Evaluating the Efficacy of Extracorporeal Shockwave Therapy in Postoperative Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Meta-Analysis Publisher



Salimi M ; Keshtkar A ; Mosalamiaghili S ; Lowe W ; Ahmad A ; Sharafatvaziri A
Source: World Journal of Orthopedics Published:2025

Abstract

BACKGROUND Recovering from anterior cruciate ligament (ACL) reconstruction can be challenging. While standard rehabilitation helps restore knee function, many patients still face a slow or incomplete recovery. Extracorporeal shockwave therapy (ESWT) has recently gained attention as a potential way to speed up healing and improve outcomes when added to traditional rehab. AIM To explore whether combining ESWT with standard postoperative rehabilitation truly leads to better recovery compared with rehab alone. METHODS A systematic review and meta-analysis were conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, evaluating participant status following ACL reconstruction with standard rehabilitation and without augmented ESWT. This meta-analysis included six studies (five randomized controlled trials, one non-randomized clinical study). The outcome measures were the Lysholm score, International Knee Documentation Committee score, visual analog score, and KT-1000 measurements. To compare the control and intervention groups, the weighted mean differences were calculated along with the 95% confidence intervals. The heterogeneity of the studies and publication bias were analyzed. RESULTS ESWT modestly improved Lysholm scores (weighted mean difference: 3.72; 95% confidence interval: -0.27 to 7.71) with high heterogeneity (I2: 96%, P < 0.001) when compared with standard rehabilitation. Focused ESWT showed greater benefits compared with radial ESWT. No significant differences were found in the International Knee Documentation Committee scores, visual analog score, or KT-1000 measurements. Substantial variability and publication bias were noted. CONCLUSION ESWT improved Lysholm scores but did not show other significant benefits. Due to the limited evidence, further standardized, placebo-controlled trials are needed to confirm its effectiveness in ACL reconstruction. ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.