Fibronectin in the ruptured human Achilles tendon and its paratenon. An immunoperoxidase study

The purpose of the present study was to examine the role and distribution of fibronectin--a major connective tissue protein--in normal and ruptured Achilles tendon and its paratenon using peroxidase antiperoxidase (PAP) method and conventional histology. Samples were taken intraoperatively 6 to 48 hours after rupture from 30 patients, and 4 male cadavers served as controls. In controls fibronectin could not be detected in the tendinous connective tissue or in the areolar tissue of the paratenon. In the ruptured tendons fibronectin was detected around the tenocytes and in the collagen fibres in the necrotic and mucinous degenerated areas, but also in the macroscopically healthy areas of the tendon. In the oedematous paratenon vascular walls were rich in fibronectin and fat cells were outlined by fibronectin. Areas of homogenous deposition of fibronectin were also frequently seen in the paratenon. A vast amount of fibronectin was observed also at the site of rupture. The present results indicate that there are striking changes in the composition of connective tissue in degenerated tendon and paratenon. These changes seem to have increased susceptibility of the tendon to rupture.