• Karin M Thijs, Johannes Zwerver, Frank J G Backx, Victor Steeneken, Stephan Rayer, Petra Groenenboom, and Maarten H Moen.
• *Department of Rehabilitation, Nursing Science and Sport, University Medical Centre Utrecht, Utrecht, the Netherlands; †Center for Sports Medicine Groningen, University Medical Center Groningen, University of Groningen, the Netherlands; ‡Department of Physical Therapy, Orthopedic Centre Annatommie MC, Utrecht, the Netherlands; §Department of Physical Therapy, Rayer Health Care Physical Therapy, Zoetermeer, the Netherlands; ¶Department of Sports Medicine, Medical Centre Haaglanden, Leidschendam, the Netherlands; ‖Department of Sports Medicine, Bergman Clinics, Naarden, the Netherlands; and **The Sportsphysician Group, OLVG West, Amsterdam, the Netherlands.
• Clin J Sport Med. 2017 Mar 1; 27 (2): 89-96.

ObjectiveTo evaluate the effectiveness of a combined treatment of focused shockwave therapy (ESWT) and eccentric training compared with sham-shockwave therapy (placebo) and eccentric training in participants with patellar tendinopathy (PT) after 24 weeks.DesignRandomized controlled trial.SettingSports medicine departments of a university hospital and a general hospital in the Netherlands.ParticipantsFifty-two physically active male and female participants with a clinical diagnosis of PT (mean age: 28.6 years; range, 18-45) were randomly allocated to the ESWT (n = 22) or sham shockwave (n = 30).InterventionsExtracorporeal shockwave therapy and sham shockwave were applied in 3 sessions at 1-week intervals with a piezoelectric device. All participants were instructed to perform eccentric exercises (3 sets of 15 repetitions twice a day) for 3 months on a decline board at home.Main Outcome MeasuresThe Victorian Institute of Sport Assessment-Patella (VISA-P) scores (primary), pain scores during functional knee loading tests, and Likert score (secondary) were registered at baseline and at 6, 12, and 24 weeks after the start with the ESWT or sham-shockwave treatment.ResultsNo significant differences for the primary and secondary outcome measures were found between the groups. In the ESWT/eccentric group, the VISA-P increased from 54.5 ± 15.4 to 70.9 ± 17.8, whereas the VISA-P in the sham-shockwave/eccentric group increased from 58.9 ± 14.6 to 78.2 ± 15.8 (between-group change in VISA-P at 24 weeks -4.8; 95% confidence interval, -12.7 to 3.0, P = 0.150).ConclusionsThis study showed no additional effect of 3 sessions ESWT in participants with PT treated with eccentric exercises. The results should be interpreted with caution because of small sample size and considerable loss to follow-up, particularly in the ESWT group.

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