The purpose of the current review is to highlight the structure-function relationship of tendons and related structures to provide an overview for readers whose interest in tendons needs to be underpinned by anatomy. Because of the availability of several recent reviews on tendon development and entheses, the focus of the current work is primarily directed towards what can best be described as the ‘tendon proper’ or the ‘mid-substance’ of tendons. The review covers all levels of tendon structure from the molecular to the gross and deals both with the extracellular matrix and with tendon cells. The latter are often called ‘tenocytes’ and are increasingly recognized as a defined cell population that is functionally and phenotypically distinct from other fibroblast-like cells. This is illustrated by their response to different types of mechanical stress. However, it is not only tendon cells, but tendons as a whole that exhibit distinct structure-function relationships geared to the changing mechanical stresses to which they are subject. This aspect of tendon biology is considered in some detail. Attention is briefly directed to the blood and nerve supply of tendons, for this is an important issue that relates to the intrinsic healing capacity of tendons. Structures closely related to tendons (joint capsules, tendon sheaths, pulleys, retinacula, fat pads and bursae) are also covered and the concept of a ‘supertendon’ is introduced to describe a collection of tendons in which the function of the whole complex exceeds that of its individual members. Finally, attention is drawn to the important relationship between tendons and fascia, highlighted by Wood Jones in his concept of an ‘ectoskeleton’ over half a century ago – work that is often forgotten today.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-7580.2008.00864.x

Structure-function relationships in tendons: a review.

Purpose. To review the current concepts on Achilles tendon involvement in various pathological conditions.Method. A literature search was conducted to trace relevant literature on Achilles tendon p...

Achilles tendon problems: not just an orthopaedic issue.

Extra skeletal soft tissue chondroma is a very rare, slow progressing, benign tumor. It has a specific tendency for hands and feet. It can sometimes be misdiagnosed as a synovial cyst or a more serious condition such as synovial sarcoma. Moreover, it can exhibit worrying radiologic and histological features mimicking chondrosarcomas. This study presents a very rare case of soft tissue chondroma of the foot.

/pdf/soft-tissue-chondroma-a-case-report-and-literature-review-e03rx359t7.pdf

Soft tissue chondroma: a case report and literature review.

Synovial chondromatosis of Hoffa’s body is uncommon. Recurrences usually result from incomplete removal of the loose bodies or diseased synovium at the initial surgery. We report a patient with synovial chondromatosis localized into the Hoffa’s body who presented with anterior knee pain and mechanical symptoms. At the first arthroscopy, all pathological tissue was removed. At 1-year follow-up, clinical and radiographic examinations were normal. Symptoms recurred at 3 years, when a bony mass in the Hoffa’s body was evident on MRI. The mass was removed through a mini-arthrotomy. Histology excluded malignancy. At 10-year follow-up, the patient remained free of symptoms. Synovial chondromatosis can occur with unusual patterns of recurrence. The growth of a large size mass confined to fat pad without intra-articular involvement does not allow to exclude the diagnosis of recurrent synovial chondromatosis.

Recurrence of synovial chondromatosis of the Hoffa’s body

Extraskeletal osteochondroma near the hip is rare and its pathological diagnosis is based on radiological and histopathological examination. It is vital that such a diagnosis be considered when a discrete, ossified mass is localized in soft tissues, even at atypical sites. Differential diagnoses inc

Extraskeletal osteochondroma near the hip: a pediatric case.

Extraskeletal cartilaginous tumors are uncommon. Osteochondromas usually arise from the metaphyseal region of the growing skeleton. A 53 year old man presented with a three years history of anterior knee pain and inability to flex his knee more than 90°. Clinical examination and imaging studies revealed a nodular calcific mass in the anterior portion of the knee, displacing the medial portion of the patellar tendon. Following excision, histopathology confirmed the diagnosis of extra-osseous osteochondroma-like soft tissue mass, with no recurrence 24 months after surgery. An integrated clinical-pathologic diagnosis helps to clarify the nature of extraskeletal cartilaginous tumors that can arise at unusual anatomic site. Complete local surgical excision is the management of choice.

/pdf/extra-osseous-osteochondroma-like-soft-tissue-mass-of-the-1qqs32ax2z.pdf

Extra-osseous osteochondroma-like soft tissue mass of the patello-femoral space

A 46-year-old female presented a six-month history of posterior heel pain. Clinical and radiographical examination revealed a nodular calcified mass into the subcutaneous tissue of the Achilles tendon bursa. Following excision, histopathology showed an extraskeletal soft-tissue chondroma. Follow up at 24 months showed no recurrence. To our knowledge, this is the first description of a soft tissue chondroma at this site: some soft tissue tumors develop at unusual anatomic location.

Stefano Fratoni

Papers

Extra-osseous osteochondroma-like soft tissue mass of the patello-femoral space

Chondroma of the subcutaneous bursa of the Achilles tendon.