Deciphering the pathogenesis of tendinopathy: a three-stages process

Area of Science:

• Orthopedics
• Sports Medicine
• Pathology

Background:

• Tendinopathy pathogenesis is poorly understood, based on fragmented evidence.
• Existing theories often label tendinopathy as an overuse injury, which may be inaccurate.

Purpose of the Study:

• To propose a unified

Main Methods:

• Characterization of pathological tendinotic tissues.
• Analysis of clinical, histological, and biochemical presentations.
• Integration of fragmented evidence into a cohesive theory.

Main Results:

• Tendinopathy involves collagenolytic injuries and an active, yet failed, healing process.
• Pathological tissues show hypervascularity and metaplasia.
• A three-stage pathogenesis model is proposed: injury, failed healing, and clinical presentation.

Conclusions:

• Tendinopathy is best explained by a failed healing theory, not simply overuse.
• This integrative model explains chronic tendon pain and rupture.
• The theory guides future research toward understanding and treating tendinopathy.