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Table 3 Pathogenetic models proposed for calcific tendinopathy (CT) of rotator cuff tendons (RCTs) and insertional CT of the Achilles tendon.

From: Physiopathology of intratendinous calcific deposition

Stage Cells Extracellular matrix Blood vessels Inflammatory cells
CT model proposed by Uhthoff [28] for the rotator cuff:
Pre-calcific stage Chondrocyte-like cells Fibrocartilaginous metaplasia, presence of calcium crystals collected into matrix vesicles None None
Calcific stage:     
Formative phase Chondrocyte-like cells Multifocal calcific deposits separated by fibrocollagenous tissue or fibrocartilage None None
Resting phase Chondrocyte-like cells Fibrocollagenous tissue borders the foci of calcification None None
Resorptive phase Chondrocyte-like cells Deposits of a thick, creamy, toothpaste-like material under pressure appear Vascular channels near the calcific deposits Macrophages and multinucleated giant cells cathepsin K-positive [22]
Post-calcific stage Fibroblast Granulation tissue, deposition of type III collagen Capillaries surround the calcific deposits Multinucleated giant cells [22]
Model proposed by Benjamin [34] for insertional CT of Achilles tendon:
Early stage Chondrocytes and fibrocartilage cells Fibrocartilage metaplasia None None
Second stage Few chondrocytes Erosion of calcaneal cartilage. Fibrocartilage metaplasia of tendon matrix. Blood vessels invade the calcaneal fibrocartilage None
Bony spur formation Few fibrocartilage cells The original cartilage has disappeared New bone is deposited around the blood vessels None