Chronic Achilles tendinopathy

Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings.
Aström, M., Rausing, A. Clin. Orthop. 1995. Jul;(316):151-64

163 patients with chronic Achilles tendinopathy, 75% of whom were athletes, underwent biopsy of the painful tendon. Degenerative changes (tendinosis) characterized by abnormal fiber structure, focal hypercellularity, and vascular proliferation were noted in 90% of biopsy specimens. Fibrinogen was identified in most and partial tendon ruptures occurred in 19%. Increasing age and male gender were associated with more pronounced microscopical pathology. Important features were a lack of inflammatory cells and a poor healing response.

Dr. Chris Reynolds notes:

To me, the last sentence reveals the most important finding of this study. “itis” means inflammation, but this was not apparent in these patients and their recovery was poor. If there is no inflammation, then what is the cause of the individual’s pain which can often last for months or even years?

Possibly autoimmunity is the underlying cause with continued physical activity an aggravating factor.

Nonetheless, wheatgrass has helped many patients recover from Achilles tendonitis and related conditions.