Search Results (11)

Background: Tranilast is an anti-inflammatory and antifibrotic agent known to inhibit TGF-β-mediated fibroblast activation and matrix overproduction. Although its therapeutic potential has been explored in several fibrotic and inflammatory conditions, its effects on tendon healing remain unknown. This study aimed to evaluate the histopathological and biomechanical impact of tranilast in a rat Achilles tendon repair model. Methods: Thirty-two male Sprague–Dawley rats were randomly assigned to four subgroups, control (C-15, C-30) and tranilast-treated (TR-15, TR-30), and sacrificed on postoperative day 15 or 30. Tranilast (30 mg/kg/day) or placebo was administered intraperitoneally. Tendons were subjected to biomechanical testing (maximum load to failure) and histological evaluation using Bonar and Movin scoring systems on Hematoxylin + Eosin (HE)-, Masson Trichrome (MT)- and Alcian Blue (AB)-stained slides. Additional analyses included Sirius Red histochemistry with assessment of collagen type I/III intensity and polarization ratio, as well as H-scores for collagen I and III. Results: Tranilast produced marked improvements in histopathological healing. Both TR-15 and TR-30 exhibited significantly lower Bonar and Movin scores compared with controls, with reductions in tenocyte degeneration, ground-substance accumulation, collagen disorganization, vascularity, and hyalinization (all p < 0.01). However, biomechanical strength did not differ significantly among the groups (p = 0.3948). Sirius Red analysis and collagen I/III H-scores revealed no significant differences in collagen composition or polarization ratio. Histological improvements were therefore not accompanied by measurable changes in collagen subtype distribution or maximum load to failure. Conclusions: Tranilast was associated with favorable histopathological changes during Achilles tendon healing, including improvements in cellular morphology, matrix organization, and overall Bonar and Movin scores. However, these findings were not accompanied by significant differences in collagen composition or biomechanical strength within the 30-day observation period. Further long-term and mechanistic studies are warranted to determine whether these histopathological changes translate into functional improvements in tendon biomechanics. Accordingly, the present findings should be considered preliminary and exploratory. Full article

Background and Objectives: Tendon healing is a multifactorial process influenced by inflammation and oxidative stress. Avocado–soybean unsaponifiables (ASU), recognized for their anti-inflammatory and antioxidant properties in osteoarthritis, have not yet been evaluated in tendon repair. This study aimed to investigate the effects of systemic ASU administration on histological, biomechanical, and biochemical parameters of tendon healing in a rat Achilles tendon injury model. Materials and Methods: Twenty male Wistar rats underwent bilateral Achilles tendon transection and repair. The ASU group received intraperitoneal ASU (300 mg/kg/day) for four weeks; controls received saline. Right tendons were analyzed histologically using a semiquantitative scoring system adapted from Curtis–DeLee, Bonar, and Modified Soslowsky criteria. Left tendons were tested biomechanically for maximum force, displacement, stress, stiffness, and energy parameters. Serum interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were measured by ELISA. Results: ASU markedly improved histological healing with better collagen alignment, reduced inflammation, and normalized tenocyte morphology (p < 0.001). Biomechanical strength increased, with higher maximum force (p = 0.002), displacement (p = 0.004), stress (p = 0.001), and total energy to failure (p = 0.001). Serum IL-1β, IL-6, and TNF-α levels were lower (p < 0.001), while TAS increased and TOS/OSI decreased (p < 0.001). Conclusions: Systemic ASU administration enhances tendon healing by improving tissue organization, increasing mechanical strength, and modulating systemic inflammation and oxidative stress. These findings suggest that ASU may serve as a safe, clinically relevant adjunct therapy to promote tendon regeneration. Full article

This study aimed to investigate the degeneration of the meniscal tissue in osteoarthritic knees and to adapt the Bonar score and its modifications to develop a microscopic examination. This study included consecutive patients who underwent total knee arthroplasty for symptomatic end-stage gonarthrosis. During the surgery, the menisci were completely dissected to preserve their original shapes. The samples were prepared using the hematoxylin and eosin (H&E) staining method and the Alcian blue protocol and were examined under light microscopy. The extent of histopathological changes was assessed based on the classical Bonar score assumptions. Additionally, in the second step of the examination, menisci remnants were evaluated using the modified Bonar score developed by Zabrzyński et al. The study involved 44 patients, from whom 83 samples of knee menisci were obtained. Histological examination of the meniscal specimens under a light microscope revealed tissue degeneration in all cases, in both the medial and lateral menisci. The mean classical Bonar score was 8.3571 and the mean modified Bonar score was 6.9398. There were no statistically significant differences in classical Bonar score assessment between medial and lateral menisci (p = 0.3014). There were no statistically significant differences in the modified-Bonar score assessment between medial and lateral menisci (p = 0.3620). We show that both menisci are implicated in the degenerative process, with high scores in the Bonar system, regardless of knee axial deformity. The Bonar score, along with its modifications, can be readily employed in the microscopic assessment of meniscus pathology. Full article

Objectives: The purpose of this study was to determine the correlation between microscopic degeneration in the long head of the biceps tendon (LHBT) and the apoptotic process. Methods: This study included 26 consecutive patients who had undergone arthroscopic biceps tenodesis or tenotomy for symptomatic LHBT with or without concomitant rotator cuff tears (RCTs). Histological examination of the specimens under a light microscope was conducted after staining with hematoxylin, eosin, and the Alcian blue. Histopathological changes were assessed using the original Bonar score and the modified Bonar score and then correlated with the expression of the subsequent apoptosis markers: activated caspase-3 (casp3), tumor protein p53 (p53), and B-cell lymphoma 2 (BCL-2). Results: The mean original Bonar score was 8.65 (range 5–11), while the modified Bonar score was 7.61. There was no correlation between the original Bonar score and the age of the patients, but a positive correlation was found between the modified Bonar score and the age of the patients (p = 0.0022). There was no correlation between the age of patients and the expression indexes of BCL-2 and casp3. However, the expression of the p53 index showed a positive correlation with patient aging (p = 0.0441). Furthermore, there was no correlation observed between the expression of apoptotic indexes and both the original and modified Bonar scale. Conclusions: In LHB tendinopathy, the expression of apoptosis does not seem to directly correlate with the extent of degeneration, particularly in the late stages of tendinopathy. However, the transformations observed in collagen and ground substance were significantly associated with age, as well as tendinous tissue degeneration quantified according to modified Bonar score. The age of patients was also linked with the expression of the p53 index, as an increased apoptosis in the studied population. Full article

Background and Objectives: The negative effects of smoking on the musculoskeletal system were presented by many authors, although the relationship between smoking and osteoarthritis remains unclear. The aim of this paper was to investigate the negative effects of smoking on meniscal tissue in osteoarthritic knees by microscopic examination, by adapting the Bonar scoring system and its modifications. Materials and Methods: The study involved 34 patients with varus knees, from whom 65 samples of knee menisci were obtained. The mean age in the studied group was 65.385 years. The smoking status of the patients concluded that there were 13 smokers and 21 nonsmokers. Results: Among smokers, the mean classical Bonar score was 8.42 and the mean modified Bonar score was 6.65, while nonsmokers were characterized by scores of 8.51 and 7.35, respectively. There was a statistically significant negative correlation between the number of cigarettes and the collagen in the medial meniscus (p = 0.0197). Moreover, in the medial meniscus, the modified Bonar score correlated negatively with the number of cigarettes (p = 0.0180). Similarly, such a correlation was observed between the number of cigarettes and the modified Bonar score in the lateral meniscus (p = 0.04571). Furthermore, no correlation was identified between the number of cigarettes and the classical Bonar score in the lateral meniscus. There was a statistically significant difference in the collagen variable value between the smokers and nonsmokers groups (p = 0.04525). Conclusions: The microscopic investigation showed no differences in the menisci of smokers and nonsmokers, except for the collagen, which was more organized in smokers. Moreover, the modified Bonar score was correlated negatively with the number of cigarettes, which supports the role of neovascularization in meniscus pathology under the influence of tobacco smoking. Full article

Targeting neovessels in chronic tendinopathies has emerged as a new therapeutic approach and several embolization agents have been reported. The aim of this study was to investigate the feasibility of embolization with different agents in a porcine model of patellar tendinopathy and evaluate their safety and efficacy. Eight 3-month-old male piglets underwent percutaneous injection of collagenase type I to induce patellar tendinopathies (n = 16 tendons). They were divided into four groups (2 piglets, 4 tendons/group): the control group, 50–100 µm microspheres group, 100–300 µm microspheres group, and the Imipenem/Cilastatin (IMP/CS) group. Angiography and embolization were performed for each patellar tendon on day 7 (D7). The neovessels were evaluated visually with an angiography on day 14. The pathological analysis assessed the efficacy (Bonar score, number of neovessels/mm²) and safety (off-target persistent cutaneous ischemic modifications and presence of off-target embolization agents). The technical success was 92%, with a failed embolization for one tendon due to an arterial dissection. Neoangiogenesis was significantly less important in the embolized groups compared to the control group angiographies (p = 0.04) but not with respect to histology (Bonar score p = 0.15, neovessels p = 0.07). Off-target cutaneous embolization was more frequently depicted in the histology of the 50–100 µm microspheres group (p = 0.02). Embolization of this animal model with induced patellar tendinopathy was technically feasible with different agents and allowed assessing the safety and efficacy of neovessel destruction. Particles smaller than 100 µm seemed to be associated with more complications. Full article

Tendinopathy is a process of chaotic extracellular matrix remodeling followed by increased secretion of enzymes and mediators of inflammation. The histopathological assessment of tendinous tissue is crucial to formulate the diagnosis and establish the severity of tendon degeneration. Nevertheless, the microscopic analysis of tendinous tissue features is often challenging. In this review, we aimed to compare the most popular scales used in tendon pathology assessment and reevaluate the role of the neovascularization process. The following scores were evaluated: the Bonar score, the Movin score, the Astrom and Rausing Score, and the Soslowsky score. Moreover, the role of neovascularization in tendon degeneration was reassessed. The Bonar system is the most commonly used in tendon pathology. According to the literature, hematoxylin and eosin with additional Alcian Blue staining seems to provide satisfactory results. Furthermore, two observers experienced in musculoskeletal pathology are sufficient for tendinopathy microscopic evaluation. The control, due to similar and typical alterations in tendinous tissue, is not necessary. Neovascularization plays an ambiguous role in tendon disorders. The neovascularization process is crucial in the tendon healing process. On the other hand, it is also an important component of the degeneration of tendinous tissue when the regeneration is incomplete and insufficient. The microscopic analysis of tendinous tissue features is often challenging. The assessment of tendinous tissue using the Bonar system is the most universal. The neovascularization variable in tendinopathy scoring systems should be reconsidered due to discrepancies in studies. Full article

Background: Therapeutic strategies targeting neovessels responsible for musculoskeletal chronic pain have emerged, including neovessels embolization. Our study aimed to develop a large animal model of patellar tendinopathy with neovascularization. Methods: Nine 3-month-old male piglets (18 patellar tendons) received percutaneous injections of increasing doses of collagenase (0 to 50 mg) at day 0 (D0). Tendinopathy was evaluated by ultrasound (D7 and D14). Neovascularization was evaluated visually and on angiographies. Bonar score was used for histological analysis (D14). Correlations were evaluated using Spearman’s rank (Rs) test. Results: Research protocol was well tolerated. All tendons were enlarged with a median increase of 31.58% [25–40.28] at D7 (p = 0.244) at D7 and 57.52% [48.41–91.45] at D14 (p = 0.065). Tendons with collagenase injection had more hypoechoic changes, with one tendon rupture (p = 0.012). Neovascularization was reported above 5 mg collagenase (p < 0.01) at D7 and D14 with dose-related neovessels induction (Rs = 0.8, p < 0.001). The Bonar score increased above 5 mg collagenase, correlated with the dose (Rs = 0.666, p = 0.003). Conclusions: The study shows the feasibility, safety and reproducibility of this new large animal model of patellar tendinopathy with neovascularization after collagenase injection. It will allow studying new treatments on direct embolization of neovessels by endovascular approach. Full article

(1) Background: The Bonar scoring system serves in the microscopic evaluation of tendon pathology. However, it can be easily adapted to investigate decreasing degeneration after treatment and quantify the healing progress. We believe that there is an actual need for a connection between clinical observations and tissue alterations arising during the treatment process, to gain superior functional outcomes. Herein, we perform a systematic review of the Bonar score’s application in the histopathological assessment of therapeutic advances in tendinopathy, with special reference to PRP therapy. (2) Methods: A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The searching strategy was conducted across major databases: PubMed, Cochrane Central, ScienceDirect, SciELO, and Web of Science. The risk-of-bias assessment was made using the Cochrane Collaboration’s Risk of Bias Tool and SYRCLE. (3) Results: The searching strategy produced 807 articles, and after selection, 22 studies were included. We collected 21 animal studies (n = 472) and 1 human study (n = 45). Three types of tendons were taken into account: 14 Achilles tendons, 7 supraspinatus tendons (SST), and in 1 case, Achilles and patellar tendons simultaneously. A variety of therapeutic methods were used—from intra-tendinous substance injections to surgical procedures or mechanical stimuli—but platelet-rich plasma (PRP) therapy dominated among them and was present in six studies. Most of the collected studies included an assessment of the tendons’ histopathology based on the classical Bonar score (with four variables and one observer). The staining protocol was based on the hematoxylin and eosin technique. An evaluation of therapeutic effects showed 15 positive results, 6 negative results, and 1 neutral result of treatments. (4) Conclusions: To understand the tendinopathy phenomenon, a link between histopathology and clinical observations in chronic tendon disorders is required due to the possibility of functional outcome improvements. The Bonar scoring system is well established in tendon pathology assessment and could also be adopted to assess therapeutic results in tendon disorders. Studies that included the PRP application showed Bonar-scoring-system-based evidence of superior tendinous tissue healing related to improved clinical results. Full article

This study aimed to perform a comprehensive systematic review, which reports the role of the Bonar score in the histopathological assessment of tendinopathy and its clinical relevance. To identify all of the studies that reported relevant information on the Bonar scoring system and tendinopathy, an extensive search of the major and the most significant electronic databases (PubMed, Cochrane Central, ScienceDirect, SciELO, Web of Science) was performed. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The extracted data included—year of study, geographical location, type of the study, radiological modifications, gender, number of patients, region of tendinopathy, mean age, control group, characteristics of the Bonar score and alterations in the scale, mean Bonar score, number of investigators, area of tendon investigation, clinical and radiological implications. An extensive search of the databases and other sources yielded a total of 807 articles. Eighteen papers were finally included in this systematic review, and of these, 13 original papers included the clinical and radiological implications of tendinopathy. Radiological evaluation was present in eight studies (both magnetic resonance imaging (MRI) and ultrasound (US)). The clinical implications were more frequent and present in 10 studies. Using the Bonar score, it is easy to quantify the pathological changes in tendinous tissue. However, its connection with clinical and radiological evaluation is much more complicated. Based on the current state of knowledge, we concluded that the neovascularization variable in the Bonar system should be reconsidered. Ideally, the microscopic assessment score should follow the established classification scale with the radiological and clinical agreement and should have a prognostic value. Full article

Background: In the Ponseti technique, the residual equinus deformity is corrected with percutaneous tenotomy. This experimental study aimed to compare the safety and effectiveness of a large-gauge needle, a corneal knife, and a No. 11 blade in percutaneous achillotomy performed in rats. Methods: Ninety Achilles tendons of 45 Sprague-Dawley rats were analyzed, following division into three study groups. In the study, group I (needle), group II (corneal knife), and group III (No. 11 blade) were compared on the basis of bleeding, incision length, requirement for primary suture, range of motion, and resulting neurovascular injury at day 0. Moreover, the groups were compared in terms of range of motion, macroscopic and microscopic adhesions, and tenocyte morphology at days 21 and 42 postoperatively. Results: On day 0, one suture was required in group III, whereas in groups I and II, no sutures were required. Postoperative bleeding was greater in group III and similar in groups I and II. Neurovascular injury was not observed in any of the groups. Three incomplete tenotomies were observed in group III and one incomplete tenotomy was observed in group II. Importantly, all tenotomies were complete in group I. In all groups, the range of motion was similar. The macroscopic adhesion score revealed high adhesion in group III (P = .009). According to Tang's criteria, microscopic adhesion was significantly higher on day 21 in group III compared with the other groups (P <0.001). No significant differences were observed in tenocyte morphology based on the Bonar criteria (P = .850). Conclusions: In the results obtained from this animal study, we observed less bleeding, less adhesion, and less incomplete tenotomy in the large-gauge needle and corneal knife groups compared with the No. 11 blade group during the percutaneous Achilles tenotomy performed in rats. (J Am Podiatr Med Assoc 111(2): 1-8, 2021) Full article