Table 3

Pathogenetic models proposed for calcific tendinopathy (CT) of rotator cuff tendons (RCTs) and insertional CT of the Achilles tendon.

Stage

Cells

Extracellular matrix

Blood vessels

Inflammatory cells


CT model proposed by Uhthoff [28] for the rotator cuff:

Pre-calcific stage

Chondrocyte-like cells

Fibrocartilaginous metaplasia, presence of calcium crystals collected into matrix vesicles

None

None

Calcific stage:

Formative phase

Chondrocyte-like cells

Multifocal calcific deposits separated by fibrocollagenous tissue or fibrocartilage

None

None

Resting phase

Chondrocyte-like cells

Fibrocollagenous tissue borders the foci of calcification

None

None

Resorptive phase

Chondrocyte-like cells

Deposits of a thick, creamy, toothpaste-like material under pressure appear

Vascular channels near the calcific deposits

Macrophages and multinucleated giant cells cathepsin K-positive [22]

Post-calcific stage

Fibroblast

Granulation tissue, deposition of type III collagen

Capillaries surround the calcific deposits

Multinucleated giant cells [22]

Model proposed by Benjamin [34] for insertional CT of Achilles tendon:

Early stage

Chondrocytes and fibrocartilage cells

Fibrocartilage metaplasia

None

None

Second stage

Few chondrocytes

Erosion of calcaneal cartilage. Fibrocartilage metaplasia of tendon matrix.

Blood vessels invade the calcaneal fibrocartilage

None

Bony spur formation

Few fibrocartilage cells

The original cartilage has disappeared

New bone is deposited around the blood vessels

None


Oliva et al. BMC Medicine 2012 10:95   doi:10.1186/1741-7015-10-95

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