Angela Fearon1, Jane E Dahlstrom2, Jane Twin3, Jill Cook4, Alex Scott5. 1. Australian National University College of Medicine, Biology and the Environment, Australia; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Canada. 2. Department of Anatomical Pathology, The Canberra Hospital, Australia. 3. Capitol Pathology, Australia. 4. Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia. 5. Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Canada. Electronic address: ascott@mail.ubc.ca.
Abstract
OBJECTIVES: Tendinopathy is a common, costly condition affecting both sporting and sedentary populations. Research into tendinopathy frequently involves the evaluation of tendinosis, a pathology characterized by a lack of inflammatory cells, collagen disruption, neovascularisation, altered cell numbers and morphology and increased glycosaminoglycans. Evaluation of these characteristics can be undertaken using the Bonar histopathology score, but the characteristics are heterogeneous throughout tendon specimens with no standardized method of determining the area to be evaluated. The objective of this study was to assess whether the Bonar score varies depending on the criteria used to define the area of evaluation. DESIGN: Case series. METHODS: Two independent assessors, with a third to resolve disputes, evaluated 103 areas from 35 tendon specimens using the Bonar score. Specimens were scored once each in the area of worst collagen disruption, degree of vascularization, and cell morphological changes. The inter-tester reliability of the updated Bonar scale was good (r(2)=0.71) RESULTS: The Bonar score was highest in the areas of worst cell morphological (CM) changes, followed by collagen disruption (CD) and lowest for the area of most extensive vascular proliferation (VS) (regression: CD vs. CM, p=0.008, CM vs. VS, p<0.001, CD vs. VS, p=0.013). Suggested modifications to the Bonar score include the addition of a cellularity domain, specific definitions of hypo- and hypercellularity, and changes to the vascularity score to include pathological avascularity. CONCLUSIONS: The updated Bonar score includes a standardized method of selecting the area of evaluation, which should provide increased reliability when assessing the extent of tendon degeneration.
OBJECTIVES:Tendinopathy is a common, costly condition affecting both sporting and sedentary populations. Research into tendinopathy frequently involves the evaluation of tendinosis, a pathology characterized by a lack of inflammatory cells, collagen disruption, neovascularisation, altered cell numbers and morphology and increased glycosaminoglycans. Evaluation of these characteristics can be undertaken using the Bonar histopathology score, but the characteristics are heterogeneous throughout tendon specimens with no standardized method of determining the area to be evaluated. The objective of this study was to assess whether the Bonar score varies depending on the criteria used to define the area of evaluation. DESIGN: Case series. METHODS: Two independent assessors, with a third to resolve disputes, evaluated 103 areas from 35 tendon specimens using the Bonar score. Specimens were scored once each in the area of worst collagen disruption, degree of vascularization, and cell morphological changes. The inter-tester reliability of the updated Bonar scale was good (r(2)=0.71) RESULTS: The Bonar score was highest in the areas of worst cell morphological (CM) changes, followed by collagen disruption (CD) and lowest for the area of most extensive vascular proliferation (VS) (regression: CD vs. CM, p=0.008, CM vs. VS, p<0.001, CD vs. VS, p=0.013). Suggested modifications to the Bonar score include the addition of a cellularity domain, specific definitions of hypo- and hypercellularity, and changes to the vascularity score to include pathological avascularity. CONCLUSIONS: The updated Bonar score includes a standardized method of selecting the area of evaluation, which should provide increased reliability when assessing the extent of tendon degeneration.
Authors: S Fasanella; E Leonardi; C Cantaloni; C Eccher; I Bazzanella; D Aldovini; E Bragantini; L Morelli; L V Cuorvo; A Ferro; F Gasperetti; G Berlanda; P Dalla Palma; M Barbareschi Journal: Diagn Pathol Date: 2011-03-30 Impact factor: 2.644
Authors: Angela Margaret Fearon; Jane Twin; Jane E Dahlstrom; Jill L Cook; Wes Cormick; Paul N Smith; Alexander Scott Journal: Rheumatol Int Date: 2014-02-23 Impact factor: 2.631
Authors: Guang-Ting Cong; Amir H Lebaschi; Christopher L Camp; Camila B Carballo; Yusuke Nakagawa; Susumu Wada; Xiang-Hua Deng; Scott A Rodeo Journal: J Orthop Res Date: 2018-05-24 Impact factor: 3.494