Evidence map›Paper›PMID 32522732›Full record

SynthesisBritish journal of sports medicine2021

Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials.

Arco C van der Vlist, Marinus Winters, Adam Weir, Clare L Ardern, Nicky J Welton, Deborah M Caldwell, Jan A N Verhaar, Robert-Jan de Vos

3 registry-linked trialsOpen access · hybridAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in British journal of sports medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 97 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
97citing papers in PubMed, 17 pooled it
22.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05659134 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Comparison of Alfredson Eccentric and Silbernagel Concentric-eccentric Therapeutical Protocol in Competitive Athletes With Chronic Achilles Tendinopathy

TypeinterventionalSponsorCharles University, Czech RepublicRan2022 to 2024Enrolled40ConditionsAchilles Tendinopathy, Tendon Injuries, Tendon Thickening, Pain, ChronicArmsAlfredson protocol, Silbernagel protocol
NCT06986759 nanot yet recruitingnot on this mapstarted 2025, after this paper: background citation

Comparative Effects of Laser and Extracorpeal Shock Wave Therapy on Pain, Range of Motion and Function in Patients With Achilles Tendinopathy.

TypeinterventionalSponsorRiphah International UniversityRan2025 to 2025Enrolled44ConditionsAchilles TendinopathyArmsLaser, Extracorporeal shock wave therapy protocol
NCT07360873 nacompletednot on this mapstarted 2025, after this paper: background citation

Effect of Eccentric Exercises of Calf Muscles Versus Heel Insole Lift on Pain, Range of Motion, and Function in Football Players With Achilles Tendinopathy

TypeinterventionalSponsorAdnan HashimRan2025 to 2025Enrolled24ConditionsAchilles Tendinopathy (AT)ArmsEccentric Calf Muscle Exercises, Heel Insole Lift
3 · Its place in the literature

Who cites it

97 citing papers in PubMed, 17 syntheses or guidelines pooled it, 187 citations in OpenAlex.

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37 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 8 countries.

Arco C van der VlistDepartment of Orthopaedics and Sports Medicine, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands a.vandervlist@erasmusmc.nl.ORCID http://orcid.org/0000-0003-4238-3540
Marinus WintersResearch Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.ORCID http://orcid.org/0000-0001-5742-7441
Adam WeirDepartment of Orthopaedics and Sports Medicine, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands.
Clare L ArdernDivision of Physiotherapy, Karolinska Institute, Stockholm, Stockholm County, Sweden.ORCID http://orcid.org/0000-0001-8102-3631
Nicky J WeltonPopulation Health Sciences, Bristol Medical School, Bristol, Bristol, UK.
Deborah M CaldwellPopulation Health Sciences, Bristol Medical School, Bristol, Bristol, UK.
Jan A N VerhaarDepartment of Orthopaedics and Sports Medicine, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands.
Robert-Jan de VosDepartment of Orthopaedics and Sports Medicine, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands.
Erasmus University Rotterdam · NLAt Bristol · GBAalborg University · DKKarolinska Institutet · SEQatar Orthopaedic and Sports Medicine Hospital · QA

Funding

Medical Research Council MR/M005615/1
6 · The paper itself

Abstract

objectiveTo provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy.

designLiving systematic review and network meta-analysis. DATA SOURCES: Multiple databases including grey literature sources were searched up to February 2019. STUDY ELIGIBILITY CRITERIA: Randomised controlled trials examining the effectiveness of any treatment in patients with both insertional and/or midportion Achilles tendinopathy. We excluded trials with 10 or fewer participants per treatment arm or trials investigating tendon ruptures. DATA EXTRACTION AND SYNTHESIS: Reviewers independently extracted data and assessed the risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation to appraise the certainty of evidence. PRIMARY OUTCOME MEASURE: The validated patient-reported Victorian Institute of Sport Assessment-Achilles questionnaire.

results29 trials investigating 42 different treatments were included. 22 trials (76%) were at high risk of bias and 7 (24%) had some concerns. Most trials included patients with midportion tendinopathy (86%). Any treatment class seemed superior to wait-and-see for midportion Achilles tendinopathy at 3 months (very low to low certainty of evidence). At 12 months, exercise therapy, exercise+injection therapy and exercise+night splint therapy were all comparable with injection therapy for midportion tendinopathy (very low to low certainty). No network meta-analysis could be performed for insertional Achilles tendinopathy. SUMMARY/

conclusionIn our living network meta-analysis no trials were at low risk of bias and there was large uncertainty in the comparative estimates. For midportion Achilles tendinopathy, wait-and-see is not recommended as all active treatments seemed superior at 3-month follow-up. There seems to be no clinically relevant difference in effectiveness between different active treatments at either 3-month or 12-month follow-up. As exercise therapy is easy to prescribe, can be of low cost and has few harms, clinicians could consider starting treatment with a calf-muscle exercise programme. PROSPERO REGISTRATION NUMBER: CRD42018086467.

Indexed as

Achilles TendonHumansRandomized Controlled Trials as TopicTendinopathyAchilles tendonefficacyinterventiontendinopathy

Identifiers

PMID32522732
PMCPMC7907558
OpenAlexW3021221396

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.