Abstract
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.
Highlights
In the structure of the tendon, two elements can be distinguished: cells and extracellular matrix
We present a few of the most popular scales used in tendon pathology assessment: the Bonar score, the Movin score, the Astrom and Rausing Score, and the Soslowsky score (Table 1)
Assessment using the Movin and Bonar systems is the most commonly used in tendon pathology [28,29]
Summary
The histopathological assessment of tendinous tissue is crucial to formulate a diagnosis and establish the severity of tendon degeneration [29,40]. The Astrom and Rausing Score is a semiquantitative score to evaluate tendinopathy It includes five parameters scored with a four-point scale. The final score reaches values between 0 (normal tendon) and 16 (the most severe degeneration) These scoring systems introduce similar variables, but they do not determine some of the pivotal issues. These include specimen preparation, staining methods, additional immunohistochemical reactions, the number of investigators, the experience of investigators, the area of investigation, and a certain magnification. These features have not yet been well-established, and they are usually selected randomly by authors [27,28,37,43–47]. The control group should not be obligatory, especially when experienced musculoskeletal observers assess the specimen
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