HOW DOES SURGERY COMPARE TO SHAM SURGERY OR PHYSIOTHERAPY AS A TREATMENT FOR TENDINOPATHY? A SYSTEMATIC REVIEW OF RANDOMISED TRIALS

BACKGROUND & OBJECTIVE

There is much debate about the role of surgical interventions in tendinopathy. There is mounting evidence for progressive loading programmes, however they are not universally effective. In one 5-year follow up study (1) less than 40% of participants were pain-free following an eccentric loading programme and nearly 50% had sought alternative treatments. There is therefore a demand for other effective treatment approaches in tendinopathy and a question as to whether surgery could be one.

This systematic review looked to answer this question by assessing the effectiveness of surgery on all tendinopathies. Surgery is thought to have a placebo effect, so comparison was made to sham surgery and physiotherapy.

METHODS

Key databases were searched for studies with a randomised design that compared surgical to non-surgical management. Study quality was assessed and the following outcome measures were examined: pain, function, range of movement (ROM), force/strength, patient satisfaction, treatment success, quality of life and complications.

RESULTS

12 studies were eligible with a total of 1051 participants and a mix of different sites of tendinopathy (shoulder 7, lateral elbow 3, patellar 1 and achilles 1). Only two of the included studies were deemed to be of good

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