Evaluation of histopathological alterations in the insertional achilles tendinopathy

Abstract

Objective: To carry out a histopathological analysis of Achilles tendon fragments, considering the following alterations: degeneration (mucoid or lipoid), tissue necrosis, neovascularization, fibrosis and regeneration, hemorrhage, inflammatory infiltrate, intratendinous calcification and thickening of the vascular wall. Methods: Twenty insertional tendinopathy patients resistant to conservative treatment, totalizing 22 biopsies, underwent surgery and section of the Achilles tendon for analysis in the period between April 2006 and January 2010. Results: Each alteration was graded according to modifications of the semi-quantified Movin scale into a score from 0 (normal tissue) to 3 (marked changes in the tissue), except for degeneration that was considered as present or absent; according to this scale, we obtained an average of 8.40, minimum 4, maximum 14 points (maximum 21 points in somatory), and neovascularization was found as the alteration markedly showed by the largest number of patients (grade 3 out of 5 in 22 patients analyzed). Among the alterations evaluated, neovascularization and thickening of the vascular wall were found in all specimens evaluated. In only 2 patients (9.09%) there were all the histological alterations, and in all specimens studied it was found at least 4 (50%) histology alterations. Conclusion: According to the histological findings in our sample, we concluded that in cases of insertional Achilles tendinopathy resistant to conservative treatment there is a tendency to poor clinic-pathological evolution, since the tendon structure is already severely altered.