Effect of extracorporeal shockwave therapy for rotator cuff tendinopathy: a systematic review and meta-analysis.

BACKGROUND: Rotator cuff tendinopathy (RCT) is a widespread musculoskeletal disorder and a primary cause of shoulder pain and limited function. The resulting pain and limited functionality have a detrimental impact on the overall quality of life. The purpose of this study was to perform a systematic review of the effects of extracorporeal shock wave therapy (ESWT) for RCT. METHODS: The literature search was conducted on the following databases from inception to February 20, 2024: PubMed, Web of Science, the Cochrane Library, Scopus, MEDLINE, EMBASE, EBSCO, and China National Knowledge Infrastructure (CNKI) were checked to identify the potential studies exploring the effect of ESWT for the treatment of Rotator cuff tendinopathy (Calcification or non-calcification), control group for sham, other treatments (including placebo), without restriction of date, language. Two researchers independently screened literature, extracted data, evaluated the risk of bias in the included studies, and performed meta-analysis using RevMan 5.3 software. RESULTS: A total of 16 RCTs with 1093 patients were included. The results showed that compared with the control group, ESWT for pain score Visual Analogue Scale/Score (VAS) (SMD = -1.95, 95% CI -2.47, -1.41, P < 0.00001), function score Constant-Murley score (CMS) (SMD = 1.30, 95% CI 0.67, 1.92, P < 0.00001), University of California Los Angeles score (UCLA) (SMD = 2.69, 95% CI 1.64, 3.74, P < 0.00001), American Shoulder and Elbow Surgeons form (ASES) (SMD = 1.29, 95% CI 0.93, 1.65, P < 0.00001), Range of motion (ROM) External rotation (SMD = 1.00, 95% CI 0.29, 1.72, P = 0.02), Total effective rate (TER) (OR = 3.64, 95% CI 1.85, 7.14, P = 0.0002), the differences in the above results were statistically significant. But ROM-Abduction (SMD = 0.72, 95% CI -0.22, 1.66, P = 0.13), the difference was not statistically significant. CONCLUSION: Currently limited evidence suggests that, compared with the control group, ESWT can provide better pain relief, functional recovery, and maintenance of function in patients with RCT.

Arthroscopic Surgery Combined With Platelet-Rich Plasma Does Not Significantly Improve Pain, Function, Complications, and Retear Rate Compared With Arthroscopic Surgery Alone for Full-Thickness Rotator Cuff Tears: A Systematic Review and Meta-analysis.

PURPOSE: To evaluate the effectiveness and safety of arthroscopic surgery combined with platelet-rich plasma (PRP) compared with arthroscopic surgery alone in the treatment of patients with full-thickness rotator cuff tears. METHODS: The Cochrane Library, PubMed, Embase, Scopus, EBSCO, Web of Science, China National Knowledge Infrastructure, and Wanfang Database were systematically searched from inception to November 2023. Subject words combined with free words were used to collect randomized controlled trials focusing on arthroscopic surgery combined with PRP in the treatment of full-thickness rotator cuff tears. The assessment of evidence quality employed the Cochrane Collaboration risk of bias tool, and data analysis was performed using RevMan 5.3 software. RESULTS: A total of 9 studies with 537 patients were included. The meta-analysis revealed that compared with the arthroscopic surgery alone group, the summary result of University of California Los Angeles score scores in the arthroscopic combined with PRP group was (mean difference [MD] = 1.08, 95% confidence interval [CI] 0.19∼1.97, P = .02), subgroup analysis of surgical suture method visual analog scale (VAS) single-row (MD = -1.00, 95% CI -1.50 to -0.50, P < .0001), VAS double-row (MD = -0.10, 95% CI -0.17 to -0.02, P = .02), and Constant-Murley score single-row (MD = 3.49, 95% CI 0.32∼6.66, P = .03), the difference was statistically significant, and the differences in VAS, Constant-Murley score, and Quick Disabilities of the Arm, Shoulder and Hand, complications, and retear rate were not statistically significant. CONCLUSIONS: Patients undergoing arthroscopic repair combined with PRP treatment showed no difference in pain, function, complications, and retear rate compared with those treated with arthroscopic surgery alone. LEVEL OF EVIDENCE: Level II, systematic review and meta-analysis of Level I and II evidence.

Effect of extracorporeal shock wave therapy for rotator cuff injury: Protocol for a systematic review and meta-analysis.

BACKGROUND: Rotator cuff injury (RCI) is a common musculoskeletal ailment and a major cause of shoulder pain and limited functionality. The ensuing pain and restricted movement significantly impact overall quality of life. This study aims to systematically review the effects of extracorporeal shock wave therapy (ESWT) on RCI. METHODS: This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. A literature search, spanning inception to November 1, 2023, will include databases such as PubMed, Web of Science, the Cochrane Library, Scopus, MEDLINE, EMBASE, EBSCO, and China National Knowledge Infrastructure (CNKI) to identify ESWT studies for RCI treatment. Excluding retrospectives, bias risk will be assessed with the Cochrane tool. Two researchers will independently screen, extract data, and evaluate bias risk. Revman 5.3 software will be used for data analysis. RESULTS: This study aims to objectively and comprehensively evaluate the effectiveness and safety of randomized controlled trials of ESWT in the treatment of RCI, and analyze in detail the effect of ESWT in the treatment of RCI. Results will be analyzed using the Pain Visual Analogue Scale (VAS), Constant-Murley score, University of California Los Angeles score (UCLA), and American Shoulder and Elbow Surgeons form (ASES). If applicable, subgroup analysis will also be performed to divide patients into groups according to the energy level of ESWT, the time of intervention, and the degree of tearing of RCI. Finally, the results are submitted for publication in a peer-reviewed journal. DISCUSSION AND CONCLUSION: There is existing evidence suggesting that ESWT may contribute to the amelioration of pain and functional limitations associated with Rotator Cuff Injury (RCI). This systematic review aims to update, consolidate, and critically evaluate relevant evidence on the effects of ESWT for RCI. The anticipated outcomes may serve as a valuable reference for clinical ESWT practices, covering treatment methods, timing, and intensity. Moreover, this review aspires to provide high-quality evidence addressing the impact of ESWT on RCI-related pain. Simultaneously, the findings of this systematic review are poised to offer guidance to clinicians and rehabilitation therapists. This guidance is intended to enhance the management of pain and functional impairments experienced by individuals with RCI, ultimately leading to improvements in their physical well-being. TRIAL REGISTRATION: Protocol registration number CRD42023441407. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441407.