Background
Methods
Histological assessment protocol
Statistics
Results
Characteristic | Patients (total n = 16) |
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Sex [M] | 11 (69 %) |
Age, years [Mean, s.d., range] | 48.9 ± 12.3 (25–68) |
Duration of symptoms [Mean, s.d.] | 2.2 ± 2.1 years |
Background | |
Diabetes type 2 | One (6 %) |
Inflammatory disease | Four (25 %) |
Intensive sports | Nine (56 %) |
Specific treatments | |
Steroid injection | Nine (56 %) |
Shock waves | Eight (50 %) |
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Bone findings: The subchondral bone showed signs of desiccation, destruction of fibroblasts and blood vessels, with osteoclasts, remodeling, fibrous tissue and fat necrosis in the nearby tissue. Bone trabeculae were thin and the bone marrow was fatty and edematous. Cortical bone with new bone formation zones and reaming of osteoblasts and osteoclasts was seen (Figs. 2 and 3).××
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Synovium findings: Adjacent to the Achilles tendon, degenerative mucoids were present with proliferation of synovial cells and lymphoplasmocytic perivascular infiltration. Hypertrophy and hyperplasia with papillary formation and numerous blood vessels were observed along with severe edema with follicles and lymphoid infiltrate. Masson histological coloration demonstrated synovial fibrotic changes.
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Cartilage findings: Significant degenerative changes, edema, deep cracks, and fragmentation into calcified zone were observed (Fig. 4). Fibrinoid changes with loose bodies were seen. Masson staining demonstrated irregularities of the collagen fibers with eburnation of the cartilage to subchondral bone. Regenerative changes were found with chondrocytes in the area (Fig. 5).××
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Tendon findings: In a minority of samples, scattered mucoid degenerative changes with multiple zones of filtrated blood vessels and lymphocitary infiltrate around the nearby fat tissue were observed. We noticed separation of fibers with the formation of cracks in the tendon (Fig. 6). Gross calcifications were found in areas of cartilage tendon transition.×