This article reviews research sourced through sport science and medical journal databases (SportDiscus and PubMed) that has attempted to quantify the effects of fatigue on tennis performance. Specific physiological perturbations and their effects on common performance measures, such as stroke velocity and accuracy, are discussed. Current literature does not convincingly support anecdotal assertions of overt performance decrements during prolonged matches or matches played during unfavourable (e.g. hot and humid) environmental conditions. The constraints of field-based research have presented, and continue to present, a methological challenge to investigators within this domain. Limitations of previous investigations have included the following: (i) a restricted measurement approach to the multifaceted skills that form the basis of match performance; (ii) a lack of sensitivity and large variability in skill or performance measures; (iii) usage of non tennis-specific methods to induce fatigue; and (iv) fatigue levels failing to reflect those recorded in match play. Hyperthermia, dehydration and hypoglycaemia have all been identified as common challenges to sustained performance proficiency in tennis, with emerging evidence suggesting central fatigue may also be a key stressor. Mixed results underpin attempts to mitigate physiological compromise and in situ performance deterioration through application of potential ergogenetic strategies (e.g. carbohydrate and caffeine supplementation, and hyperhydration). Methodological limitations are again a likely explanation, but positive findings from other skill-based sports should encourage further research in tennis. To date, tennis has largely relied on traditional methods to measure performance and has not yet realised the benefits of new sports science methods. Future research is encouraged to adopt methodological approaches that capture the multi-dimensional nature of tennis. This can be achieved through the incorporation of multifaceted performance assessment (i.e. perceptual-cognitive and biomechanical measurement approaches), the improvement of measurement sensitivity in the field setting and through the use of experimental settings that accurately simulate the energetic demands of match play.