Methodological and Interpretative Limitations in a Case Report of Achilles Tendon Rupture Following Extracorporeal Radial Pressure Wave Therapy
Bibliographic Analysis | Vol 6 | Issue 1 | January-June 2026 | page: 3-5 | Daniel Moya, Achim Loske
DOI: https://doi.org/10.13107/jrs.2026.v06.i01.187
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2026; The Author(s).
Submitted Date: 25 Feb 2026, Review Date: 13 Mar 2026, Accepted Date: April 2026 & Published: 30 June 2026
Author: Daniel Moya [1], Achim Loske [2]
[1] Department of Orthopaedics, Hospital Británico de Buenos Aires, Buenos Aires, Argentina,
[2] Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México, Querétaro, México.
Address of Correspondence
Daniel Moya,
Department of Orthopaedics, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
E-mail: drdanielmoya@yahoo.com.ar
Abstract
This commentary critically examines a case report attributing Achilles tendon rupture to shock wave therapy. The manuscript presents significant conceptual and methodological flaws, particularly the conflation of extracorporeal shock wave therapy, radial pressure wave therapy, and percussive ultrasound, despite their distinct physical and biological characteristics. The proposed mechanism of cumulative microtrauma lacks supporting evidence and contradicts current mechanotransduction-based models. In addition, insufficient reporting of treatment parameters limits reproducibility. The authors fail to consider well-established risk factors for tendon rupture, relying instead on temporal association, which constitutes a post hoc fallacy. Overall, the conclusions are speculative, unsupported, and not aligned with existing literature.
Keywords: Shock waves, Radial pressure waves, Achilles tendinopathy, Achilles rupture
References
1. Argyropoulou E, Sakellariou E, Karampinas P, Rozis M, Galanis A, Kolovos I, et al. A case report of Achilles tendon distractive rupture after shock wave therapy. J Surg Case Rep 2025;2025:rjaf206.
2. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The role of extracorporeal shockwave treatment in musculoskeletal disorders. J Bone Joint Surg Am 2018;100:251-63.
3. Loske AM, Moya D. Shock waves and radial pressure waves: Time to put a clear nomenclature into practice. J Regen Sci 2021;1:4-8.
4. Loske AM, Moya D. Errors in shock wave therory can impact clinical outcomes. J Regen Sci 2024;4:35-6.
5. Lin TC, Lin CY, Chou CL, Chiu CM. Achilles tendon tear following shock wave therapy for calcific tendinopathy of the Achilles tendon: A case report. Phys Ther Sport 2012;13:189-92.
6. Stania M, Juras G, Chmielewska D, Polak A, Kucio C, Król P. Extracorporeal shock wave therapy for Achilles tendinopathy. Biomed Res Int 2019;2019:3086910.
7. Novak P, Verdaasdonk R. Radial ESWT update – New observations explain positive treatment results in sports medicine. In: Lohrer H, Nauck T, editors. Shock Wave Therapy in Practice: Shock Waves in Sports Medicine. Heilbronn: Buchverlag; 2017. p. 126-57.
8. D’Agostino MC, Craig K, Tibalt E, Respizzi S. Shock wave as biological therapeutic tool: From mechanical stimulation to recovery and healing, through mechanotransduction. Int J Surg 2015;24:147-53.
9. Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (ESWT) on tendon tissue. Muscles Ligaments Tendons J 2012;2:33-7.
10. Wess O, Mayer J. The interaction of shock waves with biological tissue – momentum transfer, the key for tissue stimulation and fragmentation. Int J Surg 2025;111:2810-28.
11. Nikolikj-Dimitrova ED, Gjerakaroska-Savevska C, Koevska V, Mitrevska B, Gocevska M, Manoleva M, et al. The effectiveness of radial extracorporeal shock wave therapy for chronic achilles tendinopathy: A case report with 18 months follow-up. Open Access Maced J Med Sci 2018;6:523-7.
12. Oda H, Sano K, Kunimasa Y, Komi PV, Ishikawa M. Neuromechanical modulation of the achilles tendon during bilateral hopping in patients with unilateral achilles tendon rupture, over 1 year after surgical repair. Sports Med 2017;47:1221-30.
13. Tarantino D, Palermi S, Sirico F, Corrado B. Achilles tendon rupture: Mechanisms of injury, principles of rehabilitation and return to play. J Funct Morphol Kinesiol 2020;5:95.
14. Wertz J, Galli M, Borchers JR. Achilles tendon rupture: Risk assessment for aerial and ground athletes. Sports Health 2013;5:407-9.
15. Oliva F, Piccirilli E, Berardi AC, Tarantino U, Maffulli N. Influence of thyroid hormones on tendon homeostasis. Adv Exp Med Biol 2016;920:133-8.
16. Maffulli N, Cuozzo F, Migliorini F, Oliva F. The tendon unit: Biochemical, biomechanical, hormonal influences. J Orthop Surg Res 2023;18:311.
17. Feng X, Qin DA, Zhang HX. Thyroid achilles tendinopathy. Int J Surg 2025;111:8678-80.
18. Elliott WC, Ouseph A, Abraham A, Martinez J, Grimes JS. The association of body mass index and Achilles tendon rupture: A retrospective case-control study. Foot Ankle Orthop 2025;10:24730114251327212.
19. Aicale R, Tarantino D, Maffulli N. Basic science of tendons. In: Gobbi A, Espregueira-Mendes J, Lane JG, Karahan M, editors. Bio-Orthopaedics: A New Approach. Netherlands: Springer; 2017. p. 249-3.
20. Costa ML, Shepstone L, Donell ST, Thomas TL. Shock wave therapy for chronic Achilles tendon pain: A randomized placebo-controlled trial. Clin Orthop Relat Res 2005;440:199-204.
| How to Cite this article: Moya D, Loske A. Methodological and Interpretative Limitations in a Case Report of Achilles Tendon Rupture Following Extracorporeal Radial Pressure Wave Therapy.| Journal of Regenerative Science | Jan-Jun 2026; 6(1): 03-05. |
