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how does surgery compare to sham surgery or physiotherapy as a treatment for tendinopathy? a systematic review of randomised trials

by:QiMeng     2019-09-25
Abstract objective to evaluate the effectiveness of surgery for all tendon diseases by comparing surgery with non-treatment, false surgery and exercise
Basic therapy for midterm (12 months)and long-term (> 12 months)outcomes.
Our literature includes one trial method, Medline, CINAHL, and Scopus.
A comprehensive assessment of the internal effectiveness, external effectiveness and accuracy of each qualified study results in its overall study quality.
The conclusion of the result is based on strong (Level 1)or moderate (Level 2)evidence.
Results twelve studies were eligible.
Participants had the following types of tendonitis: shoulder In seven studies, lateral elbow in three studies, knee-covered bone in one study and Achilles tendon in one study.
Two studies are good, four are medium, and six are poor in overall quality.
For results of pain, function, range of motion, surgery is superior to no treatment or placebo (ROM)
Successful treatment in the short and medium term.
The effect of mid-term surgery on pain, function, and range of motion is similar to that of false surgery.
Physiotherapy is as effective as surgery in pain, function, ROM and tendon force, and pain, treatment success and quality of life.
Conclusion We recommend that healthcare professionals who treat tendinopathy encourage patients to comply with load exercise therapy for at least 12 months before the surgical options are seriously affected.
Objective to evaluate the effectiveness of surgery for all tendon diseases by comparing surgery with non-treatment, false surgery and exercise
Basic therapy for midterm (12 months)and long-term (> 12 months)outcomes.
Our literature includes one trial method, Medline, CINAHL, and Scopus.
A comprehensive assessment of the internal effectiveness, external effectiveness and accuracy of each qualified study results in its overall study quality.
The conclusion of the result is based on strong (Level 1)or moderate (Level 2)evidence.
Results twelve studies were eligible.
Participants had the following types of tendonitis: shoulder In seven studies, lateral elbow in three studies, knee-covered bone in one study and Achilles tendon in one study.
Two studies are good, four are medium, and six are poor in overall quality.
For results of pain, function, range of motion, surgery is superior to no treatment or placebo (ROM)
Successful treatment in the short and medium term.
The effect of mid-term surgery on pain, function, and range of motion is similar to that of false surgery.
Physiotherapy is as effective as surgery in pain, function, ROM and tendon force, and pain, treatment success and quality of life.
Conclusion We recommend that healthcare professionals who treat tendinopathy encourage patients to comply with load exercise therapy for at least 12 months before the surgical options are seriously affected.
Introduction tendinopathy constitutes a huge socio-economic burden worldwide, accounting for 30% of all general practitioners for skeletal consultation.
The cause of the disease is multi-factor, and its exact pathological and physiological mechanism is not clear;
However, this appears to be due to the imbalance between protective/regenerative changes and pathological responses caused by excessive tendon use.
The most common deterioration factor is considered excessive use (
Especially during sports activities)
The failure of the healing process results in repeated microtrauma and subsequent degradation.
The final result is tendon degeneration, weakness, tearing and pain.
With the increasing study of tendon disease management, new treatment models have emerged, which has brought decision-making difficulties to health care professionals.
In the absence of a complete tendon tear, the load is still the main content of the treatment and is recommended as a first-line treatment for all tendon diseases for 6 months.
7, 8, two-
Line therapy, from non
Invasive methods such as in vitro shock wave therapy (ESWT)
There is still a dispute over the use of tripolyglycerin patches9 and injection therapy in invasive procedures.
10 11 surgery, which may be open or arthroscopic, is usually reserved for patients whose symptoms persist despite conservative treatment and complete tendon tear;
However, its effectiveness has been repeatedly questioned.
In expert opinion, 13 14 guidelines 15 16 and systematic review 17 18 try to provide guidance to practicing clinicians on when surgery may be the appropriate next step. Comparative practical evidence of surgical and non-surgical studies
Surgical treatment for Tendinopathies is still limited, so clear conclusions about the benefits of surgical intervention and the ideal timing have not yet been reached.
The study to evaluate the effectiveness of orthopedic surgery has deviations due to the inability to blinding.
In recent years, some orthopedic operations have been studied and compared (
Including surgery for tendinopathy)
In a double fake surgery21-23
Reflects the placebo effect of surgery in a blind way.
In these studies, there was no difference between the control group and the intervention group.
21-23 the purpose of this systematic review is to consider evidence from studies evaluating the effectiveness of tendon surgery in the general population.
This includes the comparison of surgery (
Open or arthroscopic)
With any non
Surgical treatment, false surgery, or non-treatment of all tendonitis related to the measurement of the following results: pain, function, range of motion (ROM)
Force/force, patient satisfaction, success in treatment, quality of life (QoL)
And complications.
Methods this systematic review was conducted and written based on the \"Preferred Reporting item for systematic review and meta-analysis\"Analyses’24 (PRISMA)guidelines (figure 1).
Download figureOpen in the new tabDownload powerpoint figure 1, including the PRISMA flowchart of the study.
PRISMA, system review and Meta-Preferred Reporting ItemsAnalyses.
Included studies were randomized to compare surgery with any pattern of non-surgical
Surgical treatment of any type of tendon disease from at least one of the following results: \"Pain\", \"function\", \"exercise\", \"strength/strength\", \"Patient satisfaction \",Non-
Randomized observational studies, case reports, case series, and literature review were excluded.
Participants must be over 18 years of age with a clinical diagnosis of tendinopathy with or without radiation symptoms.
Studies including patients with complete tendon tear were excluded.
The duration of symptoms/signs is not a standard, and the duration of conservative treatment and follow-up is not a standardup.
Language standards are not applied.
The two authors conducted a thorough literature search (DC and CC)
On March 2018, the following Boolean operators were used independently through Medline, EMBASE, Scopus and CINAHL :\'(
Tendonitis or tennis elbow or jumper\'s knee or outer elbow tendonitis or the outer arch inflammation or sleeve disease or shoulder impact or knee or Achilles tendonAND (
Surgical or surgical management or surgical treatment or open surgery or arthroscopic surgery)AND (
Conservative treatment or physiotherapy or eccentric exercise or eccentric reinforcement or stretching or shock-
Wave therapy, ESWT or in vitro shock wave therapy, ultrasound, ion introduction, laser, LLLT, poidocanol, hardening therapy, Botox, GTN, sorta, or PRP or autologous blood or fake surgery)’.
Medical subject title terms are not used to minimize the risk of missing related articles.
Comment articles are used to identify qualified articles that were missed at the time of the initial search.
In addition, each related article performs reference list filtering and reference tracking in Google Scholar.
Screened out from a total of 874 articles that were initially determined after excluding duplicate and non-duplicate articles
Through review articles, reference list screening, and citation tracking identified qualified articles, title and summary screening, and addition of missing Studies, 12 studies were found to be eligible.
Figure 1 illustrates the process of screening articles based on the PRISMA guidelines.
24 quality evaluation of comprehensive evaluation of research, internal effectiveness (
Away from prejudice)
, External validity (
Versatility/applicability)and precision (
Reproduction/no random error)
Evaluated by two authors respectively (DC and CC)
Three independent opinions (PK)
To be found where there are differences.
The quality scale and the resulting score are not used, as these scales usually combine all aspects of the study method with all aspects of the report;
Therefore, they are considered inappropriate for the evaluation of the quality of learning.
25 In addition, score cuts-
Classification studies of good or bad quality are generally not provided, so these studies are usually composed of the authors of the review article, which may be highly variable.
For internal effectiveness, the \"cochrane Collaboration tool for assessing risk of bias in randomized trials\" was used, which included six questions/criteria for assessing five specific risks and one non-randomized trial riskspecific (‘other’)types of bias.
25 as a \"other\" bias, our preset evaluation criteria are as follows :(a)
Adequate and appropriate inclusion and exclusion criteria ,(b)
Differences between treatment group and control group at baseline (confounding)and (c)
The suitability of deploying statistical tests.
External effectiveness was assessed based on population, age range and clinical relevance measured by intervention measures and results.
To evaluate accuracy, sample size, statistical power calculation performance, and p-values used to define statistical significance were considered.
In the Cochrane Collaboration tool, each project is classified as a risk of bias for \"high\", \"low\" or \"unclear.
No total score is given.
The external validity and accuracy of each study were individually rated as \"high\", \"low\" or \"unclear\" risks.
Overall, based on a comprehensive assessment of their internal effectiveness, external effectiveness and accuracy independently conducted by the two authors, the study was characterized as \"good\", \"moderate\" or \"poor\" quality (DC and CC)
In cases where the two judgments are different, the opinion of the third author is provided.
The criteria for comprehensive quality assessment are as follows: \"good \"-
Quality studies have a \"high\" risk of bias in the internal validity category, external validity and accuracy of 2 internal validity categories, external validity, and accuracy.
Data extraction: the first author initially read every qualified article to gain familiarity, followed by a re-reading of each article
For ease of analysis and presentation, read and its key features are extracted and inserted into tables in Microsoft Word.
For the presentation of results, the results are divided into medium-term (up to 1-year follow-up)and long term (more than 1-year follow-up).
In the medium and long term, results are reported at more than one point in time, which is the longest
In the results table, the term results are used for each study;
However, subsequent findings
The up stage is described in the text of the result section.
When the study used tools and questionnaires as part of the outcome measurement, their results were listed under the generic outcome category according to the purpose of the questionnaire.
If the results of their testator components are also presented, additional results are listed under the corresponding result category: for example, where the Oxford shoulder score is used, the purpose is to use the overall score results of functional evaluation for \"function \";
If the findings of specific questions of the questionnaire survey related to \"pain\" are also described, this specific result is also used for \"pain\", etc.
Result category \"complexity\" includes all general and surgery
Specific surgical and postoperative complications, as well as cases where the disease develops to complete tendon tear and other weakness (
For example, sexual capsule inflammation).
To classify the strength of evidence for each outcome reported, we used a rating system developed by Van Tulder et al, 26 consisting of four levels of evidence: Strong evidence (Level 1)
Provided by consistent findings across multiple high-
Random control test of quality (RCTs).
Medium evidence (Level 2)
Provided by a highly consistent survey.
High quality randomized controlled trials and one or more low
High quality randomized controlled trials, or through multiple low-quality RCTs.
Limited or conflicting evidence (Level 3)
Only 1 randomized controlled trial (
High quality or low quality)
, Or found inconsistency in multiple randomized controlled trials. No evidence (Level 4)
It is defined by no randomized controlled trial.
As our overall quality assessment includes \"modernization \"--
Quality category, we extend level 2 to \"from high-
High quality randomized controlled trials and one or more low
Quality or medium-
Quality randomized controlled trials or multiplemoderate-quality RCTs’.
Two authors (DC and CC)
According to the above system, the level of evidence for each result is jointly determined without any disagreement.
When based on strong or medium evidence, the result is considered significant.
Definition and naming therapy (
Any routine tendon rehabilitation programme designed to strengthen the affected tendons includes \"supervised exercise\" and \"eccentric training \";
Standard postoperative rehabilitation is not included); sham surgery (
A fake surgical intervention that ignores steps deemed necessary for treatment); ORI-TETS (
Tennis elbow detection system of Orthopedic Research Institute); OSS (
Oxford shoulder rating); SDQ (
Strengths and Difficulties Questionnaire); HADS (
Hospital Anxiety and depression score); VAS (
Visual simulation scale); EQ VAS (EuroQoL VAS); EQ-5D-3L (
5-dimensional 3-level index of quality of life in Europe); PRIM (
Research and Intervention programs in monotonous work); QoL (Quality of Life); UCLA (
University of California, Los Angeles; VISA (
School of Sports assessment Victoria);
ROM: mobile range; 15D (15-dimensional).
Included studies were randomized to compare surgery with any pattern of non-surgical
Surgical treatment of any type of tendon disease from at least one of the following results: \"Pain\", \"function\", \"exercise\", \"strength/strength\", \"Patient satisfaction \",Non-
Randomized observational studies, case reports, case series, and literature review were excluded.
Participants must be over 18 years of age with a clinical diagnosis of tendinopathy with or without radiation symptoms.
Studies including patients with complete tendon tear were excluded.
The duration of symptoms/signs is not a standard, and the duration of conservative treatment and follow-up is not a standardup.
Language standards are not applied.
The two authors conducted a thorough literature search (DC and CC)
On March 2018, the following Boolean operators were used independently through Medline, EMBASE, Scopus and CINAHL :\'(
Tendonitis or tennis elbow or jumper\'s knee or outer elbow tendonitis or the outer arch inflammation or sleeve disease or shoulder impact or knee or Achilles tendonAND (
Surgical or surgical management or surgical treatment or open surgery or arthroscopic surgery)AND (
Conservative treatment or physiotherapy or eccentric exercise or eccentric reinforcement or stretching or shock-
Wave therapy, ESWT or in vitro shock wave therapy, ultrasound, ion introduction, laser, LLLT, poidocanol, hardening therapy, Botox, GTN, sorta, or PRP or autologous blood or fake surgery)’.
Medical subject title terms are not used to minimize the risk of missing related articles.
Comment articles are used to identify qualified articles that were missed at the time of the initial search.
In addition, each related article performs reference list filtering and reference tracking in Google Scholar.
Screened out from a total of 874 articles that were initially determined after excluding duplicate and non-duplicate articles
Through review articles, reference list screening, and citation tracking identified qualified articles, title and summary screening, and addition of missing Studies, 12 studies were found to be eligible.
Figure 1 illustrates the process of screening articles based on the PRISMA guidelines.
24 quality evaluation of comprehensive evaluation of research, internal effectiveness (
Away from prejudice)
, External validity (
Versatility/applicability)and precision (
Reproduction/no random error)
Evaluated by two authors respectively (DC and CC)
Three independent opinions (PK)
To be found where there are differences.
The quality scale and the resulting score are not used, as these scales usually combine all aspects of the study method with all aspects of the report;
Therefore, they are considered inappropriate for the evaluation of the quality of learning.
25 In addition, score cuts-
Classification studies of good or bad quality are generally not provided, so these studies are usually composed of the authors of the review article, which may be highly variable.
For internal effectiveness, the \"cochrane Collaboration tool for assessing risk of bias in randomized trials\" was used, which included six questions/criteria for assessing five specific risks and one non-randomized trial riskspecific (‘other’)types of bias.
25 as a \"other\" bias, our preset evaluation criteria are as follows :(a)
Adequate and appropriate inclusion and exclusion criteria ,(b)
Differences between treatment group and control group at baseline (confounding)and (c)
The suitability of deploying statistical tests.
External effectiveness was assessed based on population, age range and clinical relevance measured by intervention measures and results.
To evaluate accuracy, sample size, statistical power calculation performance, and p-values used to define statistical significance were considered.
In the Cochrane Collaboration tool, each project is classified as a risk of bias for \"high\", \"low\" or \"unclear.
No total score is given.
The external validity and accuracy of each study were individually rated as \"high\", \"low\" or \"unclear\" risks.
Overall, based on a comprehensive assessment of their internal effectiveness, external effectiveness and accuracy independently conducted by the two authors, the study was characterized as \"good\", \"moderate\" or \"poor\" quality (DC and CC)
In cases where the two judgments are different, the opinion of the third author is provided.
The criteria for comprehensive quality assessment are as follows: \"good \"-
Quality studies have a \"high\" risk of bias in the internal validity category, external validity and accuracy of 2 internal validity categories, external validity, and accuracy.
Data extraction: the first author initially read every qualified article to gain familiarity, followed by a re-reading of each article
For ease of analysis and presentation, read and its key features are extracted and inserted into tables in Microsoft Word.
For the presentation of results, the results are divided into medium-term (up to 1-year follow-up)and long term (more than 1-year follow-up).
In the medium and long term, results are reported at more than one point in time, which is the longest
In the results table, the term results are used for each study;
However, subsequent findings
The up stage is described in the text of the result section.
When the study used tools and questionnaires as part of the outcome measurement, their results were listed under the generic outcome category according to the purpose of the questionnaire.
If the results of their testator components are also presented, additional results are listed under the corresponding result category: for example, where the Oxford shoulder score is used, the purpose is to use the overall score results of functional evaluation for \"function \";
If the findings of specific questions of the questionnaire survey related to \"pain\" are also described, this specific result is also used for \"pain\", etc.
Result category \"complexity\" includes all general and surgery
Specific surgical and postoperative complications, as well as cases where the disease develops to complete tendon tear and other weakness (
For example, sexual capsule inflammation).
To classify the strength of evidence for each outcome reported, we used a rating system developed by Van Tulder et al, 26 consisting of four levels of evidence: Strong evidence (Level 1)
Provided by consistent findings across multiple high-
Random control test of quality (RCTs).
Medium evidence (Level 2)
Provided by a highly consistent survey.
High quality randomized controlled trials and one or more low
High quality randomized controlled trials, or through multiple low-quality RCTs.
Limited or conflicting evidence (Level 3)
Only 1 randomized controlled trial (
High quality or low quality)
, Or found inconsistency in multiple randomized controlled trials. No evidence (Level 4)
It is defined by no randomized controlled trial.
As our overall quality assessment includes \"modernization \"--
Quality category, we extend level 2 to \"from high-
High quality randomized controlled trials and one or more low
Quality or medium-
Quality randomized controlled trials or multiplemoderate-quality RCTs’.
Two authors (DC and CC)
According to the above system, the level of evidence for each result is jointly determined without any disagreement.
When based on strong or medium evidence, the result is considered significant.
Definition and naming therapy (
Any routine tendon rehabilitation programme designed to strengthen the affected tendons includes \"supervised exercise\" and \"eccentric training \";
Standard postoperative rehabilitation is not included); sham surgery (
A fake surgical intervention that ignores steps deemed necessary for treatment); ORI-TETS (
Tennis elbow detection system of Orthopedic Research Institute); OSS (
Oxford shoulder rating); SDQ (
Strengths and Difficulties Questionnaire); HADS (
Hospital Anxiety and depression score); VAS (
Visual simulation scale); EQ VAS (EuroQoL VAS); EQ-5D-3L (
5-dimensional 3-level index of quality of life in Europe); PRIM (
Research and Intervention programs in monotonous work); QoL (Quality of Life); UCLA (
University of California, Los Angeles; VISA (
School of Sports assessment Victoria);
ROM: mobile range; 15D (15-dimensional).
Results a total of 12 eligible studies were identified, with 1051 participants (mean 87. 4±80. 9)
Affected tendon n = 1056 (five bilateral);
Among them, n = 459 tendon underwent surgery and n = 258 tendon underwent non-operation
Surgical treatment (
N = 178 physiotherapy, n = 50 ESWT, n = 30 placebo laser, n = 20 Botox, n = 10 polycarl)
, N = 116 had a fake operation (placebo)
, N = 30 has a tuned laser (placebo)
N = 104 observed only (no treatment).
Consider combined treatment (
Physiotherapy surgery
In three studies, it was specifically noted that postoperative physiotherapy was the same or similar to the protocol implemented by only the physiotherapy group.
27-29 patients undergoing surgical treatment in all other studies followed a standard postoperative rehabilitation plan.
The affected tendon has a shoulder tendon disease (n=876)
Tendon disease outside the elbow (n=122)
Tendinopathy (n=40)
Or Achilles tendon terminal disease (n=20).
Tendon for surgical treatment (
Including fake surgery)
, N = 177 open surgery, n = 398 arthroscopic surgery.
For patients with lateral tendon disease at the elbow, all cases are open for Achilles tendon and knee tendon disease surgery, while shoulder tendon disease surgery is either open (n=45)
Or arthroscopic (n=398).
A total of eight studies were controlled because at least one of their treatment groups received placebo (
De-tuning laser or false surgery)
Or an exercise system that has been proven to be effective repeatedly, is currently recommended as the first
First-line treatment of all tendon diseases.
The average age is 48. 0 years (range 18–72).
All studies include patients with chronic terminal disease (
Duration of symptoms> 3 months).
Follow length-
Ranging from 6 months to> 10 years (
Median 12 months).
The year of publication is from 1993 to 2018.
Table 1 shows the method features, and Table 2 shows a summary of the samples, interventions, and outcome measurements included in the study.
View this table: View the inline View pop-up table 1 contains the method features of the study View this table: look at the inline View pop-up table 2 sample, interventions, and results the description of the measurement quality assessment the accuracy and overall quality of each study.
Six studies were found to have \"poor\" overall quality, four \"medium\" quality, and two \"good\" quality.
View this table: conduct a quality assessment of the included studies. Twelve studies of internal validity selection biasAll were random. Nine (9)
The study was considered to have a \"low\" risk of bias, and a study was marked as \"high risk\" because the randomized grouping was based on whether ESWT\'s reimbursement was approved by the insurance company.
30 in two studies 31 32, the random method was not described in sufficient detail (‘unclear’ risk).
In seven studies, the risk of bias in the allocation of hidden aspects was considered to be \"low\", and any of them were randomly conducted by independent statisticians, the central telephone random Center or the author specifically states that a sealed/Closed/opaque envelope is used.
22 27 29 31 33-35 as no details were provided, the remaining 5 were classified as \"unclear\" risks.
In two studies comparing surgery to false surgery, the performance of patients with bias was only blind.
However, in the study of Beard et al, only two of the three groups were blind.
Since some patients did not receive treatment, the study part of the comparison between the operation group and the non-treatment group was rated as \"high risk\" deviation;
Part of the risk of comparing the two surgical treatments was \"low \".
In the remaining 10 studies, it was not possible to blind participants (surgery vs non-
Surgical treatment; ‘high’ risk).
The detection deviation of the result measurement is considered sufficient (‘low’ risk)
In the study, trying to pass (a)
Using an independent assessor ,(b)
Participants are required not to disclose the nature of their treatment to the assessor and (c)wear t-
Shirts that hide surgical scars are applicable.
22 28 29 34 36 37 all other studies (n=6)
Labeled \"high risk.
All studies fully reported the natural attrition reasons for the dropout/withdrawal of participants (‘low’ risk)but one37 (‘high’ risk). Rate of follow-
Farfaras et al thought the risk of up completion was \"high\" in the study, with only 63% at the age of 28.
22 follow-up articles in Kroslak & Murrell\'s research
The graduation rate is 85%.
The rating results of clinical tests were only 42%;
However, the study was rated as a \"low\" risk of bias as the main outcome measure was self-rated (
Frequency of elbow pain during 6 months of activity).
The results of the report were found to be inappropriate or inadequate in five studies (‘high’ risk);
Alfredson et al, 33 Rahme et al, 37 and Ketola et al, 29 only include self
The parameters reported in their outcome measurement, in addition, the first two studies only included pain VAS (Rahme et al37)
Pain and satisfaction (
Alfred and others.
Keizer et al used classification variables in their analysis, and in some cases the number of categories was small;
For example, ROM is classified as \"normal\" or \"limited \"(>5 degrees)’.
In addition, there is no graphical or table representation of the results of Alfredson et al.
Brox et al 36 and Alfredson et al 33 did not provide details, statistical comparisons or p-values of some of their findings.
The remaining six studies were rated as \"low risk \".
Other inclusion and exclusion criteria other than the two studies are considered sufficient: there is no reference to any eligibility criteria at all by Alfredson et al 33, the exclusion criteria for Rahme et al. 37 are limited to \"patients with glenohumeral osteoarthritis and who need to remove the lateral end of the collarbone \".
In addition to the two studies, all studies showed baseline features of the treatment control group (‘high’ risk;
Alfredson et al 33 and lachme et al 37).
Of the remaining 10 studies, one did not perform statistical analysis on both groups at baseline (‘unclear’ risk; Radwan et al38)
Only the measure of results is compared, not the demographics (‘unclear’ risk; Ketola et al29). Eight (8)
Appropriate baseline comparisons were conducted in the study;
Five of them reported no difference in demographics or outcome measures between treatment groups (‘low’ risk;
Bahr et al, 27 Beard et al, 34 faras et al, 28 Kroslak & Murrell, 22 Rompe et al.
The other three identified some insignificant differences that were considered to introduce the \"low\" risk of bias (
Brox et al, 36 Haahr et al 35 and Keizer et al 32 (table 1).
The risk of \"other\" bias in the study of Keizer et al 32 was classified as \"high\" because some patients in their Botox group received a second injection after 6 weeks
And some others ended the operation.
With the exception of Rahme et al 37, all studies conducted appropriate statistical tests and comparisons using \"treatment\" instead of \"intent\"to-
At 12 months, the basis of treatment at the time of each group was compared, although the author himself acknowledged this restriction in the manuscript.
General external validity, non-
A specific population is used in all studies.
The age range of participants was wide enough to have a good generalization ability in all studies.
Clinical-related assessment tools and outcome measurements were used in nine studies.
Alfredson et al. 33 and lachme et al. 37 include themselves
Reported pain and satisfaction, while more measures were used by Ketola et 29, however, all of them were self-reported (‘high’ risk).
The nature, frequency and intensity of physiotherapy considered appropriate were used and there were no guidelines on the best formula or dose of other non-physical therapies
Surgical treatment (
Botox, polybeno and ESWT)
In clinical practice
Therefore, all doses and frequencies used are considered clinically relevant (‘low’ risk).
In addition to the three studies, all studies performed accurate statistical power calculations prior to recruitment (
Alfredson et al, 33 Keizer et al 32 and Rompe et al 30).
The sample size of Alfredson et al 33 and Keizer et al 32 was small (
N = 20 and n = 40, respectively)
Except that they do not perform statistical power calculations;
They are therefore rated as \"high risk\" bias.
Research by Rompe et al was classified as \"unclear\" risk as it had a much larger sample size (n=79)
Comparable to the study of the power to recruit at least 80% people.
In the case of power calculation, the sample size was at least 80% in addition to the study by Farfaras et al (‘high’ risk).
The significance level is set to p = 0.
05 in all studies, the level of notability was not indicated except for the study by Alfredson et al.
The included findings 4a and B provide a mid-term Summary (up to 1-year follow-up)and long-term (>1-year follow-up)
Results and the level of evidence for the overall results measured by each result.
View this table: View the inline View pop-up table 4a Mid-term results (1-year follow-up)
Comparison between surgery and non-surgery
Quality studies compared to surgery that did not treat shoulder tendonitis.
In a study by Beard et al, 06:34 P. M. month and 12-month follow-
Two surgical groups (
Corrective surgery and false surgery)
The OSS was statistically higher than the non-treatment group.
Similar patterns were observed in secondary outcomes, and all of these patterns improved 6 months after corrective surgery compared to non-treatment groups.
Modified constant-
Murley and HADS were statistically more prone to sham-operated groups than those not treated.
At 12 months, the only significant difference was observed in the modified constant
Murley scores were higher in both surgical groups compared to those in the non-treatment group.
Similarly, the patient satisfaction of the two surgical groups at 6 months was statistically higher than that of the non-treatment group;
At 12 months, only a few parameters were statistically significant and were beneficial to the surgery group.
Compared to placebo
Except for fake surgery)One moderate-
Quality studies of surgery and placebo were compared in patients with shoulder tendonitis.
Brox et al. 36 found a detuned laser (placebo)
Compared with the other two treatment groups, the group had a lower average improvement in the Neer score and all its sub-components at 6 months, at this point the author decided not to assign more patients to the placebo group because it seemed inferior.
Successful treatment 2. 5-year follow-
Up is also beneficial to the operation group, but there is no treatment in the statistical sense.
Surgery and false surgery
Quality studies compared to fake surgery.
Kroslak & Murrell22 reported no statistically significant differences in perceived pain, function, and 6-recovery between the two groupsmonth and>12-month follow-up.
Both groups have significantly improved themselves.
Rated frequency and severity of pain, elbow stiffness and at 6-month and>12-month follow-
And the pain of the upper lip, the front-
The range of rotation, grip strength and modified ORI-TETS at 6-month follow-
There was an increase compared to baseline.
In the study of 6-34, Beard et al. month and 12-month follow-
Two surgical groups (
Corrective surgery and false surgery)
Statistically was higher than the non-treatment group.
Six studies compared surgery and physiotherapy for shoulder tendon disease (n=5)
And patellar tendon disease (n=1).
Among them, 3 are medium and 3 have poor comprehensive quality.
Brox et al36 is the first person to compare surgery and any conservative management pattern with a randomized study in patients with shoulder tendinosis.
Compared with arthroscopic surgery and physiotherapy, there was no statistically significant difference in Neer score improvement and pain relief, from moderate to mild, in favor of the surgery group.
When the comparison was adjusted for gender, the latter outcome measure was found to be statistically significant (
Fewer women in the surgical group at baseline)
Favor of surgery group. At 2. 5-year follow-
Success rate (
Defined as Neer score> 80)
There is a similarity between those who only take exercise and those who undergo surgery.
In a similar study for patients with shoulder tendon disease, Haahr et al reported no difference in constant scores (Main results)and its sub-scores (
Pain, function, ROM, force)
In more than a year, between the two groups.
Differences in secondary results (
Pain and dysfunction)were also non-
In 1-year follow-up.
6 patients in physiotherapy group (14%)
The operation was completed within 12 months;
12-month comparison based on \"intention\"to-
The results may be biased towards the treatment of the physiotherapy group.
The same group 38 later found that there was no significant difference between the two groups in terms of income transfer and received a disability pension 4 Years After inclusion and self-compensation
The results of the report are measured based on the PRIM score of 4-8 years after inclusion.
In a study of shoulder tendonitis, 37-year-old Rahme et al investigated surgical patients undergoing postoperative physiotherapy, whose nature or further details were not reported;
So we don\'t think it\'s a comprehensive treatment.
Although the focus of this study is on predictors and pain
Mechanism of generation, in 6-month follow-
In the two groups, there was no difference in the proportion of the initial total pain reduction of at least 50%. After the 6-
At a point in the month, more than half of the physiotherapy group was given the opportunity to operate and at 12-month follow-
Up is presented with \"treatment\" instead of \"intention\"to-treat’ basis.
In their study, Ketola et al. 29 found no difference between shoulder tendinosis patients undergoing physiotherapy and those undergoing physiotherapy (self-rated pain)or secondary (
Disability, pain at night, SDQ score, number of days of pain, proportion of painfree patients)outcomes at 2-and 5-year follow-up.
The two groups showed statistically significant differences in all outcome measurementsyear follow-
There was an increase compared to baseline.
In another study of shoulder tendon disease in Farfaras et al, there were 28 cases in both surgical groups (
Open and arthroscopic)
After surgery, the same physiotherapy regimen was accepted as only in the physiotherapy group.
Three treatment groups were in overall SF-compared to baseline-
36 points in the follow-upup (mean 31 months)
There are no group differences.
All three groups had significant improvement in internal rotation at follow-up
There was no significant difference between groups compared to baseline.
From baseline to follow-up, the continuous score has increased in Statistical significance
Rise in the two surgical groups but not in the physiotherapy group;
However, no significant inter-group differences were observed.
At follow-up, the activity enhancement intensity of the open operation group was only significantly improved
Compared to baseline, but again, the three groups were statistically similar at follow-upup.
The same group reported the same patient at> 10-year follow-
More like surgery than physiotherapy
Compared with the physiotherapy group, the activity-enhancing ROM in the operation group was significantly improved, and the internal rotation in all groups was improved from baseline to follow-up
Inter-group and muscle strength improved significantly only at follow-up
There was no difference between groups in the open operation group.
Bahr et al. found in the study of patellar tendon terminal disease that VISA scores in both groups increased significantly over time;
However, at any stage of follow-up, there was no statistically significant difference between groupsup.
Similarly, the legs have improved --
In the two groups, the stress intensity was tested over time, but there was no difference between groups.
At any subsequent stage, the jump height of the two groups has not changed
The two groups were statistically similar compared to baseline.
Compared with baseline, the pain scores of the two groups during the functional test improved at 12 months, but did not improve at 6 months and there was no difference between the groups.
Similarly, at 12 months there was no difference in overall treatment satisfaction or return to motor status between groups.
Finally, regarding the global assessment score, the statistical significance results of the eccentric group in 3 months were improved compared with the Operation Group;
However, at 6 and 12 months, the two groups were statistically similar.
Surgery and ESWTOne-
Quality Research and a medium
Comparison of quality research (open)
Operation of chronic endinopathy with ESWT.
Rompe et al30 tested these two patterns in patients with shoulder tendonitis and reported that, at 24 months of follow-up, the UCLA score in the surgical group and ESWT Groupup. Self-
Rated pain relief at 24-hourmonth follow-
The up of the two groups is similar.
Finally, hospital stay and absence time in the ESWT group were significantly shortened.
In the study of Radwan et al, 31 patients with surgically treated lateral elbow tendon disease had no significant difference in any outcome measure compared to patients who received ESWT at any one follow-upup stages.
In all outcome measurements in both treatment groups, significant improvement over time was observed.
Surgery and botoxOne-
The quality study compared surgery and Botox injection for chronic lateral elbow tendonitis.
32 in terms of overall results and pain, the two treatment groups were statistically comparable in all follow-up visitsup stages.
Compared with the Botox group, the surgical group showed greater extension defects at 3 and 6 months, but the time difference disappeared at 12 and 24 months.
At 3 months, sick leave in the surgical group and Botox group was significantly shortened;
However, there is no statistical significance anymore.
Differences in terms were observed.
Poor Polly Cabano-
The quality study assigns patients with Achilles tendon terminal disease to two types of surgery (colour Doppler-guided)
Or injection of polycarl. 33 At 12-week follow-
Up, 67% of patients in the polidocanol group and 80% of patients in the surgical group were satisfied with the results and returned to their preoperative
Recreational/sports activities (
No statistical comparison is presented).
Pain scores in both groups were statistically lower compared to baseline, although no-
Presenting Group statistics, pain improvement seemed similar in both groups at 12 weeks (
The VAS score of the Polidocanol group was 76 to 24 points, and the surgical group was 75 to 21 points).
At 6 months, 100% of the group in the surgery group and 67% of the polydrocapol group were satisfied with the treatment and returned to their preoperative
Entertainment/sports activities;
Similarly, no statistical comparisons were reported.
Quality Evaluation Form 3 illustrates our assessment of the internal effectiveness, external effectiveness, accuracy and overall quality of each study.
Six studies were found to have \"poor\" overall quality, four \"medium\" quality, and two \"good\" quality.
View this table: conduct a quality assessment of the included studies. Twelve studies of internal validity selection biasAll were random. Nine (9)
The study was considered to have a \"low\" risk of bias, and a study was marked as \"high risk\" because the randomized grouping was based on whether ESWT\'s reimbursement was approved by the insurance company.
30 in two studies 31 32, the random method was not described in sufficient detail (‘unclear’ risk).
In seven studies, the risk of bias in the allocation of hidden aspects was considered to be \"low\", and any of them were randomly conducted by independent statisticians, the central telephone random Center or the author specifically states that a sealed/Closed/opaque envelope is used.
22 27 29 31 33-35 as no details were provided, the remaining 5 were classified as \"unclear\" risks.
In two studies comparing surgery to false surgery, the performance of patients with bias was only blind.
However, in the study of Beard et al, only two of the three groups were blind.
Since some patients did not receive treatment, the study part of the comparison between the operation group and the non-treatment group was rated as \"high risk\" deviation;
Part of the risk of comparing the two surgical treatments was \"low \".
In the remaining 10 studies, it was not possible to blind participants (surgery vs non-
Surgical treatment; ‘high’ risk).
The detection deviation of the result measurement is considered sufficient (‘low’ risk)
In the study, trying to pass (a)
Using an independent assessor ,(b)
Participants are required not to disclose the nature of their treatment to the assessor and (c)wear t-
Shirts that hide surgical scars are applicable.
22 28 29 34 36 37 all other studies (n=6)
Labeled \"high risk.
All studies fully reported the natural attrition reasons for the dropout/withdrawal of participants (‘low’ risk)but one37 (‘high’ risk). Rate of follow-
Farfaras et al thought the risk of up completion was \"high\" in the study, with only 63% at the age of 28.
22 follow-up articles in Kroslak & Murrell\'s research
The graduation rate is 85%.
The rating results of clinical tests were only 42%;
However, the study was rated as a \"low\" risk of bias as the main outcome measure was self-rated (
Frequency of elbow pain during 6 months of activity).
The results of the report were found to be inappropriate or inadequate in five studies (‘high’ risk);
Alfredson et al, 33 Rahme et al, 37 and Ketola et al, 29 only include self
The parameters reported in their outcome measurement, in addition, the first two studies only included pain VAS (Rahme et al37)
Pain and satisfaction (
Alfred and others.
Keizer et al used classification variables in their analysis, and in some cases the number of categories was small;
For example, ROM is classified as \"normal\" or \"limited \"(>5 degrees)’.
In addition, there is no graphical or table representation of the results of Alfredson et al.
Brox et al 36 and Alfredson et al 33 did not provide details, statistical comparisons or p-values of some of their findings.
The remaining six studies were rated as \"low risk \".
Other inclusion and exclusion criteria other than the two studies are considered sufficient: there is no reference to any eligibility criteria at all by Alfredson et al 33, the exclusion criteria for Rahme et al. 37 are limited to \"patients with glenohumeral osteoarthritis and who need to remove the lateral end of the collarbone \".
In addition to the two studies, all studies showed baseline features of the treatment control group (‘high’ risk;
Alfredson et al 33 and lachme et al 37).
Of the remaining 10 studies, one did not perform statistical analysis on both groups at baseline (‘unclear’ risk; Radwan et al38)
Only the measure of results is compared, not the demographics (‘unclear’ risk; Ketola et al29). Eight (8)
Appropriate baseline comparisons were conducted in the study;
Five of them reported no difference in demographics or outcome measures between treatment groups (‘low’ risk;
Bahr et al, 27 Beard et al, 34 faras et al, 28 Kroslak & Murrell, 22 Rompe et al.
The other three identified some insignificant differences that were considered to introduce the \"low\" risk of bias (
Brox et al, 36 Haahr et al 35 and Keizer et al 32 (table 1).
The risk of \"other\" bias in the study of Keizer et al 32 was classified as \"high\" because some patients in their Botox group received a second injection after 6 weeks
And some others ended the operation.
With the exception of Rahme et al 37, all studies conducted appropriate statistical tests and comparisons using \"treatment\" instead of \"intent\"to-
At 12 months, the basis of treatment at the time of each group was compared, although the author himself acknowledged this restriction in the manuscript.
Twelve studies were random. Nine (9)
The study was considered to have a \"low\" risk of bias, and a study was marked as \"high risk\" because the randomized grouping was based on whether ESWT\'s reimbursement was approved by the insurance company.
30 in two studies 31 32, the random method was not described in sufficient detail (‘unclear’ risk).
In seven studies, the risk of bias in the allocation of hidden aspects was considered to be \"low\", and any of them were randomly conducted by independent statisticians, the central telephone random Center or the author specifically states that a sealed/Closed/opaque envelope is used.
22 27 29 31 33-35 as no details were provided, the remaining 5 were classified as \"unclear\" risks.
In two studies comparing surgery to false surgery, the performance of patients with bias was only blind.
However, in the study of Beard et al, only two of the three groups were blind.
Since some patients did not receive treatment, the study part of the comparison between the operation group and the non-treatment group was rated as \"high risk\" deviation;
Part of the risk of comparing the two surgical treatments was \"low \".
In the remaining 10 studies, it was not possible to blind participants (surgery vs non-
Surgical treatment; ‘high’ risk).
The detection deviation of the result measurement is considered sufficient (‘low’ risk)
In the study, trying to pass (a)
Using an independent assessor ,(b)
Participants are required not to disclose the nature of their treatment to the assessor and (c)wear t-
Shirts that hide surgical scars are applicable.
22 28 29 34 36 37 all other studies (n=6)
Labeled \"high risk.
All studies fully reported the natural attrition reasons for the dropout/withdrawal of participants (‘low’ risk)but one37 (‘high’ risk). Rate of follow-
Farfaras et al thought the risk of up completion was \"high\" in the study, with only 63% at the age of 28.
22 follow-up articles in Kroslak & Murrell\'s research
The graduation rate is 85%.
The rating results of clinical tests were only 42%;
However, the study was rated as a \"low\" risk of bias as the main outcome measure was self-rated (
Frequency of elbow pain during 6 months of activity).
The results of the report were found to be inappropriate or inadequate in five studies (‘high’ risk);
Alfredson et al, 33 Rahme et al, 37 and Ketola et al, 29 only include self
The parameters reported in their outcome measurement, in addition, the first two studies only included pain VAS (Rahme et al37)
Pain and satisfaction (
Alfred and others.
Keizer et al used classification variables in their analysis, and in some cases the number of categories was small;
For example, ROM is classified as \"normal\" or \"limited \"(>5 degrees)’.
In addition, there is no graphical or table representation of the results of Alfredson et al.
Brox et al 36 and Alfredson et al 33 did not provide details, statistical comparisons or p-values of some of their findings.
The remaining six studies were rated as \"low risk \".
Other inclusion and exclusion criteria other than the two studies are considered sufficient: there is no reference to any eligibility criteria at all by Alfredson et al 33, the exclusion criteria for Rahme et al. 37 are limited to \"patients with glenohumeral osteoarthritis and who need to remove the lateral end of the collarbone \".
In addition to the two studies, all studies showed baseline features of the treatment control group (‘high’ risk;
Alfredson et al 33 and lachme et al 37).
Of the remaining 10 studies, one did not perform statistical analysis on both groups at baseline (‘unclear’ risk; Radwan et al38)
Only the measure of results is compared, not the demographics (‘unclear’ risk; Ketola et al29). Eight (8)
Appropriate baseline comparisons were conducted in the study;
Five of them reported no difference in demographics or outcome measures between treatment groups (‘low’ risk;
Bahr et al, 27 Beard et al, 34 faras et al, 28 Kroslak & Murrell, 22 Rompe et al.
The other three identified some insignificant differences that were considered to introduce the \"low\" risk of bias (
Brox et al, 36 Haahr et al 35 and Keizer et al 32 (table 1).
The risk of \"other\" bias in the study of Keizer et al 32 was classified as \"high\" because some patients in their Botox group received a second injection after 6 weeks
And some others ended the operation.
With the exception of Rahme et al 37, all studies conducted appropriate statistical tests and comparisons using \"treatment\" instead of \"intent\"to-
At 12 months, the basis of treatment at the time of each group was compared, although the author himself acknowledged this restriction in the manuscript.
General external validity, non-
A specific population is used in all studies.
The age range of participants was wide enough to have a good generalization ability in all studies.
Clinical-related assessment tools and outcome measurements were used in nine studies.
Alfredson et al. 33 and lachme et al. 37 include themselves
Reported pain and satisfaction, while more measures were used by Ketola et 29, however, all of them were self-reported (‘high’ risk).
The nature, frequency and intensity of physiotherapy considered appropriate were used and there were no guidelines on the best formula or dose of other non-physical therapies
Surgical treatment (
Botox, polybeno and ESWT)
In clinical practice
Therefore, all doses and frequencies used are considered clinically relevant (‘low’ risk).
In addition to the three studies, all studies performed accurate statistical power calculations prior to recruitment (
Alfredson et al, 33 Keizer et al 32 and Rompe et al 30).
The sample size of Alfredson et al 33 and Keizer et al 32 was small (
N = 20 and n = 40, respectively)
Except that they do not perform statistical power calculations;
They are therefore rated as \"high risk\" bias.
Research by Rompe et al was classified as \"unclear\" risk as it had a much larger sample size (n=79)
Comparable to the study of the power to recruit at least 80% people.
In the case of power calculation, the sample size was at least 80% in addition to the study by Farfaras et al (‘high’ risk).
The significance level is set to p = 0.
05 in all studies, the level of notability was not indicated except for the study by Alfredson et al.
The included findings 4a and B provide a mid-term Summary (up to 1-year follow-up)and long-term (>1-year follow-up)
Results and the level of evidence for the overall results measured by each result.
View this table: View the inline View pop-up table 4a Mid-term results (1-year follow-up)
Comparison between surgery and non-surgery
Quality studies compared to surgery that did not treat shoulder tendonitis.
In a study by Beard et al, 06:34 P. M. month and 12-month follow-
Two surgical groups (
Corrective surgery and false surgery)
The OSS was statistically higher than the non-treatment group.
Similar patterns were observed in secondary outcomes, and all of these patterns improved 6 months after corrective surgery compared to non-treatment groups.
Modified constant-
Murley and HADS were statistically more prone to sham-operated groups than those not treated.
At 12 months, the only significant difference was observed in the modified constant
Murley scores were higher in both surgical groups compared to those in the non-treatment group.
Similarly, the patient satisfaction of the two surgical groups at 6 months was statistically higher than that of the non-treatment group;
At 12 months, only a few parameters were statistically significant and were beneficial to the surgery group.
Compared to placebo
Except for fake surgery)One moderate-
Quality studies of surgery and placebo were compared in patients with shoulder tendonitis.
Brox et al. 36 found a detuned laser (placebo)
Compared with the other two treatment groups, the group had a lower average improvement in the Neer score and all its sub-components at 6 months, at this point the author decided not to assign more patients to the placebo group because it seemed inferior.
Successful treatment 2. 5-year follow-
Up is also beneficial to the operation group, but there is no treatment in the statistical sense.
Surgery and false surgery
Quality studies compared to fake surgery.
Kroslak & Murrell22 reported no statistically significant differences in perceived pain, function, and 6-recovery between the two groupsmonth and>12-month follow-up.
Both groups have significantly improved themselves.
Rated frequency and severity of pain, elbow stiffness and at 6-month and>12-month follow-
And the pain of the upper lip, the front-
The range of rotation, grip strength and modified ORI-TETS at 6-month follow-
There was an increase compared to baseline.
In the study of 6-34, Beard et al. month and 12-month follow-
Two surgical groups (
Corrective surgery and false surgery)
Statistically was higher than the non-treatment group.
Six studies compared surgery and physiotherapy for shoulder tendon disease (n=5)
And patellar tendon disease (n=1).
Among them, 3 are medium and 3 have poor comprehensive quality.
Brox et al36 is the first person to compare surgery and any conservative management pattern with a randomized study in patients with shoulder tendinosis.
Compared with arthroscopic surgery and physiotherapy, there was no statistically significant difference in Neer score improvement and pain relief, from moderate to mild, in favor of the surgery group.
When the comparison was adjusted for gender, the latter outcome measure was found to be statistically significant (
Fewer women in the surgical group at baseline)
Favor of surgery group. At 2. 5-year follow-
Success rate (
Defined as Neer score> 80)
There is a similarity between those who only take exercise and those who undergo surgery.
In a similar study for patients with shoulder tendon disease, Haahr et al reported no difference in constant scores (Main results)and its sub-scores (
Pain, function, ROM, force)
In more than a year, between the two groups.
Differences in secondary results (
Pain and dysfunction)were also non-
In 1-year follow-up.
6 patients in physiotherapy group (14%)
The operation was completed within 12 months;
12-month comparison based on \"intention\"to-
The results may be biased towards the treatment of the physiotherapy group.
The same group 38 later found that there was no significant difference between the two groups in terms of income transfer and received a disability pension 4 Years After inclusion and self-compensation
The results of the report are measured based on the PRIM score of 4-8 years after inclusion.
In a study of shoulder tendonitis, 37-year-old Rahme et al investigated surgical patients undergoing postoperative physiotherapy, whose nature or further details were not reported;
So we don\'t think it\'s a comprehensive treatment.
Although the focus of this study is on predictors and pain
Mechanism of generation, in 6-month follow-
In the two groups, there was no difference in the proportion of the initial total pain reduction of at least 50%. After the 6-
At a point in the month, more than half of the physiotherapy group was given the opportunity to operate and at 12-month follow-
Up is presented with \"treatment\" instead of \"intention\"to-treat’ basis.
In their study, Ketola et al. 29 found no difference between shoulder tendinosis patients undergoing physiotherapy and those undergoing physiotherapy (self-rated pain)or secondary (
Disability, pain at night, SDQ score, number of days of pain, proportion of painfree patients)outcomes at 2-and 5-year follow-up.
The two groups showed statistically significant differences in all outcome measurementsyear follow-
There was an increase compared to baseline.
In another study of shoulder tendon disease in Farfaras et al, there were 28 cases in both surgical groups (
Open and arthroscopic)
After surgery, the same physiotherapy regimen was accepted as only in the physiotherapy group.
Three treatment groups were in overall SF-compared to baseline-
36 points in the follow-upup (mean 31 months)
There are no group differences.
All three groups had significant improvement in internal rotation at follow-up
There was no significant difference between groups compared to baseline.
From baseline to follow-up, the continuous score has increased in Statistical significance
Rise in the two surgical groups but not in the physiotherapy group;
However, no significant inter-group differences were observed.
At follow-up, the activity enhancement intensity of the open operation group was only significantly improved
Compared to baseline, but again, the three groups were statistically similar at follow-upup.
The same group reported the same patient at> 10-year follow-
More like surgery than physiotherapy
Compared with the physiotherapy group, the activity-enhancing ROM in the operation group was significantly improved, and the internal rotation in all groups was improved from baseline to follow-up
Inter-group and muscle strength improved significantly only at follow-up
There was no difference between groups in the open operation group.
Bahr et al. found in the study of patellar tendon terminal disease that VISA scores in both groups increased significantly over time;
However, at any stage of follow-up, there was no statistically significant difference between groupsup.
Similarly, the legs have improved --
In the two groups, the stress intensity was tested over time, but there was no difference between groups.
At any subsequent stage, the jump height of the two groups has not changed
The two groups were statistically similar compared to baseline.
Compared with baseline, the pain scores of the two groups during the functional test improved at 12 months, but did not improve at 6 months and there was no difference between the groups.
Similarly, at 12 months there was no difference in overall treatment satisfaction or return to motor status between groups.
Finally, regarding the global assessment score, the statistical significance results of the eccentric group in 3 months were improved compared with the Operation Group;
However, at 6 and 12 months, the two groups were statistically similar.
Surgery and ESWTOne-
Quality Research and a medium
Comparison of quality research (open)
Operation of chronic endinopathy with ESWT.
Rompe et al30 tested these two patterns in patients with shoulder tendonitis and reported that, at 24 months of follow-up, the UCLA score in the surgical group and ESWT Groupup. Self-
Rated pain relief at 24-hourmonth follow-
The up of the two groups is similar.
Finally, hospital stay and absence time in the ESWT group were significantly shortened.
In the study of Radwan et al, 31 patients with surgically treated lateral elbow tendon disease had no significant difference in any outcome measure compared to patients who received ESWT at any one follow-upup stages.
In all outcome measurements in both treatment groups, significant improvement over time was observed.
Surgery and botoxOne-
The quality study compared surgery and Botox injection for chronic lateral elbow tendonitis.
32 in terms of overall results and pain, the two treatment groups were statistically comparable in all follow-up visitsup stages.
Compared with the Botox group, the surgical group showed greater extension defects at 3 and 6 months, but the time difference disappeared at 12 and 24 months.
At 3 months, sick leave in the surgical group and Botox group was significantly shortened;
However, there is no statistical significan
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