Efficacy of radiofrequency microdebridement (TOPAZ) in tendinopathy: a systematic review and meta-analysis of randomised clinical trials

OBJECTIVES: The aim of our systematic review and meta-analysis was to assess the outcomes associated with the use of radiofrequency microdebridement (RM; TOPAZ) as compared to other interventions in all tendinopathies. METHODS: We searched multiple databases for RCTs reporting efficacy outcomes associated with the use of RM in any type of tendinopathy, compared to any other treatment or no treatment. Outcome measures of interest included patient-reported pain visual analogue scale (VAS, primary outcome), patient-reported function and complications (secondary outcomes). Outcomes were pooled separately at short- (up to 12 weeks), mid- (13-52 weeks) and long-term (more than 52 weeks) follow-up. Risk of bias of each study and certainty of evidence of each result were assessed using the Cochrane Collaboration and GRADE tools, respectively. RESULTS: Nine RCTs with a total of 318 patients were included. For the primary outcome, when comparing RM with surgical release, no statistically significant differences were found at any follow-up time point when all tendinopathies were combined [lateral elbow, shoulder, Achilles; short-term mean difference, MD, 0.32, 95% confidence interval (-1.19 to 1.83); mid-term MD 0.09 (-0.22 to 0.40); long-term MD -0.04 (-0.30 to 0.23)] or when lateral elbow tendinopathy, shoulder and Achilles tendinopathies were analysed separately (low certainty evidence). When comparing RM with physiotherapy in Achilles tendinopathy, RM was statistically superior for pain at long-term follow-up [MD -3.50 (-4.90 to -2.10), low certainty, single study]. Finally, when RM was added to surgical release in shoulder and gluteal tendinopathy, there were no significant pain-relieving benefits compared to surgical release alone at short-, mid- or long-term follow-up for shoulder, and long-term follow-up for gluteal. Some functional short- and mid-term benefits were observed with the use of RM in some tendinopathies. CONCLUSION: Based on the existing evidence, the use of RM is associated with generally equivalent outcomes compared to surgical release for the included tendinopathies. A formal cost analysis may be useful in the future for definitive conclusions, as well as more high-quality RCTs.