Orthonotes
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Phases: inflammatory (days 1–7), proliferative (days 3–21), remodeling (weeks–months). Intrinsic (tenocyte) vs extrinsic (synovial/paratenon) healing; adhesion formation from extrinsic fibroblasts. Early controlled mobilization enhances tensile strength and reduces adhesions in flexor tendons. Suture techniques: core locking (e.g., 4–6 strand) + epitendinous running improves gap resistance. Rehab protocols: Kleinert, Duran (flexor); early active motion in selected repairs.
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Tendons are specialized connective tissues that connect muscles to bone and transmit the force generated by muscle contraction to produce joint movement. Tendon injuries are common in orthopaedic practice and may occur due to trauma, overuse, degeneration, or sports-related injuries.
Healing of tendons is a complex biological process involving inflammation, collagen synthesis, and gradual remodeling of the extracellular matrix. Unlike bone, tendon healing is relatively slow and often results in scar tissue formation rather than regeneration of the original tendon structure.
Successful tendon repair depends not only on surgical technique but also on appropriate postoperative rehabilitation. Early controlled mobilization has been shown to improve tendon gliding and reduce adhesion formation.
Tendons are composed primarily of collagen fibers arranged in parallel bundles. These fibers provide high tensile strength and allow tendons to withstand significant mechanical loads during muscle contraction.
| Component | Function |
|---|---|
| Type I collagen | Provides tensile strength |
| Tenocytes | Cells responsible for collagen production |
| Extracellular matrix | Maintains structural integrity |
| Proteoglycans | Provide elasticity |
The hierarchical structure of tendon allows it to transmit force efficiently while maintaining flexibility.
Tendon injuries occur through several mechanisms, including acute trauma and chronic degeneration.
Common examples include Achilles tendon rupture, rotator cuff tears, and flexor tendon injuries of the hand.
Tendon healing occurs through three overlapping phases.
This phase begins immediately after injury and lasts for several days. It is characterized by hematoma formation and infiltration of inflammatory cells.
During this phase fibroblasts proliferate and produce collagen fibers. The newly formed collagen is initially disorganized and relatively weak.
The remodeling phase may last several months. Collagen fibers gradually reorganize and align along the direction of mechanical stress.
Tendon healing may occur through intrinsic or extrinsic mechanisms.
| Type | Description |
|---|---|
| Intrinsic healing | Healing from tenocytes within tendon |
| Extrinsic healing | Healing from surrounding tissues |
Intrinsic healing results in better tendon gliding, whereas extrinsic healing often leads to adhesion formation.
Several biological and mechanical factors influence the outcome of tendon repair.
Poor vascularity in certain tendons, such as the Achilles tendon and rotator cuff tendons, contributes to delayed healing and increased risk of rupture.
Rehabilitation plays a crucial role in achieving optimal functional outcomes after tendon repair.
Early controlled mobilization is generally preferred because prolonged immobilization may lead to stiffness and adhesions.
Proper surgical technique and structured rehabilitation protocols are essential to minimize these complications.
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