Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials.

British Journal of Sports Medicine
Arco C van der VlistRobert-Jan de Vos

Abstract

To provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy. Living systematic review and network meta-analysis. Multiple databases including grey literature sources were searched up to February 2019. Randomised controlled trials examining the effectiveness of any treatment in patients with both insertional and/or midportion Achilles tendinopathy. We excluded trials with 10 or fewer participants per treatment arm or trials investigating tendon ruptures. Reviewers independently extracted data and assessed the risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation to appraise the certainty of evidence. The validated patient-reported Victorian Institute of Sport Assessment-Achilles questionnaire. 29 trials investigating 42 different treatments were included. 22 trials (76%) were at high risk of bias and 7 (24%) had some concerns. Most trials included patients with midportion tendinopathy (86%). Any treatment class seemed superior to wait-and-see for midportion Achilles tendinopathy at 3 months (very low to low certainty of evidence). At 12 months, exercise therapy, exercise+injection therapy and exercise+night splint therapy were all compa...Continue Reading

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Citations

Dec 9, 2020·British Journal of Sports Medicine·Marinus WintersAdam Weir
Mar 27, 2021·The Journal of Manual & Manipulative Therapy·Christos SavvaMichalis Efstathiou
Apr 20, 2021·BMJ Open Sport & Exercise Medicine·Tjerk S O Sleeswijk VisserRobert-Jan de Vos
Jun 4, 2021·The American Journal of Sports Medicine·Bruce Reider
Jun 9, 2021·Current Sports Medicine Reports·Kristian J von RickenbachKelly C McInnis
Jul 1, 2021·British Journal of Sports Medicine·Robert-Jan de VosAdam Weir
Jul 22, 2021·Zeitschrift für Rheumatologie·Anja Hirschmüller, Oliver Morath
Mar 21, 2021·JBI Evidence Synthesis·Lyndsay A AlexanderKay Cooper
Aug 6, 2021·Frontiers in Bioengineering and Biotechnology·Varun Arvind, Alice H Huang
Oct 26, 2021·Scandinavian Journal of Medicine & Science in Sports·Søren KaalundUlrich Fredberg
Dec 23, 2021·Seminars in Musculoskeletal Radiology·Katherine D Van Schaik, Kenneth S Lee

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Clinical Trials Mentioned

NCT02996409

Software Mentioned

Stata
Embase
WinBUGS

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