Tendon injury is very common, particularly in active people. Common examples include pathology of the rotator cuff, common extensor and flexor tendons at the elbow, gluteal tendons at the greater trochanter, patellar tendon and Achilles tendon. Healthy tendon has an ordered structure that includes uniform flat-shaped tenocyte cells, collagen fibers organised and layered end-to-end and side-by-side, and a structurally organized extracellular matrix (ECM). Response of tendon to injury is a complex pathological process for which the term ‘tendinosis’ is used. This process consists of early disruption of collagen fibre orientation, followed by cell proliferation, angiogenesis, change in tenocyte cell shape, and collagen and extracellular matrix breakdown. Tendon cell death and depletion at the centre of the affected region leads to further collagen and extracellular matrix breakdown, followed by fatigue healing and degenerative changes. Treatment options for tendon pathologies include conservative measures such as modification of behavior, strapping, oral anti-inflammatories, and lithotripsy. Ultrasound guided injection techniques include HCLA into, or adjacent to, the tendon, dry needling of the affected tendon, autologous blood injection, platelet rich plasma (PRP) and autologous tenocyte injection (ATI). Surgical options such as debridement, division or reconstruction of the affected tendon may be used when conservative treatments have failed. ATI is a cell-based therapy that involves the harvesting of healthy tendon from the patient. The autologous donor tendon material is obtained using ultrasound guided percutaneous core biopsy, usually of the quadriceps or patellar tendon. Adequate volume of tendon, sterile technique and minimal trauma to the healthy tendon and adjacent tissues is essential. This material is cultured for 6 weeks to produce a suspension of tenocytes, which are injected under ultrasound guidance into the abnormal tendon. The aim of the procedure is to grow new tendon tissue within the abnormal structure, restore function and relieve pain. The presence of multiple available treatments implies that no single treatment is reliably effective. Various treatments may be advocated based on multiple factors such as individual experience and expertise, plus local availability. A review of these treatments will be presented, with an attempt to make sense of the currently available evidence.