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How does surgery compare to sham surgery or physiotherapy as a treatment for tendinopathy? A systematic review of randomised trials
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  • Published on:
    Conclusions questioned?
    • Håkan Alfredson, Professor Orthopaedic Surgeon 2Department of Community Medicine and Rehabilitation, Sports Medicine, Umeå University S-901 87 Umeå, Sweden,

    Dear authors, I have read your paper with interest, and I have a couple of remarks that I think needs to be discussed to hopefully stimulate to more studies in this important field.
    It is a weakness that there are very few randomised trials on surgical treatment of tendinopathy. To then draw conclusions from few studies is difficult and not always possible.
    From this systematic review it is shown that 10 out 12 trials are on tendinopathy in the upper extremities (shoulder and elbow-althogether 998 tendinopathies) and only 2 on tendinopathy in the lower extremities (patellar and Achilles-althogeteher 60 tendinopathies). The authors have unfortunately missed to include 2 randomised studies on surgical treatment of patellar tendinopathy, published by Dr Willberg et al. Althogether, most information is about the shoulder and elbow, and very little about the Achilles and patellar tendons. Anyhow, when conclusions are drawn I get the impression that the authors put all tendinopathies in one group. This might be strongly misleading since there is very little information about the lower extremity tendons (only 2 studies), and conclusions cannot be drawn for Achilles and patellar tendinopathy. Furthermore, such conclusions might lead to that we miss possible differences in load response between upper and lower extremity tendons? The upper extremity non weight-bearing tendons might respond different compared to the lower extremity weight bearing tendons, as it is fo...

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    Conflict of Interest:
    None declared.