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Open research questions in Tendon Structure and Treatment

35 unresolved questions extracted from the limitations and future-work sections of 292 Tendon Structure and Treatment papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • ATT may serve as a practical marker of residual cardiovas- 1109 cular risk after PCI, particularly in ACS, and warrants further investigation as a tool for risk stratification beyond traditional lipid parameters.

    Prognostic Impact of Achilles Tendon Thickening After Percutaneous Coronary Intervention Compared Between Acute and Chronic Coronary Syndromes · 2026 · DOI

  • ABSTRACT Extracorporeal shock wave therapy (ESWT) improves tendon‐bone healing after rotator cuff injury (RCI), but its underlying cellular mechanisms remain unknown.

    Effects of Extracorporeal Shock Wave Therapy on Tendon Integrity, Biomechanical Strength, Matrix Remodeling, Inflammation, Angiogenesis, and Tenogenic Differentiation in Rotator Cuff Injury · 2026 · DOI

  • Nevertheless, given the limited size of this case series, larger studies with extended follow-up are needed to confirm these preliminary results, which may represent a starting point for further investigation into the clinical application of stromal vascular fraction obtained from mechanically processed lipoaspirate as a potential option for the treatment of plantar heel pain.

    Preliminary Clinical Experience in the Treatment of Recalcitrant Plantar Heel Pain With Stromal Vascular Fraction: Short- and Long-Term Findings From a Case Series · 2026 · DOI

  • The SWE pro- vides additional quantitative assessment, which can be implemented for stratifying disease severity; however, larger multicenter studies are warranted to validate cut- off values and to standardize SWE acquisition protocols across different ultrasound systems and populations.

    Role of shear wave elastography in the assessment of Achilles tendon pathologies using MRI as the reference standard · 2026 · DOI

  • The TGF- β signaling pathway serves as a central regulator of tendon ECM metabolic homeostasis, among which the TGF-β/Smad2 axis can directly mediate the balanced regulation of collagen synthesis and degradation in tendons, yet its specific role and underlying molecular mechanism in hyperlipidemia-induced tendon ECM dysfunction remain poorly defined.

    Hyperlipidemia-induced metabolic dysregulation impairs tendon homeostasis: the role of TGF-β/Smad2 signaling pathway in lipid-mediated extracellular matrix remodeling · 2026 · DOI

  • Several limitations should be acknowledged. First, the primary analysis intentionally focused on the first set to isolate the acute response to the initial rESWT application; therefore, the present findings do not allow conclusions regarding dose–response relationships or whether 45 repeated applications produce cumulative or longer-lasting effects. Second, mechanistic interpretation remains indirect because no physiological measures were obtained to quantify changes in pain perception, muscle activation, co-contraction, passive resistance, or sensorimotor function. Given that Joo et al. (2024) reported functional improvements without changes in tendon stiffness, future studies should incorporate complementary assessments (e.g., perceived pain/discomfort ratings, surface electromyography for agonist activation and antagonist co- activation, and passive joint torque or range of motion) to clarify the pathways underlying the observed enhancement in knee extension output. Third, because sham stimulation and alternative stimulation sites were not included, expectancy and other non-specific effects cannot be fully excluded. Finally, generalisability may be limited to the present sample and testing configuration. Future research should employ sham-controlled designs, systematically manipulate stimulation parameters (e.g., number of impulses, frequency, and pressure), and examine both immediate and time-course responses across different athlete populations and task conditions. Such studies are needed to establish causal mechanisms, dose–response relationships, and the practical relevance of rESWT as a conditioning intervention.

    EFFECT OF RADIAL EXTRACORPOREAL SHOCK WAVE THERAPY ON MUSCLE POWER OUTPUT IN THE MAJOR THIGH MUSCLE GROUPS · 2026 · DOI

  • the spatiotemporal dynamics of ROS generation in vivo. Tendon tissue is structurally heterogeneous, with distinct mechanical, metabolic, and vascular characteristics across the midsubstance, enthesis, and peritendinous regions. Emerging redox biology highly research and compartmentalized, with mitochondrial, membrane-associated pools exerting distinct functional roles (Lennicke and Cochemé, 2021; Hong et al., 2024). However, most current tendon studies rely on bulk oxidative stress markers rather than real-time or compartment-specific measurements.

    Recent advances in tendon redox biology: the interplay of oxidative stress, calcium signaling, and antioxidant defence mechanisms · 2026 · DOI

  • This study focused primarily on pain outcomes measured by the VAS and therefore cannot fully reflect broader clinical value, such as functional recovery, grip strength, return to work or sport, and recurrence.

    Time-dependent comparative efficacy of non-surgical treatments for pain relief in lateral epicondylitis: a systematic review and network meta-analysis · 2026 · DOI

  • Although its role remains debated, PRP has undeniably shown considerable potential in aiding the healing of various injuries and pathologies across multiple fields, from dermatology (e.

    Effect of platelet-rich plasma in treating musculoskeletal disorders in athletes · 2025 · DOI

  • Introduction: In the literature, the effectiveness of the extracorporeal shock wave therapy (ESWT) in patients with heel spur was confirmed, but the therapy protocol has not been established when used as monotherapy.

    Does the frequency and number of ESWT sessions in patients with heel spurs affect the final result of the therapy? · 2024 · DOI

  • The effect of KT on the range of joint motion remains unclear, and its use is still controversial, as there are many trials that do not show any beneficial effects thereof, especially in terms of effects on muscle strength and activity, and of tendon flexibility.

    KINESIO TAPING USE FOR THE PREVENTION AND TREATMENT OF SPORTS INJURIES IN ATHLETES · 2020 · DOI

  • BACKGROUND: Injection therapies are often considered alongside exercise for chronic midportion Achilles tendinopathy (AT), although evidence of their efficacy is sparse.

    Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study · 2017 · DOI

  • BACKGROUND: Platelet-rich plasma (PRP) contains various growth factors and appears to have a potential to promote tendon healing, but evidence is lacking regarding its effect on human tenocytes from rotator cuff tendons with degenerative tears.

    Platelet-Rich Plasma Stimulates Cell Proliferation and Enhances Matrix Gene Expression and Synthesis in Tenocytes From Human Rotator Cuff Tendons With Degenerative Tears · 2012 · DOI

  • In acute injuries, there is limited data indicating no discernible differences in PROs between surgical and non-surgical management. surgical management of ad- ductor tendinopathy is warranted given the limited number available.

    Surgical and Conservative Management of Adductor Tendinopathy Yield Comparable Outcomes and Complications: A Systematic Review · 2026 · DOI

  • First, the identification and characterization of previously underrecognized entheseal sites in the distal extremities, such as pulley systems, retinacula, novel tendon insertions, and collateral ligaments, broadening the morphological spectrum of entheseal imaging.

    From Invisible to Visible: Cutting-Edge Ultrasound Insights into Entheses of the Distal Extremities in Rheumatology · 2026 · DOI

  • The mechanistic interpretations offered should be regarded as evidence-based hypotheses rather than causal mechanisms directly demonstrated by the present study, as pain improvement and tissue status are not simply linearly related.

    Time-dependent comparative efficacy of non-surgical treatments for pain relief in lateral epicondylitis: a systematic review and network meta-analysis · 2026 · DOI

  • A more clinically meaningful future direction may be to explore more rational sequential, combined, or individualized treatment strategies for different stages of the condition rather than identifying one treatment that is best across all stages.

    Time-dependent comparative efficacy of non-surgical treatments for pain relief in lateral epicondylitis: a systematic review and network meta-analysis · 2026 · DOI

  • Some included studies provided insufficient information on baseline characteristics, symptom duration, and follow-up details, limiting deeper evaluation of transitivity and potential effect modifiers.

    Time-dependent comparative efficacy of non-surgical treatments for pain relief in lateral epicondylitis: a systematic review and network meta-analysis · 2026 · DOI

  • The paper lacks detailed discussion of predictive factors that determine which patients will respond to conservative rehabilitation versus those requiring surgical intervention.

    The Role of Physical Medicine and Rehabilitation in the Management of Lateral Epicondylitis · 2025 · DOI

  • The paper does not provide explicit comparative effectiveness data between different rehabilitation protocols for lateral epicondylitis across different patient populations and severity levels.

    The Role of Physical Medicine and Rehabilitation in the Management of Lateral Epicondylitis · 2025 · DOI

  • Materials need to achieve long-term stability and sustained healing capability upon aging while incorporating highly specific supramolecular interactions to prevent unwanted side-interactions and surface passivation.

    Novel Implications of Tissue Engineering in the Treatment and Management of Rotator Cuff Tendinopathy · 2021 · DOI

  • Self-healing in mechanically stiff supramolecular hydrogels based on electrostatically bound nanoclay and molecular binders becomes passivated over time due to non-specific ionic interactions prone to unwanted side reactions.

    Novel Implications of Tissue Engineering in the Treatment and Management of Rotator Cuff Tendinopathy · 2021 · DOI

  • Combining high mechanical stiffness with dynamic cross-links presents a conflicting requirement, as high hydrogel stiffness typically suggests strong and stable cross-linking interactions, yet dynamic properties are needed for self-healing.

    Novel Implications of Tissue Engineering in the Treatment and Management of Rotator Cuff Tendinopathy · 2021 · DOI

  • Excessive or inappropriate loading of the musculotendinous unit is believed to be central to the disease process, although the exact mechanism by which this occurs remains uncertain.

    Management of Tendinopathy · 2009 · DOI

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35 open questions have been extracted from the limitations and future-work passages of 292 Tendon Structure and Treatment papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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