Article Text

Download PDFPDF

How does surgery compare to sham surgery or physiotherapy as a treatment for tendinopathy? A systematic review of randomised trials
  1. Dimitrios Challoumas1,
  2. Christopher Clifford1,2,
  3. Paul Kirwan3,4,
  4. Neal L Millar1
  1. 1Institute of Infection, Immunity and Inflammation, College of Medicine,Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  2. 2Department of Physiotherapy, NHS Greater Glasgow and Clyde, Glasgow, UK
  3. 3School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
  4. 4Physiotherapy Department, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
  1. Correspondence to Mr Neal L Millar; neal.millar{at}


Purpose To assess the effectiveness of surgery on all tendinopathies by comparing it to no treatment, sham surgery and exercise-based therapies for both mid-term (12 months) and long-term (> 12 months) outcomes.

Methods Our literature search included EMBASE, Medline, CINAHL and Scopus. A combined assessment of internal validity, external validity and precision of each eligible study yielded its overall study quality. Results were considered significant if they were based on strong (Level 1) or moderate (Level 2) evidence.

Results 12 studies were eligible. Participants had the following types of tendinopathy: shoulder in seven studies, lateral elbow in three, patellar in one and Achilles in one. Two studies were of good, four of moderate and six of poor overall quality. Surgery was superior to no treatment or placebo, for the outcomes of pain, function, range of movement (ROM) and treatment success in the short and midterm. Surgery had similar effects to sham surgery on pain, function and range of motion in the midterm. Physiotherapy was as effective as surgery both in the midterm and long term for pain, function, ROM and tendon force, and pain, treatment success and quality of life, respectively.

Conclusion We recommend that healthcare professionals who treat tendinopathy encourage patients to comply with loading exercise treatment for at least 12 months before the option of surgery is seriously entertained.

  • tendinopathy
  • surgery
  • tendon
  • physiotherapy
  • sham surgery

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors NLM and DC conceived and designed the study. DC, CC and PK performed analysis. All authors analysed the data. DC and NLM wrote the paper.

  • Funding This work was funded by grants from the Medical Research Council UK (MR/R020515/1) and Versus Arthritis (21346).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement DC and NLM has access to all the data and data are available upon request.