{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T01:29:33Z","timestamp":1792891773157,"version":"4.5.0"},"reference-count":45,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Purpose: In this systematic review, we compare the effectiveness of high-intensity laser therapy (HILT) and extracorporeal shockwave therapy (ESWT) in treating lateral elbow tendinopathy (LET). Methods: A comprehensive search of PubMed, the Cochrane Library, and EMBASE was conducted from database inception to 23 June 2025 to identify randomized controlled trials (RCTs) comparing the two interventions. The primary outcome was pain intensity (visual analog scale or numeric rating scale). Secondary outcomes included upper-limb disability (qDASH), grip strength (pain-free or maximal), ultrasound-measured common extensor tendon thickness, and safety (adverse events and withdrawals). Two reviewers independently extracted data and assessed methodological quality using the Physiotherapy Evidence Database (PEDro) scale; the certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Effects were synthesized as SMD (95% CI) using random- or fixed-effects models based on heterogeneity (I2). Significance was set at p &lt; 0.05. Results: Four RCTs met the inclusion criteria and 169 participants were included. Methodological quality was moderate, with moderate-quality evidence indicating a significant improvement in short-term and medium-term upper-limb function in favor of HILT (SMD = \u22120.42; 95% CI: \u22120.73 to \u22120.12 and SMD = \u22120.50; 95% CI: \u22120.94 to \u22120.06, respectively). Evidence ranging from low to moderate quality showed no significant differences between the HILT and ESWT groups in terms of short-term or medium-term resting pain (SMD = \u22120.50; 95% CI: \u22121.15 to 0.16 and SMD = \u22120.42; 95% CI: \u22121.06 to 0.22, respectively), short-term or medium-term activity pain (SMD = \u22120.38; 95% CI: \u22121.05 to 0.29 and SMD = \u22120.73; 95% CI: \u22121.65 to 0.19, respectively), short-term or medium-term grip strength (SMD = 0.24; 95% CI: \u22120.20 to 0.67 and SMD = 0.20; 95% CI: \u22120.16 to 0.55, respectively), or short-term or medium-term common extensor tendon thickness (SMD = 0.04; 95% CI: \u22120.50 to 0.59 and SMD = \u22120.00; 95% CI: \u22120.55 to 0.55, respectively). Conclusions: HILT appears to offer significant benefits in improving upper-limb function at short-term (&lt;1 month) and medium-term (1\u20133 months) follow-up. Regarding pain, grip strength, and tendon thickness, the pooled effects did not show clear between-group differences. Evidence certainty ranged from low to moderate, demonstrating that trials with a follow-up period beyond 3 months are needed to evaluate long-term efficacy. Systematic review registration number: PROSPERO: CRD420251026387.<\/jats:p>","DOI":"10.3390\/bioengineering13020155","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T15:04:46Z","timestamp":1769612686000},"page":"155","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["High-Intensity Laser Therapy Versus Extracorporeal Shockwave Therapy for Lateral Elbow Tendinopathy: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9427-7769","authenticated-orcid":false,"given":"Pei-Ching","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Chinese Medicine, China Medical University Hospital, Taichung City 404327, Taiwan"},{"name":"College of Chinese Medicine, China Medical University, Taichung City 404333, Taiwan"},{"name":"Graduate Degree Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu City 300193, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9021-9326","authenticated-orcid":false,"given":"Dung-Huan","family":"Liu","sequence":"additional","affiliation":[{"name":"Graduate Degree Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu City 300193, Taiwan"},{"name":"Department of Physical Medicine and Rehabilitation, Taichung Municipal Geriatric Rehabilitation General Hospital Managed by China Medical University, China Medical University, Taichung City 406004, Taiwan"},{"name":"Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung City 404327, Taiwan"},{"name":"Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung City 406040, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2109-6844","authenticated-orcid":false,"given":"Yang-Shao","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung City 404327, Taiwan"},{"name":"Department of Education, China Medical University, Taichung City 404333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Sheng","family":"Lin","sequence":"additional","affiliation":[{"name":"Graduate Degree Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu City 300193, Taiwan"},{"name":"Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City 300193, Taiwan"},{"name":"Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu City 300193, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7281-0729","authenticated-orcid":false,"given":"Fu-An","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan"},{"name":"Department of Internal Medicine, China Medical University Hospital, Taichung City 404327, Taiwan"},{"name":"School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1002\/art.20535","article-title":"Prevalence and impact of musculoskeletal disorders of the upper limb in the general population","volume":"51","author":"Palmer","year":"2004","journal-title":"Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Marotta, N., de Sire, A., Lippi, L., Moggio, L., Mondardini, P., Sgro, M., Bartalotta, I., Zito, R., Giroldini, T., and Invernizzi, M. 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