Objective To provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy. Design Living systematic review and network meta-analysis. Data sources Multiple databases including grey literature sources were searched up to February 2019. Study eligibility criteria Randomised controlled trials examining the effectiveness of any treatment in patients with both insertional and/or midportion Achilles tendinopathy. We excluded trials with 10 or fewer participants per treatment arm or trials investigating tendon ruptures. Data extraction and synthesis Reviewers independently extracted data and assessed the risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation to appraise the certainty of evidence. Primary outcome measure The validated patient-reported Victorian Institute of Sport Assessment-Achilles questionnaire. Results 29 trials investigating 42 different treatments were included. 22 trials (76%) were at high risk of bias and 7 (24%) had some concerns. Most trials included patients with midportion tendinopathy (86%). Any treatment class seemed superior to wait-and-see for midportion Achilles tendinopathy at 3 months (very low to low certainty of evidence). At 12 months, exercise therapy, exercise+injection therapy and exercise+night splint therapy were all comparable with injection therapy for midportion tendinopathy (very low to low certainty). No network meta-analysis could be performed for insertional Achilles tendinopathy. Summary/conclusion In our living network meta-analysis no trials were at low risk of bias and there was large uncertainty in the comparative estimates. For midportion Achilles tendinopathy, wait-and-see is not recommended as all active treatments seemed superior at 3-month follow-up. There seems to be no clinically relevant difference in effectiveness between different active treatments at either 3-month or 12-month follow-up. As exercise therapy is easy to prescribe, can be of low cost and has few harms, clinicians could consider starting treatment with a calf-muscle exercise programme. PROSPERO registration number CRD42018086467.

中文翻译：

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哪种治疗对跟腱病患者最有效？对 29 项随机对照试验进行网络荟萃分析的实时系统评价

目的 提供跟腱病治疗比较效果的持续更新概述。设计生活系统回顾和网络荟萃分析。数据来源 检索了截至 2019 年 2 月的多个数据库，包括灰色文献来源。 研究资格标准 随机对照试验，检查任何治疗方法对插入和/或中部跟腱病患者的有效性。我们排除了每个治疗组 10 名或更少参与者的试验或调查肌腱断裂的试验。数据提取和综合审稿人独立提取数据并评估偏倚风险。我们使用建议评估、制定和评估的分级来评估证据的确定性。主要结果测量经过验证的患者报告的维多利亚运动评估研究所 - 阿基里斯问卷。结果 纳入了调查 42 种不同治疗方法的 29 项试验。22 项试验 (76%) 存在高偏倚风险，7 项试验 (24%) 存在一些担忧。大多数试验包括患有中部肌腱病的患者（86%）。对于 3 个月后的中段跟腱病，任何治疗方案似乎都优于观望（证据质量极低至低）。12 个月时，运动疗法、运动+注射疗法和运动+夜间夹板疗法均与中部肌腱病注射疗法相当（极低至低确定性）。无法对插入性跟腱病进行网络荟萃分析。摘要/结论 在我们的生活网络荟萃分析中，没有试验的偏倚风险较低，并且比较估计存在很大的不确定性。对于中部跟腱病，不建议观望，因为在 3 个月的随访中，所有积极治疗似乎都更有效。在 3 个月或 12 个月的随访中，不同积极治疗的有效性似乎没有临床相关的差异。由于运动疗法易于实施、成本低廉且危害较小，临床医生可以考虑从小腿肌肉锻炼计划开始治疗。PROSPERO 注册号 CRD42018086467。