Skip to main content
SpringerLink
Log in

Vascular changes in the ruptured achilles tendon and paratenon

  • Published:
International Orthopaedics Aims and scope Submit manuscript

Summary

Thirty patients with ruptures of the Achielles tendon were studied. There were 21 men and 9 women with an average age of 36 years. Specimens from the tendon and paratenon in 24 were examined histologically. Tissue samples of 20 were studied by electron microscopy. Marked degenerative, obliterative and/or inflammatory vascular changes were found in all the ruptured tendons and their paratenon. Our findings indicate that poor vascularity play a role in the aetiology of rupture of the Achilles tendon.

Résumé

Des prélévements tissulaires de 30 patients traités à l'Institut National Hongrois de Traumatologie pour rupture du tendon d'Achille ont fait l'objet d'une étude anatomopathologique. Dans 24 cas, des prélévements paratendineux ont également été examinés. Les prélévements de 20 patients ont été étudiés par microscopie électronique. 21 des patients étaient des hommes et 9 des femmes, d'un âge moyen de 36 ans. Dans la plupart des cas de rupture du tendon d'Achille (24 cas) et du tissu paratendineux (18 cas), des altérations dégénératives, oblitérantes et occasionnellement nécrotiques des artères et des capillaires ont été constatées. Dans les 6 cas restants (20%), des altérations vasculaires inflammatoires ont été retrouvées, aussi bien dans le tissu tendineux que paratendineux. Une prolifération vasculaire marquée a souvent été notée dans le tissu paratendineux; on a fréquemment retrouvé des exsudats tiches en fibronectine, indiquant une perméabilité vasculaire accrue. Dans 4 cas la rupture siégeait au niveau de la jonction myotendineuse et de notables altérations vasculaires ont également été constatées dans les muscles. Des altérations vasculaires profondes, dégénératives, oblitérantes et/ou inflammatoires ont été mises en évidence dans tous les cas de rupture du tendon d'Achille et du tissu paratendineux. Ceci indique que ce type de modifications joue un rôle important dans la phyio-pathologie de ces ruptures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arner O, Lindholm Å (1959) Subcutaneous rupture of the Achilles tendon: a study of 92 cases. Acta Chir Scand [Suppl] 239: 1–51

    Google Scholar 

  2. Backman C, Friden J, Widmark A (1991) Blood flow in chronic Achilles tendinosis. Radioactive microsphere study in rabbits. Acta Orthop Scand 62: 386–387

    Google Scholar 

  3. Barfred T (1973) Achilles tendon rupture. Aetiology and pathogenesis of subcutaneous rupture assessed on the basis of the literature and rupture experiments on rats. Acta Orthop Scand [Suppl] 152: 1–124

    Google Scholar 

  4. Becker V, Krahl H (1978) Die Tendopathien. Thieme, Stuttgart

    Google Scholar 

  5. Bergljung I (1968) Vascular reactions after tendon suture and tendon transplantation. A stereomicroangiographic study of the calcaneal tendon of the rabbit. Scand J Plast Reconstr Surg [Suppl] 4: 7–63

    Google Scholar 

  6. Burns J, Dixon AJ, Woods JC (1980) Immunoperoxidase localization of fibronectin in glomeruli of formalin fixed paraffin processed renal tissue. Histochemistry 67: 73–78

    Google Scholar 

  7. Davidsson L, Salo M (1969) Pathogenesis of subcutaneous tendon ruptures. Acta Chir Scand 135: 209–212

    Google Scholar 

  8. Edwards DAW (1946) The blood supply and lymphatic drainage of tendons. J Anat 80: 147–152

    Google Scholar 

  9. Field PL (1971) Tendon fibre arrangement and blood supply. Austr N Z J Surg 40: 298–302

    Google Scholar 

  10. Folkow B, Gaskell P, Waaler BA (1970) Blood flow through limb muscles during heavy rhythmic exercise. Acta Physiol Scand 80: 61–72

    Google Scholar 

  11. Harms J, Biehl H, Hochbach G (1977) Pathologie der Paratenonitis achillea bei Hochleistungssportlern II. Arch Orthop Unfall-Chir 88: 65–74

    Google Scholar 

  12. Holz U, Aschler J (1981) Die Achillessehnenruptur. Eine klinische Analyse von 560 Verletzungen. Chir Praxis 28: 511–526

    Google Scholar 

  13. Józsa L, Bálint BJ, Reffy A, Demel Z (1982) Hypoxic alterations of tenocytes in degenerative tendinopathy. Acta Orthop Traumat Surg 99: 243–246

    Google Scholar 

  14. Józsa L, Reffy A, Bálint BJ (1986) Feinstrukturelle Veränderungen bei degenerativer Tendinopathie. Zentralbl Allg Pathol 131: 429–435

    Google Scholar 

  15. Józsa L, Kvist M, Bálint BJ, Reffy A, Järvinen M, Lehto M, Barzo M (1989) The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical and sociological study of 292 cases. Am J Sports Med 17: 338–343

    Google Scholar 

  16. Józsa L, Lehto M, Kannus P, Kvist M, Reffy A, Vieno T, Järvinen M, Demel S, Elek E (1989) Fibronectin and laminin in Achilles tendon. Acta Orthop Scand 60: 469–471

    Google Scholar 

  17. Józsa L, Reffy A, Kannus P, Demel S, Elek E (1990) Pathological alterations in human tendons. Acta Orthop Trauma Surg 110: 15–21

    Google Scholar 

  18. Komi PV, Salonen M, Järvinen M, Kokko O (1987) In vivo registration of Achilles tendon forces in man. Int J Sports Med 8, Suppl 1: 3–8

    Google Scholar 

  19. Kvist M, Józsa L, Järvinen M, Kvist H (1987) Chronic Achilles paratenonitis in athletes: A histological and histochemical study. Pathology 19: 1–11

    Google Scholar 

  20. Kvist M, Lehto M, Józsa M, Järvinen M, Kvist H (1988) Chronic Achilles paratenonitis. An immunohistologic study of fibronectin and fibrinogen. Am J Sports Med 16: 616–623

    Google Scholar 

  21. Kvist M (1991) Achilles tendon overuse injuries. A clinical and pathophysiological study in athletes with special reference to Achilles paratenonitis. Thesis, University of Turku. Ser D, No 87, Turku, Finland

    Google Scholar 

  22. Landi P, Altman FP, Pringle J, Sayer DCJ, Landi A (1980) Oxidative enzymes metabolism in rabbit intrasynovial flexor tendons. III. Changes in enzyme activity of hypovascular tendons after physical activity. J Surg Res 29: 287–292

    Google Scholar 

  23. Lagergren G, Lindholm Å (1959) Vascular distribution of the achilles tendon — an angiographic and microangiographic study 116:491–497

    Google Scholar 

  24. Lehto M, Józsa L, Kvist M, Järvinen M, Bálint BJ, Reffy A (1990) Fibronectin in the ruptured human Achilles tendon and its paratenon. Ann Chir Gynaecol 79: 72–77

    Google Scholar 

  25. Lundborg G, Eiken O, Rank F (1977) Synovium as a nutritional medium in tendon grafting. Handchirurgie 9: 107–111

    Google Scholar 

  26. Lundborg G, Holm S, Myrhage R (1980) The role of the synovial fluid and tendon sheath for flexor tendon nutrition. Scand J Plast Reconstr Surg 14: 99–107

    Google Scholar 

  27. Malik AB, Johnson A, Tahamont MV (1982) Mechanism of lung vascular injury after intravascular coagulation. Ann NY Acad Sci 384: 213–234

    Google Scholar 

  28. Mittelmeier H (1960) Pathologie der Sehnengleitgewebe. Verh Tagung DGOT 48: 28–38

    Google Scholar 

  29. Naito M, Ogata K (1983) The blood supply of tendon with a paratenon. An experimental study using hydrogen washout technique. Hand 15: 9–14

    Google Scholar 

  30. Schatzker J, Br»nemark PI (1969) Intravital observations on the microvascular anatomy and microcirculation of the tendon. Acta Orthop Scand [Suppl] 126

  31. Schneider H, Grilli PF (1955) Die Ätiologie und Pathogenese der Achillodynie. Z Orthop 86: 595–612

    Google Scholar 

  32. Schnorrenberg G (1962) Über die Gefässversorgung der Achillessehne. Gegenbaurs Morphol Jahrb 103: 428–456

    Google Scholar 

  33. Smith JW (1965) Blood supply of tendons. Am J Surg 109: 272–276

    Google Scholar 

  34. Styf J, Körner L, Suurkula M (1987) Intramuscular pressure and muscle blood flow during exercise in chronic compartment syndrome. J Bone Joint Surg [Br] 69B: 301–305

    Google Scholar 

  35. Schönbauer HR (1986) Erkrankungen der Achillessehne. Wien Klin Wschr [Suppl 168] 98: 1–47

    Google Scholar 

  36. Tornling G (1982) Capillary neoformation in the heart and skeletal muscle during dipyridamole treatment and exercise. Acta Pathol Microbiol Immunol Scand, Section A, Suppl 278

  37. Walmsley B, Hodgson JA, Burke RE (1978) Forces produced by medial gastrocnemius and soleus during locomotion in freely moving cats. J Neurophysiol 41: 1203–1216

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sports Medical Research Unit Paavo Nurmi Centre, University of Turku, Kiinamyllynkatu 10, SF-20 520, Turku, Finland

    M. Kvist

  2. Department of Morphology, National Institute of Traumatology, Budapest, Hungary

    L. Józsa

  3. Division of Orthopaedics, University Hospital, Tampere, Finland

    M. Järvinen

Authors
  1. M. Kvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Józsa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Järvinen
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This work was supported by the Ministry of Education, Finland, and the Sigrid Juselius Foundation

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kvist, M., Józsa, L. & Järvinen, M. Vascular changes in the ruptured achilles tendon and paratenon. International Orthopaedics 16, 377–382 (1992). https://doi.org/10.1007/BF00189623

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00189623

Keywords

Search

Navigation