Which treatment is most effective for adults with Achilles tendinopathy?

Introduction Achilles tendinopathy is a condition that affects both active and sedentary individuals. It is characterized by localized pain in relation to tendon-loading activities. As chronic Achilles tendinopathy results in substantial disease burden, it is vital to treat it effectively. There are many different conservative and surgical treatments available, but the comparative effectiveness of these treatments has never been evaluated.
Methods and analysis The primary outcome measure of this living systematic review with network meta-analysis is the Victorian Institute of Sports Assessment-Achilles (VISA-A) score. The secondary outcome measures are return-to-sport (yes/no) at 6–12 weeks, 13–52 weeks and >52 weeks. Completed published and unpublished randomized controlled trials with full-text reports are eligible for inclusion. We will search Embase, MEDLINE Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and CINAHL, SPORTDiscus and AMED OpenGrey, WorldCat, Google Scholar, the WHO trial registry and Clinicaltrials.gov register for potentially eligible trials. Two researchers will appraise trial eligibility and perform data extraction. The risk of bias will be assessed using the Cochrane Risk of Bias Tool V2. Bayesian network meta-analyses will be constructed for VISA-A score and return-to-sport. Consistency between direct and indirect comparisons will be assessed. We will explore between study variability, and perform a threshold analysis for the credibility of the network meta-analyses’ conclusions.
Ethics and dissemination No ethical approval is required. The study commenced on 1st November 2018, and its expected completion date is 15 August 2019. Upon completion, we will seek publication in an international peer-reviewed journal and publish translational articles to disseminate the work to clinicians.