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Chronic Achilles paratenonitis

An immunohistologic study of fibronectin and fibrinogen

Paavo-Nurmi Center of Turku, Sports Medical Research Unit, Turku, Finland

Matti U.K. Lehto, MD, PhD

Department of Surgery, Turku University Central Hospital, Turku, Finland

Laszlo Jozsa, MD, PhD

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

Markku Järvinen, MD, PhD

Department of Surgery, Tampere University Central Hospital, Tampere, Finland

Helmer T. Kvist, MD, PhD

Division of Surgery, District Hospital, Rauma, Finland

Pathological alterations in chronic Achilles paratenonitis were studied histologically and using immunofluores cence techniques for fibronectin and fibrinogen in tissue samples obtained operatively from 11 athletes with this complaint and from 4 male cadavers serving as con trols. The average duration of the paratenonitis was 20.4 months. The paratendineal fatty areolar tissue was clearly thickened and edematous, showing widespread fat necrosis and considerable connective tissue prolif eration. The blood vessels were often obliterated and degenerated. Fibronectin and fibrinogen were com monly found in the proliferating connective tissue areas and in the vascular walls. Exudates rich in fibrinogen and fibronectin were seen in the inflamed paratendineal tissues, but not in the controls.

The results indicate that increased vascular permea bility and fibrin formation still persist in chronic Achilles paratenonitis and that marked obliterative and degen erative alterations of the blood vessels are frequent. The presence of fibronectin and fibrinogen points to an immature nature of scar tissue in chronic paratenonitis.

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