Most cases of patellar or Achilles tendonitis improve with exercise therapy that strengthens the muscles above and below the affected tendon. For complex cases, we add treatments such as GTN patches, shockwave, and tendon injections. Yet even with the best rehabilitation, some people don’t return to sport. In those cases, we consider surgery – or a less invasive procedure called tendon scraping.

Tendon scraping is one of the advanced procedures offered at our tendon clinic.

What are the results of Achilles or patellar tendon surgery?

A study in the British Journal of Sports Medicine compared surgery with other treatments. It found surgery was no better than exercise for tennis elbow, shoulder tendonitis, and Achilles tendonitis – and carried much higher risks than shockwave or injections. The authors concluded surgery should only be considered after 12 months of failed conservative therapy.

Traditional surgery for patellar tendonitis, which involves cutting the diseased tendon, also has poor outcomes. One randomised trial found a 50% success rate – equal to physiotherapy, and in our experience, those who fail traditional surgery have a poor outlook.

A newer procedure has changed this. A study co-authored by Dr Masci showed that patellar tendon scraping reduces pain and speeds the return to sport in athletes with patellar tendonitis. Scraping is also safer, because it doesn’t open or damage the tendon itself.

How does tendon scraping work?

jumpers knee on ultrasound

We believe scraping removes the abnormal nerves lying on the surface of the tendon. These nerves follow abnormal blood vessels, and both show up on ultrasound. Using ultrasound, we precisely locate the vessels and nerves and remove them – reducing pain and speeding the return to sport. Because the procedure works on the tendon’s surface, it avoids the direct harm to the tendon that open surgery causes.

These abnormal vessels are visible on a standard ultrasound of a tendinosis, which is how we map the nerves to target.

Can tendon scraping be done like an injection?

Yes. Scraping can be performed much like an injection – without sutures or general anaesthesia – using a specialised needle with a small blade, guided by ultrasound. We perform needle scraping of the Achilles and patellar tendons in people who’ve failed other treatments.

Needle scraping is considered safer than surgical scraping, though more studies are needed to confirm it’s as effective as surgery. Even so, it’s a good option for people who want a safer, less invasive approach than surgical scraping.

What is recovery like after tendon scraping?

Recovery depends on the tendon and the extent of scraping, but the basic principles are:

  • Keep the ankle or knee elevated for the rest of the day
  • Keep the bandage on and avoid driving until the next day
  • Don’t submerge the area – showering is fine, but avoid swimming and hot tubs
  • Apply ice every 3-4 hours with a compressive bandage until pain and swelling settle
  • For the first week, rest the ankle or knee and reduce your step count to about 50% of normal; you can continue upper-body training.
  • After a week, resume tendon loading and cross-training such as cycling and swimming; once you hit your strength goals, progress to running and sport-specific training

Returning to sport usually takes 4-6 weeks, or longer, depending on your strength before the procedure.

What are the risks of tendon scraping?

Like any tendon procedure, scraping carries some risk:

  • Infection (about 1 in 10,000)
  • Tendon rupture (the risk of complete rupture is extremely low)
  • Worsening tendon pain

These risks are minimised by using a doctor experienced in ultrasound-guided tendon scraping. Dr Masci performs scraping under local anaesthetic in a sterile clinic – a safer, more cost-effective option than theatre surgery.

Tendon scraping and the Tenex procedure

The Tenex procedure is another minimally invasive treatment for tendonitis. It uses ultrasonic energy to remove damaged tendon tissue while sparing the healthy tissue, under local anaesthetic, avoiding more invasive surgery. It suits upper- and lower-limb tendonitis that hasn’t responded to other treatments, and we sometimes combine it with tendon scraping for certain cases.

How much does tendon scraping cost?

Achilles and patellar tendon scraping are among our advanced procedures. Dr Masci performs it as a one-stop visit – assessment, diagnostic ultrasound, and procedure – in a single appointment at Chelsea, the most cost-effective clinic. Review the current fees here.

Frequently asked questions about tendon scraping.

Is tendon scraping the same as surgery?

Not in the traditional sense. Surgical scraping is done in theatre, but needle scraping is performed like an injection – through the skin with a specialised bladed needle under ultrasound and local anaesthetic, with no sutures or general anaesthetic. Both target the abnormal nerves on the tendon surface rather than cutting the tendon.

Which tendons can be scraped?

Most commonly, the Achilles and patellar (kneecap) tendons, which sit close to the skin and are easy to reach with ultrasound. Scraping is reserved for tendonitis that hasn’t responded to rehab, GTN patches, shockwave, or injections.

Does tendon scraping hurt?

The area is first numbed with local anaesthetic, so the procedure is well tolerated. Some soreness and swelling afterwards is normal and settles with ice and a compressive bandage over the following days.

How long is the recovery after Achilles or patellar tendon scraping?

Most people return to sport in about 4-6 weeks, sometimes longer, depending on their strength beforehand. You rest the tendon for the first week, then build loading and cross-training before progressing to running.

Is tendon scraping better than surgery?

For the right patient, it offers a similar benefit with far less risk, because it doesn’t cut or open the tendon. Open surgery has poor outcomes for patellar tendonitis (around 50% success) and higher complication rates, so we try scraping first.

Final word from Sport Doctor London about tendon scraping

Tendon scraping is an option for Achilles and patellar tendonitis that has failed strength training, GTN patches, and shockwave. While some cases are done in theatre, more are now performed in a treatment room with a specialised blade, much like an injection – safer and more cost-effective.

Dr Masci performs tendon scraping for Achilles and patellar tendonitis in London. For costs and booking, contact his team here or call +44 (0) 203 488 0350.

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