The distal tendon of the biceps brachii. Structure and clinical correlations.

The structure and blood supply of 42 distal biceps tendons were investigated by means of light and electron microscopy as well as by immunohistochemistry. Possible structural causes for the rupture of the tendon are discussed. The distal biceps tendon wraps around the radius during pronation of the forearm. In this area the tendon is exposed to pressure and shearing forces in addition to those caused by tension. Two fibrocartilaginous areas were regularly observed. Large chondrocyte-like cells were found inside the fibrocartilage. As an expression of strain, the extracellular matrix is rich in acidic glycosaminoglycans and stains intensely with toluidine blue at pH 1. Electron microscopy showed a granular pericellular matrix that increases in size towards the gliding surface. Type I collagen is the main component of the distal biceps tendon. Type II collagen is found in tendon fibrocartilage but not in traction tendons. The gliding surface of the tendon is made up of reticular fibres that are equivalent to type III collagen. Monoclonal antibodies revealed the presence of dermatan-sulfate, keratansulfate and chondroitin-4- as well as chondroitin-6-sulfate. Blood vessels are usually absent in fibrocartilage, as was shown with a polyclonal antibody against the basement membrane component laminine. There are significant differences between the extracellular matrix of traction and gliding tendons, which may be responsible for the location of tendon rupture.