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From SUN Orthopedics and Sports Medicine, Lewisburg, Pennsylvania
* Address correspondence to John Patrick Furia, MD, 900 Buffalo Road, Lewisburg, PA 17837 (e-mail: jfuria{at}ptd.net).
Background: Results of high-energy extracorporeal shock wave therapy for the treatment of insertional Achilles tendinopathy are not determined. It is unclear how local anesthesia alters the outcome of this procedure.
Hypothesis: Extracorporeal shock wave therapy is an effective treatment for insertional Achilles tendinopathy. Local anesthesia field block adversely affects outcome.
Study Design: Case control study; Level of evidence, 3.
Methods: Thirty-five patients with chronic insertional Achilles tendinopathy were treated with 1 dose of high-energy extracorporeal shock wave therapy (ESWT group; 3000 shocks; 0.21 mJ/mm2; total energy flux density, 604 mJ/mm2), and 33 were treated with nonoperative therapy (control group). All extracorporeal shock wave therapy procedures were performed using a local anesthesia field block (LA subgroup, 12 patients) or a nonlocal anesthesia (NLA subgroup, 23 patients). Evaluation was by visual analog score and by Roles and Maudsley score.
Results: One month, 3 months, and 12 months after treatment, the mean visual analog score for the control and ESWT groups were 8.2 and 4.2 (P < .001), 7.2 and 2.9 (P < .001), and 7.0 and 2.8 (P < .001), respectively. Twelve months after treatment, the number of patients with successful Roles and Maudsley scores was statistically greater in the ESWT group compared with the control group (P > .0002), with 83% of ESWT group patients having a successful result, and the mean improvement in visual analog score for the LA subgroup was significantly less than that in the NLA subgroup (F = 16.77 vs F = 53.95, P < .001). The percentage of patients with successful Roles and Maudsley scores did not differ among the LA and NLA subgroups.
Conclusion: Extracorporeal shock wave therapy is an effective treatment for chronic insertional Achilles tendinopathy. Local field block anesthesia may decrease the effectiveness of this procedure.
Key Words: tendon injuries • Achilles tendinopathy • extracorporeal shock wave therapy (ESWT)
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  P Jonsson, H Alfredson, K Sunding, M Fahlstrom, and J Cook New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study Br. J. Sports Med., September 1, 2008; 42(9): 746 - 749. [Abstract] [Full Text] [PDF]
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 J. P. Furia High-Energy Extracorporeal Shock Wave Therapy as a Treatment for Chronic Noninsertional Achilles Tendinopathy Am. J. Sports Med., March 1, 2008; 36(3): 502 - 508. [Abstract] [Full Text] [PDF]
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 J. D. Rompe, J. Furia, and N. Maffulli Eccentric Loading Compared with Shock Wave Treatment for Chronic Insertional Achilles Tendinopathy. A Randomized, Controlled Trial J. Bone Joint Surg. Am., January 1, 2008; 90(1): 52 - 61. [Abstract] [Full Text] [PDF]
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J. D. Rompe, B. Nafe, J. P. Furia, and N. Maffulli Eccentric Loading, Shock-Wave Treatment, or a Wait-and-See Policy for Tendinopathy of the Main Body of Tendo Achillis: A Randomized Controlled Trial Am. J. Sports Med., March 1, 2007; 35(3): 374 - 383. [Abstract] [Full Text] [PDF]
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