Use of extracorporeal shockwave therapy combined with standard rehabilitation following anterior cruciate ligament reconstruction: a systematic review with meta-analysis
Abstract Background Anterior cruciate ligament (ACL) injuries are one of the most common sports injuries, accounting for approximately 50% of knee-related injuries. Extracorporeal shockwave therapy (ESWT), in the form of the radial (R-SWT) or focused shockwave (F-SWT), has been shown effective in tr...
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BMC
2025-01-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-025-08277-9 |
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| author | Jaehyung Shin Hye Chang Rhim James Kim Raymond Guo Ramy Elshafey Ki-Mo Jang |
| author_facet | Jaehyung Shin Hye Chang Rhim James Kim Raymond Guo Ramy Elshafey Ki-Mo Jang |
| author_sort | Jaehyung Shin |
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| description | Abstract Background Anterior cruciate ligament (ACL) injuries are one of the most common sports injuries, accounting for approximately 50% of knee-related injuries. Extracorporeal shockwave therapy (ESWT), in the form of the radial (R-SWT) or focused shockwave (F-SWT), has been shown effective in treating various orthopaedic conditions. Recently, studies have investigated whether ESWT combined with standard rehabilitation may improve outcomes following anterior cruciate ligament reconstruction (ACLR). Therefore, this study aimed to determine whether ESWT can improve clinical outcomes following ACLR. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched PubMed, Embase, and Web of Science and included studies involving ESWT treatment following ACLR, which consisted of randomized controlled trials (RCTs) and cohort studies. Two authors independently extracted the outcome measurements and used a revised Cochrane risk-of-bias tool (RoB 2) for RCTs and the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) for a cohort study to assess the risk of bias. A random effects pairwise meta-analysis was used to compare patient-reported outcomes between ESWT and controlled treatments. Results Five studies (Level I: 4; Level II: 1) with 242 participants (male: 167; female: 75) were included. Regarding the patient-reported outcomes, the risk of bias for all RCTs was ‘high’ and ‘serious’ for a non-randomized study. The meta-analysis demonstrated that the Lysholm scores were significantly higher in ESWT groups than those of controls at 12 months (Weighted mean difference [WMD]: 7.037, 95% confidence interval [CI]: 6.172–7.902, I2: 0%) and 24 months (WMD: 5.463, 95% CI: 2.870–8.056, I2: 0%). Furthermore, the International Knee Documentation Committee (IKDC) scores were also significantly higher in the ESWT group than that of the control at 12 months (WMD: 6.371, 95% CI: 3.397–9.344, I2: 68.8%). However, the WMDs for these outcomes between the two groups did not exceed the minimal clinically important difference (MCID). Conclusion Based on the meta-analyses performed with a few studies, ESWT combined with standard rehabilitation may potentially lead to better patient-reported outcomes. However, these differences may not be clinically significant. Further high-quality studies are needed to confirm our review’s findings. |
| format | Article |
| id | doaj-art-e4f8e9c8f7ae4d83beedd41cc3b38820 |
| institution | Kabale University |
| issn | 1471-2474 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-e4f8e9c8f7ae4d83beedd41cc3b388202025-01-26T12:10:13ZengBMCBMC Musculoskeletal Disorders1471-24742025-01-0126111410.1186/s12891-025-08277-9Use of extracorporeal shockwave therapy combined with standard rehabilitation following anterior cruciate ligament reconstruction: a systematic review with meta-analysisJaehyung Shin0Hye Chang Rhim1James Kim2Raymond Guo3Ramy Elshafey4Ki-Mo Jang5Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical SchoolFoot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical SchoolChobanian and Avedisian School of Medicine, Boston UniversityDepartment of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation HospitalDepartment of Orthopedics & Rehabilitation, Tufts Medical CenterDepartment of Orthopaedic Surgery, Anam Hospital, Korea University College of MedicineAbstract Background Anterior cruciate ligament (ACL) injuries are one of the most common sports injuries, accounting for approximately 50% of knee-related injuries. Extracorporeal shockwave therapy (ESWT), in the form of the radial (R-SWT) or focused shockwave (F-SWT), has been shown effective in treating various orthopaedic conditions. Recently, studies have investigated whether ESWT combined with standard rehabilitation may improve outcomes following anterior cruciate ligament reconstruction (ACLR). Therefore, this study aimed to determine whether ESWT can improve clinical outcomes following ACLR. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched PubMed, Embase, and Web of Science and included studies involving ESWT treatment following ACLR, which consisted of randomized controlled trials (RCTs) and cohort studies. Two authors independently extracted the outcome measurements and used a revised Cochrane risk-of-bias tool (RoB 2) for RCTs and the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) for a cohort study to assess the risk of bias. A random effects pairwise meta-analysis was used to compare patient-reported outcomes between ESWT and controlled treatments. Results Five studies (Level I: 4; Level II: 1) with 242 participants (male: 167; female: 75) were included. Regarding the patient-reported outcomes, the risk of bias for all RCTs was ‘high’ and ‘serious’ for a non-randomized study. The meta-analysis demonstrated that the Lysholm scores were significantly higher in ESWT groups than those of controls at 12 months (Weighted mean difference [WMD]: 7.037, 95% confidence interval [CI]: 6.172–7.902, I2: 0%) and 24 months (WMD: 5.463, 95% CI: 2.870–8.056, I2: 0%). Furthermore, the International Knee Documentation Committee (IKDC) scores were also significantly higher in the ESWT group than that of the control at 12 months (WMD: 6.371, 95% CI: 3.397–9.344, I2: 68.8%). However, the WMDs for these outcomes between the two groups did not exceed the minimal clinically important difference (MCID). Conclusion Based on the meta-analyses performed with a few studies, ESWT combined with standard rehabilitation may potentially lead to better patient-reported outcomes. However, these differences may not be clinically significant. Further high-quality studies are needed to confirm our review’s findings.https://doi.org/10.1186/s12891-025-08277-9Extracorporeal shockwave therapyAnterior cruciate ligamentAnterior cruciate ligament reconstructionPostoperative rehabilitationKnee joint |
| spellingShingle | Jaehyung Shin Hye Chang Rhim James Kim Raymond Guo Ramy Elshafey Ki-Mo Jang Use of extracorporeal shockwave therapy combined with standard rehabilitation following anterior cruciate ligament reconstruction: a systematic review with meta-analysis BMC Musculoskeletal Disorders Extracorporeal shockwave therapy Anterior cruciate ligament Anterior cruciate ligament reconstruction Postoperative rehabilitation Knee joint |
| title | Use of extracorporeal shockwave therapy combined with standard rehabilitation following anterior cruciate ligament reconstruction: a systematic review with meta-analysis |
| title_full | Use of extracorporeal shockwave therapy combined with standard rehabilitation following anterior cruciate ligament reconstruction: a systematic review with meta-analysis |
| title_fullStr | Use of extracorporeal shockwave therapy combined with standard rehabilitation following anterior cruciate ligament reconstruction: a systematic review with meta-analysis |
| title_full_unstemmed | Use of extracorporeal shockwave therapy combined with standard rehabilitation following anterior cruciate ligament reconstruction: a systematic review with meta-analysis |
| title_short | Use of extracorporeal shockwave therapy combined with standard rehabilitation following anterior cruciate ligament reconstruction: a systematic review with meta-analysis |
| title_sort | use of extracorporeal shockwave therapy combined with standard rehabilitation following anterior cruciate ligament reconstruction a systematic review with meta analysis |
| topic | Extracorporeal shockwave therapy Anterior cruciate ligament Anterior cruciate ligament reconstruction Postoperative rehabilitation Knee joint |
| url | https://doi.org/10.1186/s12891-025-08277-9 |
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