Salimi M, Keshtkar A, Mosalamiaghili S, Lowe W, Ahmad A, Sharafatvaziri A. Evaluating the efficacy of extracorporeal shockwave therapy in postoperative rehabilitation after anterior cruciate ligament reconstruction: A meta-analysis. World J Orthop 2025; 16(12): 110324 [DOI: 10.5312/wjo.v16.i12.110324]
Corresponding Author of This Article
Maryam Salimi, MD, Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Fannin Street, Houston, TX 77030, United States. salimimaryam7496@gmail.com
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Orthopedics
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Meta-Analysis
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Dec 17, 2025
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World Journal of Orthopedics
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2218-5836
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Salimi M, Keshtkar A, Mosalamiaghili S, Lowe W, Ahmad A, Sharafatvaziri A. Evaluating the efficacy of extracorporeal shockwave therapy in postoperative rehabilitation after anterior cruciate ligament reconstruction: A meta-analysis. World J Orthop 2025; 16(12): 110324 [DOI: 10.5312/wjo.v16.i12.110324]
World J Orthop. Dec 18, 2025; 16(12): 110324 Published online Dec 18, 2025. doi: 10.5312/wjo.v16.i12.110324
Evaluating the efficacy of extracorporeal shockwave therapy in postoperative rehabilitation after anterior cruciate ligament reconstruction: A meta-analysis
Maryam Salimi, Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Houston, TX 77030, United States
Alireza Keshtkar, Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom 7414846199, Iran
Seyedarad Mosalamiaghili, Rheumatology Research Center, Biomedical Research Institute, Golestan University of Medical Sciences, Gorgan 4918936316, Iran
Walter Lowe, University of Texas Health Sciences Center, McGovern Medical School, Houston, TX 75080, United States
Aamir Ahmad, Orthopedic Surgery, University of Texas Rio Grande Valley SOM, Edinburg, TX 78541, United States
Arash Sharafatvaziri, Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran 1914953616, Iran
Co-first authors: Maryam Salimi and Alireza Keshtkar.
Author contributions: Salimi M contributed to the design and implementation of the study and the writing of the manuscript; Keshtkar A contributed to the statistical analyses; Mosalamiaghili A and Ahmad A contributed to drafting the manuscript; Lowe W and Sharafatvaziri A contributed to the revision of the manuscript; All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maryam Salimi, MD, Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Fannin Street, Houston, TX 77030, United States. salimimaryam7496@gmail.com
Received: June 4, 2025 Revised: June 15, 2025 Accepted: October 20, 2025 Published online: December 18, 2025 Processing time: 196 Days and 13.8 Hours
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.
Core Tip: This systematic review and meta-analysis investigated the functional benefits of the addition of extracorporeal shockwave therapy (ESWT) to postoperative rehabilitation after anterior cruciate ligament reconstruction. While some studies showed promising improvements, especially with focused ESWT, overall evidence remains mixed due to variations in technique, study design, and follow-up duration. Our findings suggest that ESWT may support recovery; however, more rigorous, standardized trials are needed to confirm its actual clinical value.
