Tendinopathy: actual aspects of pathogenesis, diagnosis and treatment: a review of foreign literature

Authors:

Konovalenko Kirill Anatolyevich – physical rehabilitation medical doctor at Beloostrov Clinic of High Technologies, Clinic Beloostrov, 1 Yukki urban settlement, Vsevolozhsk District, 188640 Leningrad Region, Russian Federation; e-mail: doctor@kirill-konovalenko.ru; https://orcid.org/0009-0007-5476-0194.

Guzalov Pavel Irkinovich – Grand PhD in Medical Sciences (Dr. Med. Sci.), Deputy Medical Director for Rehabilitation at Beloostrov Clinic of High Technologies, Clinic Beloostrov, 1 Yukki urban settlement, Vsevolozhsk District, 188640 Leningrad Region, Russian Federation; Professor, Department of Physical and Rehabilitation Medicine of North-Western State Medical University named after I.I. Mechnikov, 47 Piskarevsky Ave, 195067 St. Petersburg, Russian Federation; e-mail: guzalov@mail.ru; https://orcid.org/0000-0002-3379-8333.

Annotation:

Introduction. Tendinopathy is a widespread condition, that affects all aspects of patient’s life, independently of age, sex or physical activity. It is commonly characterized by incomplete recovery and a tendency to recurrence, which requires clinicians to possess a deep understanding of pathophysiology, biomechanics, and modern therapeutic approaches. Therefore, selecting an appropriate treatment strategy becomes crucial.

Aim. To study, systematize, and summarize the results of recent researches (2016-2025) and earlier fundamental studies addressing the etiology, mechanisms of development, diagnosis, and modern treatment strategies for tendinopathy.

Materials and methods. A total of 44 publications identified through searches in international databases including PubMed, Scopus, and Web of Science for the period 2016-2025, were analyzed. In addition, earlier fundamental studies that significantly influenced current understanding of the pathogenesis, diagnosis, and treatment of tendinopathy were included in the analysis.

Results. The development of tendinopathy is caused by a combination of internal factors (age, obesity, diabetes) and excessive mechanical stress. Modern developmental models include the theory of the “continuum” (the stages of the process) and the model of “impaired recovery” (the role of inflammation and cellular changes). The diagnosis is comprehensive: clinical examination, imaging (ultrasound with elastography, MRI), biomarker analysis and neural network technologies. The basis of treatment is kinesiotherapy. Shock wave therapy and manual techniques are effective. Pharmacotherapy gives only a short-term effect and is not recommended for long-term use. Biological methods include PRP therapy and stem cells. If conservative treatment is ineffective for 6-12 months, surgical intervention is possible. The best result is achieved with a combination of individually selected methods. Prevention includes load optimization, the use of orthopedic insoles, muscle strengthening and full recovery.

Discussion. Current researches demonstrate that tendinopathy has a polyetiological nature. Two leading “continuum” and “failed healing” concepts explain the chronic course of the disease and the limited effectiveness of isolated treatment approaches. It seems, that further investigation into tendon stem cell differentiation in response to mechanical load appears to be the most promising.

Summary. Tendinopathy is a multifactorial disease that requires a comprehensive and individualized approach. It’s exercise therapy has the strongest evidence base, while other treatment methods serve as adjunctive modalities. Obviously, the absence of unified clinical standards underscores the need for large randomized controlled trials. It appears, that future studies should aim to clarify the roles of inflammation, immune response, and stem cells in the development of tendinopathy, to identify reliable biomarkers, standardize diagnostic and biological therapy protocols, and integrate artificial intelligence into diagnostic algorithms. A comprehensive approach combining preventive strategies, early diagnosis, and multilevel treatment seems to be the most effective way to reduce disease prevalence and improve outcomes in patients with tendinopathy.

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