achilles tendinopathy by mika paavola, pekka kannus, tero a.h. järvinen, karim khan, lászlo...
TRANSCRIPT
![Page 1: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/1.jpg)
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.
![Page 2: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/2.jpg)
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.
![Page 3: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/3.jpg)
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.
![Page 4: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/4.jpg)
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.
![Page 5: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/5.jpg)
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.
![Page 6: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/6.jpg)
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.
![Page 7: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/7.jpg)
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.
![Page 8: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/8.jpg)
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.
![Page 9: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/9.jpg)
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.
![Page 10: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/10.jpg)
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.
![Page 11: Achilles Tendinopathy by Mika Paavola, Pekka Kannus, Tero A.H. Järvinen, Karim Khan, Lászlo Józsa, and Markku Järvinen J Bone Joint Surg Am Volume 84(11):2062-2076](https://reader035.vdocuments.us/reader035/viewer/2022062803/56649f1e5503460f94c358db/html5/thumbnails/11.jpg)
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.