Clinical Outcomes Of Extracorporeal Shockwave Therapy (ESWT) In Adolescents And Young Adults With Patellar Tendinopathy

PURPOSE: This retrospective study aimed to assess clinical pain and ultrasound-derived patellar tendon quality outcomes of Extracorporeal Shockwave Therapy (ESWT) in adolescents and young adults with patellar tendinopathy. METHODS: A retrospective study was conducted involving patients aged 13-21 years who underwent ESWT for patellar tendinopathy at a pediatric medical center between January 2022 and September 2023. Clinical outcomes including the 100-mmVisualAnalog Scale (VAS) for pain and ultrasound assessments were collected pre- and post-ESWT. B-mode ultrasound short- and long-axis images were obtained by a trained clinician at the thickest portion of the patellar tendon. Pre-post ESWT structural changes were assessed using ImageJ software for all ultrasound images to compare patellar tendon echogenicity (short-axis) and thickness(long-axis) . Pearson’s correlations were used to assess relationships between changes in tendon structure and pain. Descriptive analyses were used for patient demographics, and paired samples t-tests were used to compare pre- to post-EPAT treatment changes for all ultrasound and VAS pain outcomes (alpha = 0.05). Cohen’s d effect sizes were used to assess the magnitude of change. RESULTS: 16 participants were included in analyses (6 Females, 10 Males; Age: 18.22 ± 1.73 years; BMI: 27.12 ± 6.26 kg/m2), and 87.5%received focused, 12.5% received radial ESWT (number of sessions: 4.4 ± 1.2). Patients had significantly decreased patellar tendon thickness post-intervention compared to pre-intervention measures with a large effect (Mean Difference [MD]: -0.04 ± 0.02 cm; p = 0.03;d = 0.60). Echogenicity did not significantly change (p = 0.83). Pain decreased at post-intervention; the magnitude of difference was moderate, though not statistically significant (MD: -19.3 ± 10.6 mm;p = 0.07;d = 0.48). Changes in patellar tendon thickness and pain were significantly directly correlated (r = 0.55,p = 0.03). CONCLUSIONS: Adolescents and young adults with patellar tendinopathy treated with ESWT had a reduction in patellar tendon thickness on post-treatment ultrasound, which significantlycorrelated with an improvement in pain.