This 1998 commentary by Maffulli, Khan, and Puddu challenges the routine use of '-itis' terminology for overuse tendon conditions. The authors argue that chronic tendon overuse produces degeneration (tendinosis), not inflammation, and propose a tissue-based classification to standardize clinical and research language.
When a patient presents with chronic Achilles or patellar pain, the instinct to diagnose 'tendinitis' and prescribe NSAIDs reflects a fundamental histologic misunderstanding. Biopsy studies consistently show degeneration with absent inflammatory cells — not inflammation. As the underlying pathology in overuse tendon conditions.
In clinical practice, use 'tendinopathy' for the syndrome of pain, swelling, and impaired performance. Reserve 'tendinosis' and 'paratenonitis' for when you have biopsy data, and abandon 'tendinitis' as a clinical label altogether.
When you see a surgical series describing 'partial tear' repair, read critically: the authors were almost certainly operating on degenerative tendinopathy. True partial tears are acute, macroscopic, and uncommon.
The practical consequence: patients labeled with 'tendinitis' expect a short inflammatory illness and return to sport quickly. Patients correctly counseled about tendinosis understand they have a degenerative condition with proven chronicity. Which changes compliance with load management, rehabilitation timelines, and rupture-risk counseling.
This 1998 commentary by Maffulli, Khan, and Puddu challenges the routine use of '-itis' terminology for overuse tendon conditions. The authors argue that chronic tendon overuse produces degeneration (tendinosis), not inflammation, and propose a tissue-based classification to standardize clinical and research language.
When a patient presents with chronic Achilles or patellar pain, the instinct to diagnose 'tendinitis' and prescribe NSAIDs reflects a fundamental histologic misunderstanding. Biopsy studies consistently show degeneration with absent inflammatory cells — not inflammation. As the underlying pathology in overuse tendon conditions.
In clinical practice, use 'tendinopathy' for the syndrome of pain, swelling, and impaired performance. Reserve 'tendinosis' and 'paratenonitis' for when you have biopsy data, and abandon 'tendinitis' as a clinical label altogether.
When you see a surgical series describing 'partial tear' repair, read critically: the authors were almost certainly operating on degenerative tendinopathy. True partial tears are acute, macroscopic, and uncommon.
The practical consequence: patients labeled with 'tendinitis' expect a short inflammatory illness and return to sport quickly. Patients correctly counseled about tendinosis understand they have a degenerative condition with proven chronicity. Which changes compliance with load management, rehabilitation timelines, and rupture-risk counseling.