achilles tendinopathy by mika paavola, pekka kannus, tero a.h. järvinen, karim khan, lászlo...

Achilles Tendinopathy

by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen

J Bone Joint Surg AmVolume 84(11):2062-2076

November 1, 2002

©2002 by The Journal of Bone and Joint Surgery, Inc.

Myofibroblast in the paratenon of the Achilles tendon.

Mika Paavola et al. J Bone Joint Surg Am 2002;84:2062-2076

©2002 by The Journal of Bone and Joint Surgery, Inc.

Lysis of the collagen fiber can be seen around degenerated tenocytes in Achilles tendinopathy (Masson trichrome staining, ×300).

Mika Paavola et al. J Bone Joint Surg Am 2002;84:2062-2076

©2002 by The Journal of Bone and Joint Surgery, Inc.

Only a few unconnected collagen fibers are visible in the mucoid degeneration (asterisks) located inside the Achilles tendon.

Mika Paavola et al. J Bone Joint Surg Am 2002;84:2062-2076

©2002 by The Journal of Bone and Joint Surgery, Inc.

Calcium deposits (black) have been precipitated on the surface of the collagen fibers in the calcifying tendinopathy of the Achilles tendon (transmission electron microscope, ×6800).

Mika Paavola et al. J Bone Joint Surg Am 2002;84:2062-2076

©2002 by The Journal of Bone and Joint Surgery, Inc.

Tendolipomatosis in Achilles tendinopathy.

Mika Paavola et al. J Bone Joint Surg Am 2002;84:2062-2076

©2002 by The Journal of Bone and Joint Surgery, Inc.

Obliterative arteritis (thin arrows) and venous proliferation with periphlebitis (thick arrow) are visible in the paratenon of patients with chronic Achilles tendinopathy (hematoxylin and eosin,

×100).

Mika Paavola et al. J Bone Joint Surg Am 2002;84:2062-2076

©2002 by The Journal of Bone and Joint Surgery, Inc.

Longitudinal ultrasound image of an Achilles tendon with intratendinous changes.

Mika Paavola et al. J Bone Joint Surg Am 2002;84:2062-2076

©2002 by The Journal of Bone and Joint Surgery, Inc.

Figs. 8-A and 8-B Longitudinal (Fig. 8-A) and transverse (Fig. 8-B) T2-weighted gradient echo magnetic resonance images of Achilles tendinopathy demonstrate thickening of the tendon and

signal changes within the Achilles tendon.

Mika Paavola et al. J Bone Joint Surg Am 2002;84:2062-2076

©2002 by The Journal of Bone and Joint Surgery, Inc.

Photograph of a patient with chronic Achilles tendinopathy, demonstrating a tender, nodular swelling (arrows) that moved as the ankle was dorsiflexed and plantar flexed.

Mika Paavola et al. J Bone Joint Surg Am 2002;84:2062-2076

©2002 by The Journal of Bone and Joint Surgery, Inc.

This patient had an intratendinous necrotic focus, which was excised and sent for histopathologic analysis.

Mika Paavola et al. J Bone Joint Surg Am 2002;84:2062-2076

©2002 by The Journal of Bone and Joint Surgery, Inc.