BACKGROUND: Alfredson isolated eccentric loading and Silbernagel concentric-eccentric loading have both shown beneficial effects on clinical symptoms in midportion Achilles tendinopathy (AT), but they have never been compared directly. PURPOSE: To test for differences in clinical effects at 1-year follow-up between Alfredson and Silbernagel loading in midportion AT. STUDY DESIGN: Randomized controlled trial; level of evidence 2. METHODS: A total of 40 recreational athletes were allocated to the Alfredson group (AG) or the Silbernagel group (SG). The primary outcome was the difference in the Victorian Institute of Sports Assessment-Achilles (VISA-A) at 1-year follow-up. Secondary outcomes were the visual analog scale for pain during activities of daily living (VAS-ADL) and sports activities (VAS-sports), the EuroQol 5 Dimensions instrument (EQ-5D), and global perceived effect score. Measurements were performed at baseline and 12-week, 26-week, and 1-year follow-up. Analysis was performed using a linear mixed-regression model with intervention (AG versus SG), time (12 weeks, 26 weeks, and 1 year postoperatively), and intervention-by-time interaction. RESULTS: The VISA-A score improved for both AG and SG, from 60.7 +/- 17.1 at baseline to 89.4 +/- 13.0 at 1-year follow-up and from 59.8 +/- 22.2 to 83.2 +/- 22.4, respectively (p < 0.001 for both). Because the interaction term did not significantly improve the model, we reported a treatment effect without interaction term, indicating a constant difference at each follow-up. The linear mixed model with correction for baseline VISA-A and confounders revealed a nonsignificant treatment effect (2.4 (95% CI -8.5 to 13.3); p = 0.656). In addition, after adjustment for the respective baseline values and confounders, nonsignificant treatment effects were found for the VAS-ADL (-2.0 (95% CI -11.3 to 7.3); p = 0.665) and VAS-sports (1.3 (95% CI -12.8 to 15.3), p = 0.858). The EQ-5D subscales improved in both groups. After 1 year, significantly more SG participants considered themselves improved (77.3% (SG) versus 50.0% (AG); p = 0.04). CONCLUSION: No differences in clinical effects were found between Alfredson and Silbernagel loading at up to 1-year follow-up. Both programs significantly improved clinical symptoms, and given their high adherence rates, offering either of them as a home-based program with limited supervision appears to be an effective treatment strategy for midportion AT. REGISTRATION: NTR5638 (Netherlands Trial Register number).

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