Chondral Metaplasia in Calcific Insertional Tendinopathy of the Achilles Tendon

Maffulli, Nicola; Reaper, Jacqueline; Ewen, S. W. B.; Waterston, Stuart W.; Barrass, Victoria

doi:10.1097/00042752-200607000-00008

Cited by 79 publications

(75 citation statements)

References 21 publications

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“…The possible involvement of these genes is also supported by evidence obtained in other tendon injuries: increased type II collagen expression has been detected in human rotator cuff tendinopathy (Maffulli et al, 2006;Sharma and Maffulli, 2005), and we observed tTG2 and TG2 mRNAs down-regulation in all injured supraspinatus tendons (Oliva et al, 2009). …”

Section: Discussionsupporting

confidence: 87%

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Gene expression analysis in calcific tendinopathy of the rotator cuff

Oliva

Barisani²,

Grasso³

et al. 2011

eCM

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We evaluated the expression of several genes involved in tissue remodelling and bone development in patients with calcifi c tendinopathy of the rotator cuff. Biopsies from calcifi ed and non-calcifi ed areas were obtained from 10 patients (8 women and 2 men; average age: 55 years; range: 40-68) with calcifi c tendinopathy of the rotator cuff. To evaluate the expression of selected genes, RNA extraction, cDNA synthesis and quantitative polymerase chain reaction (PCR) were performed. A signifi cantly increased expression of tissue transglutaminase (tTG)2 and its substrate, osteopontin, was detected in the calcifi c areas compared to the levels observed in the normal tissue from the same subject with calcifi c tendinopathy, whereas a modest increase was observed for catepsin K. There was also a signifi cant decrease in mRNA expression of Bone Morphogenetic Protein (BMP)4 and BMP6 in the calcifi c area. BMP-2, collagen V and vascular endothelial growth factor (VEGF) did not show signifi cant differences. Collagen X and matrix metalloproteinase (MMP)-9 were not detectable. A variation in expression of these genes could be characteristic of this form tendinopathy, since an increased level of these genes has not been detected in other forms of tendon lesions.

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Section: Discussionsupporting

confidence: 87%

“…A variation in expression of these genes could be, in theory, a fi nding characteristic of calcifi c tendinopathy, since an increased level of these genes has not been detected in other forms of tendon lesions (Maffulli et al, 2006;Archambault et al, 2007;Jelinsky et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

Gene expression analysis in calcific tendinopathy of the rotator cuff

Oliva

Barisani²,

Grasso³

et al. 2011

eCM

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“…In line with previous studies in the Achilles [20,22,27], patellar [25], and supraspinatus tendon [17] performed by our group and others using the semiquantitative scale employed in the present study, the evaluation of the number of cells is performed in a semiquantitative, not quantitative, fashion. We agree it is possible to actually count the number of cells per each microscopic field [30], but this would have changed the criteria used in calculating the pathological score.…”

Section: Discussionmentioning

confidence: 66%

“…In the present investigation, only a few specimens showed any evidence of hyalinization. In our previous use of Movin's scale in tendinopathy of the lower limb [20,22,25], we came to realize that hyalinization is seldom present, and it is a poorly reproducible histopathological criterion in tendinopathic samples. For this reason, we proposed to remove this criterion from the assessment scale.…”

Section: Discussionmentioning

confidence: 99%

Movin and Bonar Scores Assess the Same Characteristics of Tendon Histology

Maffulli

Longo

Franceschi

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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190

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The Movin scoring system and its validated modifications and the Bonar scoring system are used to classify the histopathological findings of tendinopathy. We compared the reliability of these two different histopathological evaluation scores of tendon tissue. Tendon samples were harvested from 88 individuals (49 men, 39 women; mean age, 58.2 years) who underwent arthroscopic repair of a rotator cuff tear, and from five male patients who died of cardiovascular events (mean age, 69.6 years). A piece of supraspinatus tendon that was not directly involved in the tear was harvested en bloc within the intact middle portion of the tendon. Using hematoxylin and eosin staining and Alcian blue, slides were assessed using Bonar and Movin scores. The intraclass correlation was 0.921 (confidence interval 95% 0.790-0.963). Movin's and Bonar's scores have a high correlation and assess similar characteristics and variables of tendon abnormalities.

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“…Acquisition of chondrocyte phenotypes and ectopic ossification has been reported in clinical samples and animal models of tendinopathy. 23,25 Given unfavorable factors, acute injury might develop tendinopathic-like changes.…”

mentioning

confidence: 99%

Ectopic chondro‐ossification and erroneous extracellular matrix deposition in a tendon window injury model

Lui

Cheuk

Lee

et al. 2011

Journal Orthopaedic Research

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The acquisition of chondro-osteogenic phenotypes and erroneous matrix deposition may account for poor tissue quality after acute tendon injury. We investigated the presence of chondrocyte phenotype, ossification, and the changes in the expression of major collagens and proteoglycans in the window wound in a rat patellar tendon window injury model using histology, von Kossa staining and immunohistochemistry of Sox 9, major collagens, and proteoglycans. Our results showed that the repair tissue did not restore to normal after acute injury. Ectopic chondrogenesis was observed in 33% of samples inside wound at week 4 while ectopic ossification surrounded by chondrocyte-like cells were observed in the window wound in 50% of samples at week 12. There was sustained expression of biglycan and reduced expression of aggrecan and decorin in the tendon matrix in the repair tissue. The erroneous deposition of extracellular matrix and ectopic chondro-ossification in the repair tissue, both might influence each other, might account for the poor tissue quality after acute injury. Higher expression of biglycan and aggrecan were observed in the ectopic chondro-ossification sites in the repair tissue, suggesting that they might have roles in ectopic chondro-osteogenesis. Tendons regenerate and repair slowly and inefficiently after injury. The crimp pattern of collagen fibers and fibrils was smaller than that of the control 1 and the regenerated fibrotic scar tissue could not return to its original mechanical strength for a long time after injury. 1-3 It was known that collagens and proteoglycans in the extracellular matrix (ECM) have roles in modulating the activities of tenocytes in addition to their structural roles. 4 Despite studies about the tendon healing process, there is still limited and inconsistent understanding about the change in biochemical composition of ECM after tendon injury 5-7 and how does the ECM regulate cellular functions. On the other hand, ectopic ossification after midpoint tenotomy of rat or mouse Achilles tendon has been reported. [8][9][10][11][12] Clinical studies have occasionally reported ectopic calcification after Achilles tendon rupture 13,14 as well as calcification and tendinopathic-like changes in patellar tendon donor site after anterior cruciate ligament (ACL) reconstruction. [15][16][17][18][19][20][21] We hypothesized that chondro-osteogenesis and change in the ECM composition of the repair tissue after acute tendon injury might contribute to the poor tissue quality. This study therefore aimed to examine the presence of chondrocyte phenotype and ossification inside the window wound of the patellar tendon. The spatial-temporal changes of major collagens including collagen types I and III and major proteoglycans including decorin, biglycan, fibromodulin, and aggrecan in the window wound after tendon injury were also investigated. METHODOLOGY Tendon Injury ModelThis study was approved by the Animal Research Ethics Committee of the authors' institution. Eighteen SpragueDawley male ad...

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Chondral Metaplasia in Calcific Insertional Tendinopathy of the Achilles Tendon

Cited by 79 publications

References 21 publications

Gene expression analysis in calcific tendinopathy of the rotator cuff

Gene expression analysis in calcific tendinopathy of the rotator cuff

Movin and Bonar Scores Assess the Same Characteristics of Tendon Histology

Ectopic chondro‐ossification and erroneous extracellular matrix deposition in a tendon window injury model

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