Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 15, Issue 10, pp 1272–1279 | Cite as

Nerve-related characteristics of ventral paratendinous tissue in chronic Achilles tendinosis

  • Gustav Andersson
  • Patrik Danielson
  • Håkan Alfredson
  • Sture Forsgren
Sports Medicine


Ultrasound and Doppler examination has shown high blood flow-neovascularisation inside and outside the ventral Achilles tendon in chronic painful tendinosis, but not in pain-free normal Achilles tendons. In patients with Achilles tendinosis, injections with the sclerosing substance polidocanol, targeting the areas with increased blood flow, have been demonstrated to give pain relief. A drawback when interpreting these findings is the fact that the pattern of nerve supply in the target area, i.e. the ventral area of the tendon, is so far unknown. In this study, therefore, tissue specimens from this area, obtained during surgical treatment of patients with chronic painful midportion Achilles tendinosis, were examined. In the examined area, containing loose connective tissue, the general finding was a presence of large and small arteries and nerve fascicles. The nerve fascicles were distinguished in sections processed for the pan-neural marker protein gene-product 9.5. The nerve fascicles contain sensory nerve fibers, as shown via staining for the sensory markers substance P (SP) and calcitonin gene-related peptide, and sympathetic nerve fibers as seen via processing for tyrosine hydroxylase. In addition, there were immunoreactions for the SP-preferred receptor, the neurokinin-1 receptor, in blood vessel walls and nerve fascicles. Some of the blood vessels were supplied by an extensive peri-vascular innervation, sympathetic nerve fibers being a distinct component of this innervation. There was also a marked occurrence of immunoreactions for the α1-adrenoreceptor in arterial walls as well as in the nerve fascicles. Altogether, these findings suggest that the area investigated is under marked influence by the nervous system, including sympathetic and sensory components. Thus, sympathetic/sensory influences may be involved in the pain mechanisms from this area. In conclusion, the nerve-related characteristics of the area targeted by the polidicanol injection treatment for Achilles tendinosis, are shown here for the first time.


Achilles tendon Tendinosis Sympathetic innervation Sensory innervation 



The authors thank Ms. Ulla Hedlund for excellent technical services. Financial support was obtained by the Faculty of Medicine at Umeå University, the Swedish National Centre for Research in Sports and the County Council of Västerbotten.


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Gustav Andersson
    • 1
  • Patrik Danielson
    • 1
  • Håkan Alfredson
    • 2
  • Sture Forsgren
    • 1
  1. 1.Department of Integrative Medical Biology, Section for AnatomyUmeå UniversityUmeåSweden
  2. 2.Department of Surgical and Perioperative Science, Sports MedicineUmeå UniversityUmeåSweden

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