M. Astrom et A. Rausing, CHRONIC ACHILLES TENDINOPATHY - A SURVEY OF SURGICAL AND HISTOPATHOLOGIC FINDINGS, Clinical orthopaedics and related research, (316), 1995, pp. 151-164
The surgical findings and the histopathology are reported for 163 pati
ents (134 males, 29 females; mean age, 38 years; range, 13-72 years; 7
5% athletes) with chronic Achilles tendinopathy, Biopsy specimens from
symptomatic (155 cases) and nonsymptomatic (90 cases) parts of the te
ndon and from the paratenon (97 cases) were obtained, Surgical reports
were reviewed and histopathology was evaluated according to a standar
dized protocol, Eighteen tendons also were analyzed by immunofluoresce
nce for fibrinogen, immunoglobulins, and complement, Degenerative chan
ges (tendinosis) characterized by abnormal fiber structure, focal hype
rcellularity, and vascular proliferation were noted in 90% of biopsy s
pecimens from symptomatic parts of the tendons and, to a lesser degree
, in 20% from nonsymptomatic parts, Fibrinogen could be identified in
most lesion biopsy specimens, Partial tendon ruptures were present in
19% of the patients and always occurred in areas afflicted with tendin
osis. The paratenon was mostly normal or revealed only slight changes,
Increasing age and male gender were associated with more pronounced h
istopathologic changes, Tendinosis, sometimes complicated by partial r
upture, appears to be the major lesion in chronic Achilles tendinopath
y; the paratenon is rarely involved, Important features are a lack of
inflammatory cells and a poor healing response.