Tendinopathy is a common musculoskeletal disorder causing significant pain and functional impairment. High-intensity laser therapy (HILT) has increasingly been employed for tendinopathy. However, further research is required to elucidate therapeutic efficacy differences across various subtypes, determine optimal treatment parameters, and assess long-term effects. To evaluate the effectiveness of HILT for tendinopathy. PubMed, Embase, Cochrane Library, China Biology Medicine, Web of Science, CNKI, and SCOPUS databases were searched to include randomised controlled trials comparing HILT with placebo or other treatments up to 20 October 2025. Primary outcome measures included pain intensity and disability, analyzed as MD and SMD with 95% confidence intervals, respectively. Risk of bias was assessed using the Cochrane Tool and Physiotherapy Evidence Database scale. Heterogeneity was assessed with I², and random-effects models were used. 15 studies involving 629 patients were included: lateral epicondylitis (53%), rotator cuff tendinopathy (27%), and others (20%). Studies showed moderate quality (mean PEDro score 6.3), with strong randomisation (100% low risk) but weaknesses in allocation concealment (20% low risk) and blinding. HILT significantly improved pain (MD: -1.15; 95%CI: -1.73 to -0.58) and disability (SMD: -1.00; 95%CI: -1.77 to -0.22, p < 0.05). Pain reduction exceeded the MCID, though the lower confidence interval bound suggests marginal benefit in some. For disability, subgroup analysis by anatomical site revealed greater improvement in shoulder-related conditions (MD: -2.54) than in elbow-related conditions (MD: -0.91). Stress pain showed the most substantial relief (MD: -2.30), and treatment effects increased over time, peaking after 16 weeks. HILT effectively improves pain and disability in tendinopathy, with site-specific and cumulative benefits. Given methodological limitations, future high-quality studies are needed to optimize parameters and confirm long-term benefits.