Term
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Definition
CT surrounds each of tertiary bundles and fascicles
Contains blood vessels, lymphatics and nerves, contains fibroblasts which repair and replace the collagenous fibril |
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Term
| How often fibroblast replace all of the collagen in the tendon? |
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Definition
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Term
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Definition
fine, loose CT shealth that covers the tendon and extends deep within it between the tertiary bundles as the endotenon
"Visceral Layer" of the tendon and moves with it
Composed of a fibroblastic and a synovial layer |
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Term
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Definition
| Type I and III collagen fibrils, some elastic fibrils and an inner lining of synovial cells |
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Term
| Why Paratenon is important for? |
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Definition
gliding phenomenon
transmits majority of blood supply
traumatic injury can lead to vascular necrosis of tendon |
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Term
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Definition
synovial sheath: thin visceral and pariety sheets and adheres to epitenon on the tendon site
Outer: fibrotic sheath, adheres loosely to the fascia |
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Term
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Definition
is the junction of double layered synovial sheath
Hilus is location where mesotenon is attached to the epitenon of the tendon
Important route of blood and nerve supply
Involved in gliding phenomenon |
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Term
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Definition
Paratenon exist at straight-line course of tendon
Mesotenon and plicae assumes gliding phenomenon responsibility in a curved course: allow liberal to and from motion |
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Term
| Where does tendon receive blood supply? |
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Definition
Central blood vessel originating in the muscle belly
Vessel of the bone and periosteum near the point of insertion of the tendon
MAJORITY: vessels running in the connective tissue covering fascicles |
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Term
| What is the avascular zones? |
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Definition
| Achillies and posterior tibial tendons |
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Term
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Definition
| both sympathetic and parasympathetic fibers are present in tendons |
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Term
| What is the primary source of fibroblasts? |
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Definition
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Term
| What is the Inflammatory phase in tendon healing? |
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Definition
| Within hrs after the trauma and can last for at least 48-72 hrs |
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Term
| What is the fibroblastic or Proliferative Phase? |
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Definition
| Usually starts at day 5 and can last up to day 15 |
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Term
| What is remodeling phase? |
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Definition
day 15-28: can be broken down into a consolidation and maturation stage
Post-op importance even though it can take up to 4 weeks for tendon healing,
ROM can be started at 3 weeks |
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Term
| What happened in week 1 of tendon healing? |
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Definition
Tendon ends retract and become erythematous and edematous as vascularity increases (palpable defect)
Immediately a hematoma formation begins and platelets aggregate to the area
Cells Infiltrate the area:
First cells are neutrophils which release cytokines to attract macrophages
Macrophages phagocytose necrotic material
macrophages then release growth factors to stimulate fibroblasts to proliferate
These migrate from epitenon, mesotenon and paratenon and later from the endotenon
Fibroblastic splint or tendon callus forms
Neovscularization/angiogenesis: capillaries grow into the gap
Stability required |
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Term
| What happened in week 2 of tendon healing? |
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Definition
Fibroblasts continue to proliferatee to bridge the gap: a temporary and mechanically inferior matrix is laid down composed to type III COLLAGEN
No Tensile strength yet
Active function at this point will cause further irritation and swelling of the tendon and more adhesions, not a stronger union
At the end of 2 weeks, the tendon stumps appear to be connected again: however, tendon is still considered weak and rupture could occur |
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Term
| What happened in week 3 of tendon healing? |
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Definition
Production of collagens fibrils that coalesce into bundles and begin to align themselves longitudinally to form new tendon fibers across the gap:
Type III collgen to type I collagen
Cleavage begins between the tendon and surrounding tissure in preparation for movement
Gentle ROM will increase the strength of the union and discourage adhesion formaiton |
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Term
| What happened in week 4 of tendon healing? |
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Definition
Reduced swelling and vascularity occurs
The Tendon loosens from surrounding tissue to increase gliding function
Force through passive ROM and muscle contraction will stimulate the collagen fibers into parallel formation so as to give optimal strength to the union
Gradual return to maximum contracture because complete strength has not yet been fully restored |
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Term
| What happened in week 6-10 of tendon healing? |
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Definition
Consolidation phase
Repair tissue changes from cellular to fibrous
High Proportion of type I collagen synthesized |
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Term
| What happened in after 10 weeks of tendon healing? |
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Definition
| gradual change of fibrous tissue to scar-like tendon |
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Term
| What happened in after 6 months of tendon healing? |
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Definition
there are minimal histological differences b/w repair tissue and normal tissue
The repair tissue continues to have inferior material properties for a year or more |
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Term
| What is scarring in tendon healing complication? |
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Definition
decrease strength
Increasing stiffness
Greater propensity toward adhesion formation |
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Term
| What is adhesion in tendon healing complication? |
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Definition
| Disruption of the synovial sheath at the time of injury allows granulation tissue and tenocytes from the surrounding tissue to invade the repair site |
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