Stress-shielding as a cause of insertional tendinopathy: the operative technique of limited adductor tenotomy supports this theory

J Sci Med Sport. 2004 Dec;7(4):424-8. doi: 10.1016/s1440-2440(04)80259-7.


The aetiology of tendinopathy is poorly understood. A new hypothesis proposed argues that tendinopathy may not be purely a tensile injury, rather that altered mechanics such as compression or stress-shielding may be important. Both tendon compression and a decrease in tendon load (stress-shielding) will induce change in a tendon similar to that seen in an insertional tendinopathy. Stress-shielding as a cause of tendinopathy is supported by the clinical success of operative release of adductor longus. This surgery releases the superficial section of the normal adductor longus tendon at a point distal to the insertion. This may have the effect of transferring stress from the superficial section of the tendon to the stress-shielded deeper portion, and the induction of normal loads in both the deeper and superficial portions of the tendon may assist in tendon recovery. This interesting hypothesis and clinical intervention require further investigation

Publication types

  • Review

MeSH terms

  • Athletic Injuries / physiopathology*
  • Athletic Injuries / surgery*
  • Humans
  • Knee Injuries / physiopathology
  • Knee Injuries / surgery
  • Sports Medicine / methods*
  • Sprains and Strains / physiopathology
  • Stress, Physiological / physiopathology
  • Tendon Injuries / physiopathology*
  • Tendon Injuries / surgery*
  • Tensile Strength
  • Weight-Bearing