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Key Points Tendon disorders are common, often under-reported and a major clinical problem Most current treatments for tendinopathy are neither effective nor evidence-based Molecular processes underlying tendinopathy are now being elucidated: metalloproteinase enzymes are thought to have a key role in the regulation of the activity of tendon cells and matrix remodeling in both normal and pathologic tendon The potential roles of neuropeptides, inflammatory mediators and mechanical strain (either too much or too little) acting on the resident tenocytes are the source of some controversy and require in-depth investigation using in vitro and in vivo models Excessive or inappropriate activity of destructive matrix-degrading enzymes might be a novel therapeutic target for tendinopathy

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