The short answer
Tendon scraping is a minimally invasive procedure for chronic Achilles or patellar tendon pain. Under local anesthesia through a 2mm opening, Dr. Gruner uses ultrasound to scrape away the fat, blood vessels, and nerves on the tendon's surface that cause pain and restrict gliding — preserving the tendon itself and allowing most patients to return to sport within 2–4 weeks.
Medically reviewed by Marc Gruner, DO, MBA, RMSK
Sports medicine physician, Mayo Clinic fellowship. Last reviewed June 2026
Tendon Scraping and Tenex Treatments — Dr. Marc Gruner
How it works
In chronic Achilles and patellar tendinopathy, abnormal blood vessels and nerves grow on the deep surface of the tendon and drive pain. Tendon scraping addresses these directly: through a 2mm opening under local anesthesia and ultrasound guidance, the surface is cleaned of the fat, vessels, and nerves causing pain and restricting the tendon's normal gliding.
Because the procedure works on the outside of the tendon rather than cutting into it, rehabilitation is faster than other tendon procedures — the procedure takes about an hour and most patients return to sport within 2–4 weeks.
Why patients choose it
- Minimally invasive — 2mm opening under local anesthesia
- Preserves the tendon
- Ultrasound-guided
- Faster rehab — often back to sport in 2–4 weeks
What to expect at your visit
- 1.
A focused conversation
Dr. Gruner reviews your history, prior imaging, and goals — what you want to get back to doing.
- 2.
Point-of-care ultrasound
When useful, a diagnostic musculoskeletal ultrasound evaluates the injury in real time, with no radiation.
- 3.
A clear, individualized plan
You leave understanding the diagnosis, the non-surgical options, and the expected timeline — in plain language.
Before and after your procedure
- How do I prepare for Achilles or patellar tendon scraping?
- Hold NSAIDs and, when advised, blood thinners beforehand and arrange a ride home. The procedure is done through a 2mm opening under local anesthesia. Dr. Gruner confirms you've tried appropriate conservative care first.
- What is recovery like after tendon scraping?
- Because the procedure is performed outside the tendon, rehabilitation is faster than most tendon procedures — most patients return to sport within 2–4 weeks. Keep the small incision clean and dry, expect mild soreness, and follow the progressive loading program Dr. Gruner provides.
Rehabilitation protocols
What to expect week by week after your procedure. Your plan is individualized; follow these alongside your physical therapist.
Achilles Tendon — Ultrasound-Guided Tenotomy / PRP Protocol
Week 0–1
Protect, reduce pain and swelling
- Non-weight-bearing with crutches in a CAM boot
- Gentle active ankle ROM; gait training with crutches
- Optional BFR 0–2 weeks
Weeks 1–2
Restore ROM, minimize atrophy
- Partial weight-bearing in CAM boot (pain-limited)
- Core and non-weight-bearing lower-limb strengthening
- Upper-body aerobic/strength work
Weeks 2–4
Progress weight bearing
- Continue weight-bearing progression
- Restore normal joint mechanics
- Increase tendon tolerance to daily activities
Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.
Knee (Quad / Patellar Tendon) — Ultrasound-Guided PRP / Tenotomy Protocol
Week 0–1
Protect, reduce pain and swelling
- Non-weight-bearing with crutches ~4 days; knee immobilizer 1 week
- Begin gentle active knee ROM
- Gait training with crutches
Weeks 1–2
Restore ROM, progress weight bearing
- Continue knee ROM
- Begin core and lower-limb strengthening
- Upper-body aerobic/strength work; optional BFR
Weeks 2–4
Improve strength and tendon tolerance
- Begin isometric knee strengthening
- Joint mobilizations as needed
- Non-impact aerobic (bike); pool once incision healed
Weeks 4–6
Normalize gait, add balance
- Progress knee strengthening
- Initiate balance/proprioception
Weeks 6–8 (return to play)
Gradual return to sport
- No painful activities; no soreness > 24 hrs; no pain with running
- Gradual return to sport activities
Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.
Frequently asked questions
- How long is recovery after tendon scraping?
- The procedure takes about an hour, and because it is performed on the outside of the tendon, rehabilitation is faster than other tendon procedures — most patients return to sport within 2–4 weeks.