Journal of orthopaedic surgery and research · 2026
Comparison of the efficacy of different types and intensities of extracorporeal shock wave therapy for lateral epicondylitis: a systematic review and network meta-analysis.
СтатьяСистематический обзорNetwork Meta-AnalysisСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Jin Ran, Wang Haijing, Lv Wenwen, Cheng Hengqiang, Li Yanru, Yuan Qingqiang
Аннотация
BACKGROUND: To evaluate the efficacy of different types and intensities of extracorporeal shock wave therapy (ESWT) for lateral epicondylitis using a network meta-analysis.
METHODS: Following a systematic retrieval of major databases (e.g. PubMed, Web of Science, Embase, Scopus, and Cochrane Library) from their respective inception dates up to September 2025, relevant RCTs and cohort studies on ESWT for lateral epicondylitis were identified, with data analyzed in R software (version 4.4.3).
RESULTS: The analysis included 11 RCTs and 2 cohort studies involving 938 patients with lateral epicondylitis. Network meta-analysis demonstrated that medium-intensity radial ESWT (rESWT-M) ranked highest in improving visual analog scale (VAS) scores at 1 month post-treatment, with a surface under the cumulative ranking curve (SUCRA) of 100%. Significant benefits were also observed for rESWT-L [SMD = - 1.91, 95% CrI (- 2.34, - 1.47)], fESWT-M [SMD = - 1.80, 95% CrI (- 2.45, - 1.15)], fESWT-H [SMD = - 1.74, 95% CrI (- 2.38, - 1.10)], and sham ESWT [SMD = - 1.74, 95% CrI (- 2.30, - 1.19)], when compared to waiting for therapy. fESWT-L excelled in long-term pain relief (SUCRA = 99.06%) and RM score improvement (SUCRA = 99.81%); it also significantly reduced VAS scores at 6 months post-treatment versus sham ESWT [SMD = - 2.10, 95% CrI (- 2.72, - 1.50)]. rESWT-L was most effective on DASH (SUCRA = 97.15%) and PRTEE (SUCRA = 97.66%) scores. Furthermore, sham ESWT significantly outperformed waiting for therapy on post-treatment PRTEE scores [SMD = - 5.97, 95% CrI - 6.93, - 5.02].
CONCLUSION: The findings indicate distinct advantages for different ESWT types and intensities in managing lateral epicondylitis. rESWT-M offers superior short-term analgesic effects, whereas fESWT-L is more beneficial for long-term pain relief. Overall, low-energy ESWT appears to yield the most favorable therapeutic profile. Validation through additional high-quality RCTs is recommended, as the current evidence is limited by the scarcity and suboptimal quality of existing research.
METHODS: Following a systematic retrieval of major databases (e.g. PubMed, Web of Science, Embase, Scopus, and Cochrane Library) from their respective inception dates up to September 2025, relevant RCTs and cohort studies on ESWT for lateral epicondylitis were identified, with data analyzed in R software (version 4.4.3).
RESULTS: The analysis included 11 RCTs and 2 cohort studies involving 938 patients with lateral epicondylitis. Network meta-analysis demonstrated that medium-intensity radial ESWT (rESWT-M) ranked highest in improving visual analog scale (VAS) scores at 1 month post-treatment, with a surface under the cumulative ranking curve (SUCRA) of 100%. Significant benefits were also observed for rESWT-L [SMD = - 1.91, 95% CrI (- 2.34, - 1.47)], fESWT-M [SMD = - 1.80, 95% CrI (- 2.45, - 1.15)], fESWT-H [SMD = - 1.74, 95% CrI (- 2.38, - 1.10)], and sham ESWT [SMD = - 1.74, 95% CrI (- 2.30, - 1.19)], when compared to waiting for therapy. fESWT-L excelled in long-term pain relief (SUCRA = 99.06%) and RM score improvement (SUCRA = 99.81%); it also significantly reduced VAS scores at 6 months post-treatment versus sham ESWT [SMD = - 2.10, 95% CrI (- 2.72, - 1.50)]. rESWT-L was most effective on DASH (SUCRA = 97.15%) and PRTEE (SUCRA = 97.66%) scores. Furthermore, sham ESWT significantly outperformed waiting for therapy on post-treatment PRTEE scores [SMD = - 5.97, 95% CrI - 6.93, - 5.02].
CONCLUSION: The findings indicate distinct advantages for different ESWT types and intensities in managing lateral epicondylitis. rESWT-M offers superior short-term analgesic effects, whereas fESWT-L is more beneficial for long-term pain relief. Overall, low-energy ESWT appears to yield the most favorable therapeutic profile. Validation through additional high-quality RCTs is recommended, as the current evidence is limited by the scarcity and suboptimal quality of existing research.