Excessive apoptosis in patellar tendinopathy in athletes

Background: The pathogenesis of tendon overuse injuries is poorly understood. The histopathology underlying tendinopathy at various anatomical locations is similar and may reflect a common pathologic process. Hypothesis: Apoptosis contributes to the pathophysiology in patellar tendinopathy. Study Design: Case control study; Level of evidence, 3. Methods: We compared biopsy specimens from the patellar tendon in patients with patellar tendinopathy diagnosed clinically and with typical magnetic resonance image findings with biopsy specimens from a control group without any previous or current knee complaints to suggest patellar tendinopathy. The presence of apoptosis was examined with immunohistochemical methods using a polyclonal antibody recognizing active caspase-3, confirmed by labeling DNA strand breaks (F7-26 antibody) and nuclear morphology (fragmentation and condensation). Results: The number of apoptotic cells per unit area (4.5 mm(2)) was 0.91 +/- 0.81 (SD) in tendinopathic samples and 0.21 +/- 0.21 in controls (P = .026). Although the tendinopathic samples displayed increased cellularity (average 162.5 nuclei/mm(2) vs 98.9 nuclei/mm(2)), the apoptotic index was higher (0.42% vs 0.17%, P = .014). Conclusion: Increased apoptotic cell death is a feature of patellar tendinosis. The role of apoptosis within the broader framework and time course of tendon overuse injury remains to be established.