“…A number of degenerative changes have been reported including, hypoxia, loss Drake et al (1996), Everts et al (1992), Garnero et al (1998), Hou et al (1999), Kamiya et al (1998) MMP-13 Metallo Cleavage of matrix from demineralised zones Delaissé et al (2003), Everts et al (2002), Fuller and Chambers (1995) Osteoclast activation and migration MMP-13 Metallo Cleavage of type I collagen generating an activation factor for osteoclasts Millar et al (1998), Riley et al (2002) of fibrillar collagen structure, glycosaminoglycan accumulation between the collagen fibres and cell rounding together with an absence of inflammatory cells (Kannus & Józsa, 1991). Similar changes have been reported in chronic tendinopathy, including an abnormal fibre structure and arrangement, focal changes in cellularity, rounded cells and an increase in proteoglycan content (Movin, Gad, Reinholt, & Rolf, 1997).…”