This histological analysis reveals differences in achilles tendon structure influenced by diabetes mellitus, suggesting impaired regenerative capacity.
Background: The Achilles tendon (AT) is crucial for locomotion but is vulnerable to diabetes mellitus (DM) associated pathologies. Comprehensive human histological comparisons between diabetic and non-diabetic ATs are scarce. This study provides this detailed histological comparison, addressing a significant knowledge gap. Materials and methods: Achilles tendons from four diabetic individuals (undergoing amputations for diabetic foot syndrome) and four non-diabetic donors were analysed. Samples from three anatomical levels (Level 1: calcaneal insertion; Level 2: mid-portion; Level 3: myotendinous junction) underwent histological processing, including Hematoxylin & Eosin and Sirius Red staining. Key features were semi-quantitatively scored. Results: Diabetic ATs exhibited a tendency for increased adipose tissue at Level 1 and a higher frequency of blood vessels across all levels. Control (non-diabetic) ATs exhibited a higher prevalence of cells located in lacunae (Levels 1 and 2). At Level 1, non-diabetic cases also presented more developed cartilage compared to its traces in diabetics, and exclusively showed ossification. Conclusions: Diabetes mellitus is associated with distinct histological alterations in the human Achilles tendon, affecting adipose tissue, vascularity, cellular components, and entheseal features, such as cartilage development and ossification. This study presents novel human histological evidence of DM's impact on AT structure, suggesting impaired adaptive and regenerative capacity in individuals with diabetes.
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Łazarz et al. (2025) studied this question.
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