An overview of tendon physiology: the impact of injury and disease on structure, function and healing

Tendons are vital structures that connect muscle to bone, enabling movement while maintaining joint stability. Their highly specialized architecture, comprising aligned type I collagen, proteoglycans, glycoproteins, elastin and a unique extracellular matrix ensures a balance between mechanical strength and flexibility. When disrupted by acute trauma, chronic overuse, or systemic diseases, tendon integrity is compromised, leading to pain, functional deficits, and a significant healthcare burden. This review synthesizes current knowledge on tendon anatomy, cellular and molecular regulation, and the multi-phase repair process following injury. It also explores contemporary diagnostic methods, management strategies, from conservative treatments and rehabilitation to advanced surgical interventions. As well as emerging biological therapies such as platelet-rich plasma (PRP), stem cell applications and gene modulation. Furthermore, this review highlights the challenges inherent in tendon regeneration, the impact of systemic conditions like diabetes, rheumatoid arthritis and chronic kidney disease (CKD) on tendon integrity. By bridging laboratory findings with clinical practice, this article offers a comprehensive resource intended to support informed decision-making and enhance patient outcomes in orthopaedic care.