The Image Changes And The Effectiveness Of Extracorporeal Shock Wave Therapy For Patellar Tendinopathy

Purpose:To observe the image changes and the effectiveness of the extracorporeal shock wave therapy for patellar tendinopathy from the aspects of eliminating the clinical symptoms, improving the knee function and repairing the patellar tendon tissues. To study the mechanism of the extracorporeal shock wave therapy for treating patellar tendinopathy from the aspect of morphosis and to discuss the value of musculoskeletal ultrasound in application of diagnosis, location and assessment for patellar tendinopathy.Method:The 65 cases were randomly divided into the treatment group (33 cases) and the control group(32 cases), The treatment group received five sessions of radial shock wave therapy at 1-week intervals and the control group just received relative rest. The outcome measurment include VAS, VISA, Lysholm and 2000 IKDC. The image changes were evaluated by musculoskeletal ultrasound examination. The effectiveness were observed from the aspects of eliminating the clinical symptoms, improving the knee function and repairing the patellar tendon tissues. The follow-up were scheduled continu 9 months.Result:1.VAS score:The total VAS scores both of the treatment group and the control group were improved after 9 months and they were statistically significant (P<0.05), and the treatment group was better than the control group (P<0.05).2. VISA, Lysholm and 2000 IKDC score:The VISA, Lysholm and 2000 IKDC scores both of the treatment group and the control group were improved after 9 months and they were statistically significant (P<0.01), the treatment group was superior to the control group in all these scores (P<0.01).3. Ultrasound evaluation:①Patellar tendon length. In both the treatment group and the control group, the patellar tendons of their affected legs were longer than that of their normal contralateral legs in length before the intervention (P<0.05), and the patellar tendons of their affected legs became significantly shorter than before after 6 momths (P<0.01). The patellar tendon lengths of the treatment group were shortened sharply than before after the 6 momths’ treatment (P<0.05), but the length reduction of the patellar tendon of the control group was not statistically significant after 6 momths (P>0.05). ②Patellar tendon thickness:In the treatment group and the control group, both the upper parts and the lower parts of the patellar tendons of the affected legs were thicker than that of their normal contralateral legs as the baseline (P<0.05). The thicknesses of both the upper and the lower parts of the patellar tendons of the effected legs were reduced significantly after 6 momths (P<0.05). Both the upper and the lower patellar tendons of the treatment group were thiner than before after 6 momths (P<0.05), but the thickness reductions of the upper and the lower patellar tendons of the control group were not statistically significant after 6 momths (P>0.05). ③Hypoechoic area:The treatment group’s patellar tendon hypoechoic areas became significantly smaller than before after 6 momths (P<0.01), the hypoechoic area of the control group also became smaller than before after 6 momths (P<0.05), but the treatment group was superior to the control group in the decrease of the hypoechoic area (P<0.01).④ Calcification area:The patellar tendon calcification area of the treatment group became significantly smaller than before after the 6 momths’ treatment (P<0.01), but the control group’s calcification area decreases were not statistically significant after 6 momths (P>0.05), and the treatment group was evidently superior to the control group in the decrease of the calcification area(P<0.05).⑤The doppler signal:The doppler signals of the treatment group were increased significantly than before after the first treatment (P<0.01), and decreased significantly than before after the 3 and 6 months (P<0.01). The doppler signals of the control group were decreased significantly than before after 3 and 6 months (P <0.05), and the treatment group was superior to the control group in the decrease of the doppler signals(P<0.05).Conclusion:1. Both the extracorporeal shock wave therapy and the relative rest has the effectiveness in treating patellar tendinopathy, but the extracorporeal shock wave therapy comblined with relative rest is better than the relative rest.2. Both the extracorporeal shock wave therapy and the relative rest has the effectiveness in repairing patellar tendon tissues, but the extracorporeal shock wave therapy comblined with relative rest is better than the relative rest.3.Using the extracorporeal shock wave therapy to treat the patellar tendinopathy can not only relieve the pain, improve the functions of the knee, but also accelerate the tissue repair of the patellar tendon and has the function of treating both the manifestation and the root cause of the disease.4. Musculoskeletal ultrasound has not only the function in application of diagnosis, localization for treatment, but also the value of assessment for patellar tendinopathy.