Different Achilles Tendon Pathologies Show Distinct Histological and Molecular Characteristics

Klatte‐Schulz, Franka; Minkwitz, Susann; Schmock, Aysha; Bormann, Nicole; Kurtoglu, Alper; Tsitsilonis, Serafeim; Manegold, Sebastian; Wildemann, Britt

doi:10.3390/ijms19020404

Cited by 50 publications

(53 citation statements)

References 62 publications

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“…The hierarchical structure with aligned collagen fibers was observed in both groups. The findings of the present study showed no signs of a degenerated tendon as the fibers were aligned and evidence of disorganization was not found [32][33][34]. Therefore, we conclude that axial compression of the tibia used in this study does not induce a degeneration process in the mouse Achilles tendon.…”

Section: Discussionsupporting

confidence: 39%

In Vivo and In Vitro Mechanical Loading of Mouse Achilles Tendons and Tenocytes—A Pilot Study

Fleischhacker

Klatte‐Schulz

Minkwitz

et al. 2020

IJMS

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Mechanical force is a key factor for the maintenance, adaptation, and function of tendons. Investigating the impact of mechanical loading in tenocytes and tendons might provide important information on in vivo tendon mechanobiology. Therefore, the study aimed at understanding if an in vitro loading set up of tenocytes leads to similar regulations of cell shape and gene expression, as loading of the Achilles tendon in an in vivo mouse model. In vivo: The left tibiae of mice (n = 12) were subject to axial cyclic compressive loading for 3 weeks, and the Achilles tendons were harvested. The right tibiae served as the internal non-loaded control. In vitro: tenocytes were isolated from mice Achilles tendons and were loaded for 4 h or 5 days (n = 6 per group) based on the in vivo protocol. Histology showed significant differences in the cell shape between in vivo and in vitro loading. On the molecular level, quantitative real-time PCR revealed significant differences in the gene expression of collagen type I and III and of the matrix metalloproteinases (MMP). Tendon-associated markers showed a similar expression profile. This study showed that the gene expression of tendon markers was similar, whereas significant changes in the expression of extracellular matrix (ECM) related genes were detected between in vivo and in vitro loading. This first pilot study is important for understanding to which extent in vitro stimulation set-ups of tenocytes can mimic in vivo characteristics.

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Section: Discussionsupporting

confidence: 39%

In Vivo and In Vitro Mechanical Loading of Mouse Achilles Tendons and Tenocytes—A Pilot Study

Fleischhacker

Klatte‐Schulz

Minkwitz

et al. 2020

IJMS

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“…Kannus et al found that, in most of the spontaneously ruptured tendons, the pathological changes via biopsy were degenerative such as hypoxic degenerative tendinopathy, mucoid degeneration, and tendolipomatosis [4]. Compared with the normal tendons, the fat metabolism and inflammatory cells of the tendons suffering from acute or chronic ruptures were detectable [23]. With the elastography technique, De Zordo et al found that a normal tendon was hard, and 57% of tendons with symptoms of tendinopathy showed marked softening [11].…”

Section: Discussionmentioning

confidence: 99%

Patients with Achilles Tendon Rupture Have a Degenerated Contralateral Achilles Tendon: An Elastography Study

Zhang

Cai

et al. 2018

BioMed Research International

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Purpose To evaluate differences of Achilles tendon (AT) hardness and morphology between asymptomatic tendons in patients with acute AT ruptures on the contralateral side and asymptomatic tendons in healthy people by using computer-assisted quantification on axial-strain sonoelastography (ASE). Methods The study consisted of 33 asymptomatic tendons in 33 patients (study group) and 34 tendons in 19 healthy volunteers (control group). All the tendons were examined by both ASE and conventional ultrasound. Computer-assisted quantification on ASE was applied to extract hardness variables, including the mean (Hmean), 20th percentile (H20), median (H50) and skewness (Hsk) of the hardness within tendon, and the ratio of the mean hardness within tendon to that outside tendon (Hratio) and three morphological variables: the thickness (THK), cross-sectional area, and eccentricity (ECC) of tendons. Results The Hmean, Hsk, H20, H50, and Hratio in the proximal third of the tendon body in study group were significantly smaller than those in control group (Hmean: 0.43±0.09 vs 0.50±0.07, p=0.001; Hsk: -0.53±0.51 vs -1.09±0.51, p<0.001; H20: 0.31±0.10 vs 0.40±0.10, p=0.001; H50: 0.45±0.10 vs 0.53±0.08, p<0.001; Hratio: 1.01±0.25 vs 1.20±0.23, p=0.003). The THK and cross-sectional area of tendons in the study group were larger than those in the control group (p<0.05). Conclusions As a quantitative objective method, the computer-assisted ASE reveals that the asymptomatic ATs contralateral to acute rupture are softer than those of healthy control group at the proximal third and the asymptomatic tendons in people with rupture history are thicker, larger, and rounder than those of normal volunteers especially at the middle and distal thirds of AT body.

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“…The numerous micromorphological changes of tendinosis include decreased collagen density; disruption of collagen orientation and organization; increased sonographic hypoechogenicity; angiogenesis; and possible ingrowth of nerves (Riley, 2004;Cook and Purdam, 2008;Xu and Murrell, 2008;Klatte-Schulz et al, 2018). Although the tendinotic Achilles may show these changes at the myotendinous junction or insertion, they are most common in its mid-substance, where tendon thickening is localized (focal thickening).…”

Section: Morphological Considerations In Achilles Tendinosismentioning

confidence: 99%

A Perspective on Reversibility of Tendinosis-Induced Multi-Level Adaptations

2020

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Achilles tendinopathy is a well-known pathology that can display interindividual variations in chronicity, symptom presentation, and tendon morphology. Furthermore, symptoms may fluctuate within an individual throughout the stages of the pathology. Although pain is often used as a marker of condition severity, individuals may not consistently report pain due to periods of remission. Persons with tendinosis, which is characterized by advanced morphological alterations, have shown consistent changes in neuromechanics that indicate adaptations in the sensory-motor and the central nervous systems. The current treatment strategy involves repetitive resistance exercise aiming to achieve recovery of lost function. This treatment approach, however, has gauged such functional recovery through symptom relief and return to sport, which, in our opinion, may not suffice and may not prevent symptom recurrence or tendon rupture. In this physiologically informed perspective, we briefly review what is currently known about the consequences of Achilles tendon degeneration and examine the topic of reversing these changes. Shortcomings of contemporary treatment strategies are discussed and we therefore call for a new paradigm to focus on the whole-body level, targeting not only the tendon but also the reversal of the neuromotor control system adaptations.

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Different Achilles Tendon Pathologies Show Distinct Histological and Molecular Characteristics

Cited by 50 publications

References 62 publications

In Vivo and In Vitro Mechanical Loading of Mouse Achilles Tendons and Tenocytes—A Pilot Study

In Vivo and In Vitro Mechanical Loading of Mouse Achilles Tendons and Tenocytes—A Pilot Study

Patients with Achilles Tendon Rupture Have a Degenerated Contralateral Achilles Tendon: An Elastography Study

A Perspective on Reversibility of Tendinosis-Induced Multi-Level Adaptations

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