Histopathology of common tendinopathies: Update and implications for clinical management

Sports Medicine

Volumn 27, Issue 6, 1999, Pages 393-408

  Khan, Karim M ^a   Cook, Jill L ^b   Bonar, Fiona ^c   Harcourt, Peter ^b   Åstrom, Mats ^d  

^a UNIVERSITY OF BRITISH COLUMBIA   (Canada)

^b Victorian Institute of Sport   (Australia)

^c DOUGLASS HANLY MOIR PATHOLOGY   (Australia)

^d LUND UNIVERSITY   (Sweden)

Author keywords

[No Author keywords available]

Indexed keywords

ALCIAN BLUE; ALPHA ACTIN; APROTININ; COLLAGEN FIBER; CORTICOSTEROID; GLYCOSAMINOGLYCAN; HEPARIN; NONSTEROID ANTIINFLAMMATORY AGENT;

ACHILLES TENDON RUPTURE; ARTICLE; ATHLETE; CAPILLARY PROLIFERATION; CARPAL BONE; CARTILAGE CELL; CELL DAMAGE; CELL PROLIFERATION; COMPARATIVE STUDY; EXTENSOR MUSCLE; EXTRACELLULAR MATRIX; FIBROBLAST; HISTOPATHOLOGY; HUMAN; MYOFIBROBLAST; POLARIZATION MICROSCOPY; RADIUS; ROTATOR CUFF RUPTURE; SPORT; SPORT INJURY; SYMPTOMATOLOGY; TENDINITIS; TENDON DISEASE; TISSUE DEGENERATION; VASCULARIZATION;

ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL; ATHLETIC INJURIES; COLLAGEN; CUMULATIVE TRAUMA DISORDERS; HUMANS; PHYSICAL THERAPY MODALITIES; SPLINTS; SPORTS MEDICINE; TENDINOPATHY; TENDON INJURIES; TENDONS;

EID: 0032785647     PISSN: 01121642     EISSN: None     Source Type: Journal    
DOI: 10.2165/00007256-199927060-00004     Document Type: Article

References (145)

1. Kannus P. Tendons - a source of major concern in competitive and recreational athletes [editorial]. Scand J Med Sci Sports 1997; 7: 53-4
2. Perugia L, Postacchini F, Ippolito E. The tendons: biology, pathology, clinical aspects, Milan: Editrice Kurtis s.r.l., 1986
3. Khan KM, Maffulli N. Tendinopathy: an Achilles' heel for athletes and clinicians [editorial]. Clin J Sports Med 1998; 8: 151-4
4. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 1998; 14: 840-3
5. Józsa L, Kannus P. Human tendons. Champaign (IL): Human Kinetics, 1997; 576: 4-95
6. O'Brien M. Structure and metabolism of tendons. Scand J Med Sci Sports 1997; 7: 55-61
7. Ästrom M. On the nature and etiology of chronic achilles tendinopathy [thesis]. Sweden: Lund University, 1997
8. Kvist M, Jozsa L, Jarvinen M, et al. Fine structural alterations in chronic Achilles paratenonitis in athletes. Path Res Pract 1985; 180: 416-23
9. Williams JG. Achilles tendon lesions in sport. Sports Med 1986; 3: 114-35
10. Cooper RR, Misol S. Tendon and ligament insertion: a light and electron microscopic study. J Bone Joint Surg Am 1970; 52: 1-20
11. Becker W, Krahl H. Die Tendinopathien (Grundlagen, Klinic, Therapie). Stuttgart: Georg Thieme Verlag, 1978: 9-19
12. Astrom M, Rausing A. Chronic Achilles tendinopathy: a survey of surgical and histopathologic findings. Clin Orthop 1995; 316: 151-64
13. Khan KM, Bonar F, Desmond PM, et al. Patellar tendinosis (jumper's knee): findings at histopathologic examination, US and MR imaging. Radiology 1996; 200: 821-7
14. Denstad TF, Roaas A. Surgical treatment of partial Achilles tendon rupture. Am J Sports Med 1979; 7: 15-7
15. Fox JM, Blazina ME, Jobe FW, et al. Degeneration and rupture of the Achilles tendon. Clin Orthop 1975; 107: 221-4
16. Harms J, Biehl G, von Hobach G. Pathologie der paratenonitis achillea bei Hochleistungssportlern. Arch Orthop Unfallchir 1977; 88: 65-74
17. Kalebo P, Goksor L.-A, Sward L, et al. Soft tissue radiography, computed tomography and ultrasonography of partial Achilles tendon ruptures. Acta Radiol 1990; 31: 565-70
18. Ljungqvist R. Subcutaneous partial rupture of the Achilles tendon. Acta Orthop Scand 1967; Suppl. 113: 1-86
19. Merkel KH, Hess H, Kunz M. Insertion tendinopathy in athletes: a light microscopic, histochemical and electron microscopic examination. Pathol Res Pract 1982; 173: 303-9
20. Nelen G, Martens M, Burssens A. Surgical treatment of chronic Achilles tendinitis. Am J Sports Med 1989; 17: 754-9
21. Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med 1976; 4: 145-50
22. Benazzo F, Stennardo G, Valli M. Achilles and patellar tendinopathies in athletes: pathogenesis and surgical treatment. Bull Hosp Jt Dis 1996; 54: 236-40
23. Burry HC, Pool CJ. Central degeneration of the achilles tendon. Rheumatol Rehabil 1973; 12: 177-81
24. Burry HC. The pathology of the painful heel. Br J Sports Med 1971; 6: 9-12
25. Clancy WGJ, Neidhart D, Brand RL. Achilles tendonitis in runners: a report of 5 cakes. Am J Sports Med 1976; 4: 46-57
26. Kvist M, Jozsa L, Jarvinen M, et al. Chronic achilles paratenonitis in athletes: a histological and histochemical study. Pathology 1987; 19: 1-11
27. Kvist M, M Lehto, Jozsa L, et al. Chronic achilles paratenonitis. An immunohistologic study of fibronectin and fibrinogen. Am J Sports Med 1988; 16: 616-23
28. Snook GA. Achilles tendon tenosynovitis in long-distance runners. Med Sci Sports Exerc 1972; 4: 155-8
29. Movin T, Kristoffersen-Wiberg M, Rolf C, et al. MR imaging in chronic Achilles tendon disorder. Acta Radiol 1998; 39: 126-32
30. Maffulli N, Regine R, Angelillo M, et al. Ultrasound diagnosis of Achilles tendon pathology in runners. Br J Sports Med 1987; 21: 158-62
31. Kalebo P, Allenmark C, Peterson L, et al. Diagnostic value of ultrasonography in partial ruptures of the Achilles tendon. Am J Sports Med 1992; 20: 378-81
32. Movin T, Kristoffersen-Wiberg M, Shalabi A, et al. Intratendinous alterations as imaged by ultrasound and contrast medium enhanced magnetic resonance in chronic achillodynia. Foot Ankle 1998; 19: 311-7
33. Movin T. Aspects of aetiology, pathoanatomy and diagnostic methods in chronic mid-portion achillodynia [thesis]. Stockholm: Karolinska Institute, 1998
34. Movin T, Gad A, Reinholt FP, et al. Tendon pathology in long-standing achillodynia: biopsy findings in 40 patients. Acta Orthop Scand 1997; 68: 170-5
35. Torstensen ET, Bray RC, Wiley JP. Patellar tendinitis: a review of current concepts and treatment. Clin J Sport Med 1994; 4: 77-82
36. Khan KM, Maffulli N, Coleman BD, et al. Patellar tendinopathy: some aspects of basic science and clinical management. Br J Sports Med 1998; 32: 346-55
37. Karlsson J, Kalebo P, Goksor L-A, et al. Partial rupture of the patellar ligament. Am J Sports Med 1992; 20: 390-5
38. Karlsson J, Lundin O, Lossing IW, et al. Partial rupture of the patellar ligament: results after operative treatment. Am J Sports Med 1991; 19: 403-8
39. Raatikainen T, Karpakka J, Puranen J, et al. Operative treatment of partial rupture of the patellar ligament: a study of 138 cases. Int J Sports Med 1994; 15: 46-9
40. Colosimo AJ, Bassett FH. Jumper's knee: diagnosis and treatment. Orthop Rev 1990; 29: 139-49
41. Yu JS, Popp JE, Kaeding CC, et al. Correlation of MR imaging and pathologic findings in athletes undergoing surgery for chronic patellar tendinitis. Am J Roentgenol 1995; 165: 115-8
42. King JB, Perry DJ, Mourad K, et al. Lesions of the patellar ligament. J Bone Joint Surg Br 1990; 72: 46-8
43. Fritschy D, Wallensten R. Surgical treatment of patellar tendinitis. Knee Surg Sports Trauma Arthrosc 1993; 1: 131-3
44. Roels J, Martens M, Mulier JC, et al. Patellar tendinitis (jumper's knee). Am J Sports Med 1978; 6: 362-8
45. Martens M, Wouters P, Burssens A, et al. Patellar tendonitis: pathology and results of treatment. Acta Orthop Scand 1982; 53: 445-50
46. Ferretti A, Ippolito E, Mariani P, et al. Jumper's knee. Am J Sports Med 1983; 11: 58-62
47. Cook JL, Khan K, Harcourt PR, et al. A cross-sectional study of 100 cases of jumper's knee managed conservatively and surgically. Br J Sports Med 1997; 31: 332-6
48. Nichols CE. Patellar tendon injuries. Clin Sports Med 1992; 11: 807-13
49. Clancy WGJ. Tendon trauma and overuse injuries. In: Leadbetter WB, Buckwalter JA, Gordon SL, editors. Sports-induced inflammation: clinical and basic science concepts. Park Ridge (IL): American Academy of Orthopaedic Surgeons, 1990: 609-18.
50. Blazina ME, Kerlan RK, Jobe FW, et al. Jumper's knee. Orthop Clin North Am 1973; 4: 665-78
51. Fritschy D, de Gautard R. Jumper's knee and ultrasonography. Am J Sports Med 1988; 16: 637-40
52. Myllymäki T, Bondestam S, Suramo I, et al. Ultrasonography of jumper's, knee. Acta Radiol 1990; 31 (2): 147-9
53. Bodne D, Quinn SF, Murray WT, et al. Magnetic resonance imaging of chronic patellar tenditis. Skeletal Radiol 1988; 17: 24-8
54. Davies SG, Baudouin CJ, King JB, et al. Ultrasound, computed tomography and magnetic resonance imaging in patellar tendinitis. Clin Radiol 1991; 43: 52-6
55. Mourad K, King J, Guggiana P. Computed tomography and ultrasound imaging of jumper's knee - patellar tendinitis. Clin Radiol 1988; 39: 162-5
56. Maffulli N, Regine R, Carrillo F, et al. Ultrasonographic scan in knee pain in athletes. Br J Sports Med 1992; 26 (2): 93-6
57. Cook JL, Khan KM, Harcourt PR, et al. Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions: a study of 320 tendons. Clin J Sports Med 1998; 8: 73-7
58. Lian O, Holen KJ, Engebrestson, L, et al. Relationship between symptoms of jumper's knee and the ultrasound characteristics of the patellar tendon among high level male volleyball players. Scand J Med Sci Sports 1996; 6: 291-6
59. Khan KM, Cook JL, Kiss ZS, et al. Patellar tendon ultrasonography and jumper's knee in elite female basketball players: a longitudinal study. Clin J Sports Med 1997; 7: 199-206
60. Khan KM, Cook JL, Bonar SF, et al. Subcutaneous rupture of the Achilles tendon [letter]. Br J Sports Med 1998; 32: 184-6
61. Maffulli N, Waterston SW, Ewen SWB, Subcutaneous rupture of the Achilles tendon [letter]. Br J Sports Med 1998; 32: 184-5
62. Nirschl RP, Pettrone FA. Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surg 1979; 61-A: 832-9
63. Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med 1992; 11: 851-70
64. Potter HG, Hannafin JA, Morwessel RM, et al. Lateral epicondylitis: correlation of MR imaging, surgical, and histopathologic findings. Radiology 1995; 196: 43-6
65. Ollivierre CO, Nirschl RP, Pettrone FA. Resection and repair for medial tennis elbow: a prospective analysis. Am J Sports Med 1995; 23: 214-21
66. Fukuda H, Hamada K, Yamanaka K. Pathology and pathogenesis of bursal side rotator cuff tears viewed from en bloc histologic sections. Clin Orthop 1990; 254: 75-80
67. Pettersson G. Rupture of the tendon aponeurosis of the shoulder joint in anterio-inferior dislocation: a study on the origin and occurrence of ruptures. Acta Chir Scand 1942; 87 Suppl. 77: 1-184
68. Nixon JE, DiStefano V. Ruptures of the rotator cuff. Orthop Clin North Am 1975; 6: 423-47
69. Kjellin I, Ho CP, Cervilla V, et al. Alterations in the supraspinatus tendon at MR imaging: correlation with histopathologic findings in cadavers. Radiology 1991; 181: 837-41
70. Codman EA. The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston (MA): Thomas Todd, 1934
71. Wilson DL, Duff GL. Pathologic study of degeneration and rupture of the supraspinatus tendon. Arch Surg 1943; 47: 121-35
72. McLaughlin HL. Lesions of the musculotendinous cuff of the shoulder. III-Observations on the pathology, course and treatment of calcific deposits. Ann Surg 1946; 124: 354
73. Unthoff HK, Sano H. Pathology of failure of the rotator cuff tendon. Orthop Clin North Am 1997; 28: 31-41
74. Swiontkowski M, Iannotti JP, Boulas JH, et al. Intraoperative assessment of rotator cuff vascularity using laser Doppler flowmetry. In: Post M, Morrey BE, Hawkins RJ, editor. Surgery of the shoulder. St Louis (MO): Mosby-Year Book, 1990: 208-12
75. Rathbun JB, McNab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br 1970; 52-B: 540-53
76. Miniaci A, Dowdy PA, Willits KR, et al. Magnetic resonance imaging evaluation of the rotator cuff tendons in the asymptomatic shoulder. Am J Sports Med 1995; 23: 142-5
77. Neumann CH, Holt RG, Steinbach LS, et al. MR imaging of the shoulder. Appearance of the supraspinatos tendon in asymptomatic volunteers. Am J Roentgenol 1992; 158: 1281-7
78. Mirovitz SA. Normal rotator cuff: MR imaging with conventional and fat-suppression techniques. Radiology 1991; 180: 735-40
79. Kaplan PA, Bryans KC, Davick JP, et al. MR imaging of the normal shoulder: variants and pitfalls. Radiology 1992; 184: 519-24
80. Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med 1992; 11: 533-78
81. Järvinen M, Jozsa L, Kannus P, et al. Histopathological findings in chronic tendon disorders. Scand J Med Sci Sports 1997; 7: 86-95
82. El-Khoury GY, Wira RL, Berbaum KS, et al. MR imaging of patellar tendinitis. Radiology 1992; 184: 849-54
83. Woo S-LY, Tkach LV. The cellular and matrix response of ligaments and tendons to mechanical injury. In: Leadbetter WB, Buckwalter JA, Gordon SL, editors. Sports-induced inflammation: clinical and basic concepts. Park Ridge (IL): American Academy of Orthopaedic Surgeons, 1990: 198-204
84. Nirschl RP. Patterns of failed healing in tendon injury. In: Leadbetter WB, Buckwalter JA, Gordon SL, editors. Sports-induced inflammation: clinical and basic concepts. Park Ridge (IL): American Academy of Orthopaedic Surgeons, 1990: 577-85
85. Enwemeka CS. Inflammation, cellularity, and fibrillogenegis in regenerating tendon: implications for tendon rehabilitation. Phys Ther 1989; 69: 816-25
86. Almekinders LC. Tendinitis and other chronic tendinopathies. J Am Acad Orthop Surg 1998; 6: 157-64
87. Kvist M, Jozsa L, Jarvinen M. Vascular changes in the ruptured achilles tendon and its paratenon. Int Orthop 1992; 16: 377-82
88. Curwin S. The aetiology and treatment of tendinitis. In: Harries M, Williams C, Stanish WD, et al., editors. Oxford textbook of sports medicine. Oxford: Oxford University Press, 1994; 512-28
89. Niesen-Vertommen SL, Taunton JE, Clement DB, et al. The effect of eccentric versus concentric exercise in the management of Achilles tendonitis. Clin J Sports Med 1992; 2: 109-13
90. El Hawary R, Stanish WD, Curwin SL. Rehabilitation of tendon injuries in sport. Sports Med 1997; 24: 347-58
91. Sandmeier R, Renstrom P. Diagnosis and treatment of chronic tendon disorders in sport. Scand J Med Sci Sports 1997; 7: 96-106
92. Brukner P, Khan K. Clinical sports medicine. Sydney: McGraw-Hill, 1993
93. Curwin S, Stanish WD. Tendinitis: its etiology and treatment. Lexington: Collamore Press, 1984
94. Vailas AC, Tipton CM, Laughlin HL, et al. Physical activity and hypophysectomy on the aerobic capacity of ligaments and tendons. J Appl Physiol 1978; 44: 542-6
95. Zernicke RF, Garhammer J, Jobe FW. Human patellar-tendon rupture: a kinetic analysis. J Bone Joint Surg Am 1977; 59A: 179-83
96. Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med 1984; 12: 179-84
97. Cannell LJ. The effects of an eccentric-type exercise versus a concentric-type exercise in the management of chronic patellar tendonitis [thesis]. Vancouver: University of British Columbia, 1982
98. Alfredson H, Pietila T, Jonsson P, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998; 26: 360-6
99. Holmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet 1999; 353: 439-43
100. Kannus P, Jozsa L, Natri A, et al. Effects of training, immobilization and remobilization on tendons. Scand J Med Sci Sports 1997; 7: 67-71
101. Reddy GK, Gum S, Stehno-Bittel L, et al. Biochemistry and biomechanics of healing tendon: II. Effects of combined laser therapy and electrical stimulation. Med Sci Sports Exerc 1988; 30: 794-800
102. Fyfe I, Stanish WD. The use of eccentric training and stretching in the treatment and prevention of tendon injuries. Clin Sports Med 1992; 11: 601-24
103. Almekinders L.C. The efficacy of nonsteroidal anti-inflammatory drugs in the treatment of ligament injuries. Sports Med 1990; 9: 137-42
104. Rolf C, Movin T, Engstrom B, et al. An open, randomized study of ketoprofen in patients in surgery for Achilles or Patellar tendinopathy. J Rheumatol 1997; 24: 1595-8
105. Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc 1998; 30: 1183-90
106. Astrom M, Westlin N. No effect of piroxicam on achilles tendinopathy. A randomized study of 70 patients. Acta Orthop Scand 1992; 63: 631-4
107. Vogel HG. Mechanical and chemical properties of various connective tissue organs in rats as influenced by non-steroidal antirheumatic drugs. Connect Tiss Res 1977; 5: 91-5
108. Weiler JM. Medical modifiers of sports injury: the use of non-steroidal anti-inflammatory drugs (NSAIDs) in sports soft tissue injury. Clin Sports Med 1992; 11: 625-44
109. Kennedy JC, Willis RB. The effects of local steroid injections on tendons: a biomechanical and microscopic correlative study. Am J Sports Med 1976; 4: 11-21
110. Shrier I, Matheson GO, Kohl HW. Achilles tendonitis: are corticosteroid injections useful or harmful. Clin J Sports Med 1996; 6: 245-50
111. Stahl S, Kaufman T. The efficacy of an injection of steroids for medial epicondylitis: a prospective study of sixty elbows. J Bone Joint Surg 1997; 79A: 1648-52
112. Anastassiades T, Dziewiatkowski D. The effect of cortisone on connective tissue in the rat. J Lab Clin Med 1970; 75: 826-39
113. Berliner DL, Nabors CJ. Effects of corticosteroids on fibroblast functions. Res J Reticuloendothel Soc 1967; 4: 284-313
114. Kapetanos G. The effect of local corticosteroids on the healing and biomechanical properties of the partially injured tendon. Clin Orthop 1982; 163: 170-9
115. Capasso G, Maffulli N, Testa V, et al. Preliminary results with peritendinous protease inhibitor injections in the management of achilles tendinitis. J Sports Traumatol Rel Res 1993; 15: 37-43
116. Capasso G, Testa V, Maffulli N, et al. Aprotinin, corticosteroids and normosaline in the management of patellar tendinopathy in athletes: a prospective randomized study. Sports Exerc Injury 1997; 3: 111-5
117. Kvist M, Jarvinen M. Clinical, histochemical and biomechanical features in repair of muscle and tendon injuries. Int J Sports Med 1982; 3 Suppl. 1: 12-4
118. Dow SM, Wilson AM, Goodship AE. Treatment of acute superficial digital flexor tendon injury in horses with polysulphated glycosaminoglycan. Vet Rec 1996; 139: 413-6
119. Sundqvist H, Forsskahl B, Kvist M. A promising novel therapy for achilles peritendinitis: double-blind comparison of glycosaminoglycan polysulfate and high-dose indomethacin. Int J Sports Med 1987; 8: 298-303
120. Rivenburgh DW. Physical modalities in the treatment of tendon injuries. Clin Sports Med 1992; 11: 645-59
121. Harvey W, Dyson M, Pond JB, et al. The stimulation of protein synthesis in human fibroblasts by therapeutic ultrasound [abstract]. Rheumatol Rehab 1975; 14: 237
122. Enwemeka CS. The effects of therapeutic ultrasound on tendon healing. A biomechanical study. Am J Phys Med Rehab 1989; 68: 283-7
123. Jackson BA, Schwanc JA, Starcher BC. Effect of ultrasound therapy on the repair of achilles tendon injuries in rats. Med Sci Sports Exerc 1991; 23: 171-6
124. Snow CJ, Johnson KA. Effect of therapeutic ultrasound on acute inflammation. Physiother Can 1988; 40: 162-7
125. Enwemeka CS. Laser biostimulation of healing wounds: specific effects and mechanisms of action. J Sports Phys Ther 1988; 9: 333-8
126. Reddy GK, Stehno-Bittel L, Enwemeka CS. Laser photostimulation of collagen production in healing rabbit Achilles tendons. Lasers Surg Med 1998; 22: 281-7
127. Gum SL, Reddy GK, Stehno-Bittel L, et al. Combined ultrasound, electrical stimulation and laser promote collagen synthesis with moderate changes in tendon biomechanics. Am J Phys Med Rehabil 1997; 76: 288-96
128. Astrom M, Arvidson T. Alignment and joint motion in the normal foot. J Orthop Sports Phys Ther 1995; 22: 216-22
129. Kamien M. A rational management of tennis elbow. Sports Med 1990; 9: 173-91
130. Lian O, Engebretsen L, Ovrebo RV, et al. Characteristics of the leg extensors in male volleyball players with jumper's knee. Am J Sports Med 1996; 24: 380-5
131. Leadbetter WB, Mooar PA, Lane GJ, et al. The surgical treatment of tendinitis: clinical rationale and biologic basis. Clin Sports Med 1992; 11; 679-712
132. Anderson DL, Taunton JE, Davidson RG. Surgical management of chronic Achilles tendinitis. Clin J Sports Med 1992; 2: 38-42
133. Coleman BD, Khan KM, Kiss ZS, et al. Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy: a retrospective outcome study. Am J Sports Med. In Press
134. Archambault JM, Wiley JP, Bray RC. Exercise loading of tendons and the development of overuse injuries: a review of the current literature. Sports Med 1995; 20; 77-89
135. Banes AJ, Tsuzaki M, Yamamoto J, et al. Mechanoreception at the cellular level: the detection, interpretation, and diversity of responses to mechanical signals. Biochem Cell Biol 1995; 73: 349-65
136. Fukuda H, Hamada K, Nakajima T, et al. Partial thickness tears of the rotator cuff: a clinicopathological review based on 66 surgically verified cases. Int Orthop 1996; 20: 257-65
137. Hamada K, Tomonaga A, Gotoh M, et al. Intrinsic healing capacity and tearing process of torn supraspinatus tendons: in situ hybridization study of alpha 1 (I) procollagen mRNA. J Orthop Res 1997; 15: 24-32
138. Frank CB. Ligament healing: current knowledge and clinical applications. J Am Acad Orthop Surg 1996; 4: 74-83
139. Lee E, Maffulli N, Li CK, et al. Pulsed magnetic and electromagnetic fields in experimental achilles tendonitis in the rat: a prospective randomised study. Arch Phys Med Rehab 1997; 78: 399-404
140. Backman C, Boquist L, Friden J, et al. Chronic achilles paratenonitits with tendinosis: an experimental model in the rabbit. J Orthop Res 1990; 1990; 8: 541-7
141. Visentini PJ, Khan KM, Cook JL, et al. The VISA score: an index of the severity of jumper's knee (patellar tendinosis). J Sci Med Sport 1998; 1: 22-8
142. Coleman BD, Khan KM, Maffulli N, et al. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Scand J Med Sci Sports. In press
143. Kiss ZS, Kellaway D, Cook J, et al. Postoperative patellar tendon healing - an ultrasound study. Australas Radiol 1998; 42: 28-32
144. Wiley JP, Bray RC, Wiseman DA, et al. Serial ultrasonographic imaging evaluation of the patellar tendon after harvesting its central one-third for anterior cruciate ligament reconstruction. J Ultrasound Med 1997; 16: 251-5
145. Khan KM, Visentini PJ, Cook JL, et al. Open patellar tenotomy for jumper's knee: MR and ultrasound correlation with clinical outcome [abstract]. Med Sci Sports Exerc 1998: 30 (5 Suppl.): S300