Tendon Biopsy – Procedure, Purpose and Risks
A tendon biopsy is a diagnostic procedure in which a small tissue sample is taken from a tendon for microscopic analysis. It helps diagnose conditions such as tendinopathies or tumors.
Things worth knowing about "Tendon Biopsy"
A tendon biopsy is a diagnostic procedure in which a small tissue sample is taken from a tendon for microscopic analysis. It helps diagnose conditions such as tendinopathies or tumors.
What Is a Tendon Biopsy?
A tendon biopsy is a medical procedure in which a small sample of tissue is removed from a tendon for laboratory analysis. Tendons are tough, fibrous connective tissue structures that connect muscles to bones and play a key role in enabling movement. The collected tissue sample is examined under a microscope to detect any pathological changes within the tendon tissue.
When Is a Tendon Biopsy Performed?
A tendon biopsy is typically recommended when other diagnostic tools such as imaging or clinical examination fail to provide a definitive diagnosis. Common indications include:
- Chronic tendinopathies: Persistent degenerative changes in the tendon that do not respond to conservative treatment.
- Suspected tumors or tumor-like lesions: To evaluate masses or growths in or around the tendon.
- Inflammatory tendon conditions: For example, in cases of rheumatic diseases or infections affecting tendon tissue.
- Unexplained tendon ruptures: To identify underlying causes such as systemic diseases.
How Is a Tendon Biopsy Performed?
A tendon biopsy is usually performed on an outpatient or inpatient basis by a specialist in orthopedics, trauma surgery, or sports medicine. The procedure is carried out under local anesthesia and can be performed either as an open surgical biopsy or as a minimally invasive procedure, such as an ultrasound-guided needle biopsy.
Open Biopsy
In an open biopsy, a small incision is made in the skin, and a tissue sample is directly taken from the affected tendon. This method provides direct visualization of the tissue and is particularly suitable for deeper tendons.
Ultrasound-Guided Biopsy
In an ultrasound-guided biopsy, a needle is directed into the tendon under real-time ultrasound imaging to obtain a targeted tissue sample. This approach is less invasive and allows precise sampling from specific areas of the tendon.
What Is Examined in the Laboratory?
The tendon tissue sample is analyzed histologically, meaning it is examined under a microscope. The following changes may be identified:
- Degenerative changes: Disruption of collagen fibers, mucoid degeneration, or the presence of cartilage-like cells (known as tendinosis).
- Inflammatory infiltrates: Accumulations of immune cells indicating an inflammatory condition.
- Tumor tissue: Benign or malignant cell changes, for example in giant cell tumor of the tendon sheath.
- Infectious agents: Detection of bacteria or other pathogens in cases of infectious tenosynovitis.
Risks and Side Effects
As with any surgical procedure, a tendon biopsy carries certain risks, though these are generally considered low:
- Infection at the biopsy site
- Bleeding or bruising (hematoma)
- Scar tissue formation
- Temporary pain or swelling
- In rare cases, weakening of the tendon at the biopsy site
Before the procedure, the treating physician will provide a thorough explanation of possible risks and the expected course of the procedure.
Aftercare and Recovery
Following a tendon biopsy, a short period of rest and protection of the affected area is typically required. Depending on the location and extent of the biopsy, physiotherapy may be recommended to support recovery. Laboratory results are usually available within a few days to two weeks and will serve as the basis for further treatment planning.
References
- Maffulli, N. et al. - Tendon injuries: basic science and clinical medicine. Springer, London, 2005.
- Khan, K.M. et al. - Histopathology of common tendinopathies. Sports Medicine, 27(6), 393-408, 1999. PubMed PMID: 10418074.
- World Health Organization (WHO) - Classification of Tumours of Soft Tissue and Bone. IARC Press, Lyon, 2020.
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