53, 95% CI -0.76 to -0.30), Achilles tendinopathy (-0.49, -0.83 to -0.16) and rotator cuff tendinopathy (-1.25, -1.61 to -0.89, though heterogeneity was high). For patellar tendinopathy it was no better than placebo (VISA-P -0.15, -0.42 to 0.12). In network comparisons it ranked near the top for lateral epicondylitis, Achilles and rotator cuff tendinopathy, without clearly beating the best alternative.

That makes shockwave therapy a reasonable option for lateral epicondylitis, Achilles and rotator cuff tendinopathy, but not a treatment to reach for in patellar tendinopathy. The overall certainty is limited, so position it as one of several conservative options rather than a first choice.

• Network meta-analysis of 65 randomised trials, 3,921 patients, across five tendinopathies.
• Versus placebo, it reduced pain in lateral epicondylitis, Achilles and rotator cuff tendinopathy.
• It was no better than placebo for patellar tendinopathy (VISA-P -0.15, 95% CI -0.42 to 0.12).
• It ranked among the better options but did not clearly beat the best alternative treatment.
• Offer it as one conservative option, not a guaranteed first choice.

Why it matters

It separates the tendinopathies where shockwave therapy is worth offering from the one where it is not, sharpening a commonly used referral.

Don't overread it

Overall certainty was limited and heterogeneity high for some tendons; this ranks options rather than proving shockwave therapy superior.

The statistics, in plain English

A standardised mean difference around -0.5 is a moderate effect where the interval stays below zero; the patellar interval crosses zero, meaning no benefit, and high heterogeneity in rotator cuff tendinopathy makes that estimate less certain.

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