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Light Microscopic Histology of Achilles Tendon Ruptures

A Comparison With Unruptured Tendons

Nicola Maffulli, MD, MS, PhD, FRCS(Orth)^*,, Victoria Barrass, BSc Med Sci (Hons)^* and Stanley W.B. Ewen, PhD, FRCPath

^* Department of Orthopaedic Surgery, University of Aberdeen, Aberdeen, Scotland
Department of Pathology, University of Aberdeen, Aberdeen, Scotland

Address correspondence and reprint requests to Nicola Maffulli, MD, Department of Orthopaedic Surgery, University of Aberdeen Medical School, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland

We studied biopsies from the Achilles tendons of patients undergoing open repair for a subcutaneous rupture of their Achilles tendons (27 men, 11 women; mean age, 45.3 ± 13.8 years) and specimens of Achilles tendons from persons with no known tendon ailments (43 men, 3 women; mean age, 64.2 ± 9.7 years). Histologic examination was performed using stained slides that were interpreted using a semiquantitative grading scale assessing fiber structure and arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, hyalinization, and glycosaminoglycan. We gave up to three marks for each of these variables, with 0 being normal and 3 being maximally abnormal. All the histology slides were assessed twice in a blinded manner; the agreement between two readings ranged from 0.56 to 0.87 (kappa statistics). The score of ruptured tendons was significantly greater than the average score of control tendons (20.5 ± 3.6 versus 6.5 ± 2.1), and there was significantly higher degeneration in the ruptured tendons. Nonruptured Achilles tendons, even at an advanced age, and ruptured Achilles tendons are clearly part of two distinct populations. Using these staining techniques, light microscopic degeneration is not a feature of tendons from healthy, older persons.

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				D Kader, A Saxena, T Movin, and N Maffulli Achilles tendinopathy: some aspects of basic science and clinical management Br. J. Sports Med., August 1, 2002; 36(4): 239 - 249. [Abstract] [Full Text] [PDF]