11: Tendon Healing and Rupture - Frush Flashcards Preview

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Flashcards in 11: Tendon Healing and Rupture - Frush Deck (34)
1

define tendon transfer

detachment of a tendon of a functioning muscle at its insertion and then its relocation to a new insertion or attachment

2

define tendon transposition

the rerouting of the course of a normal muscle tendon without detachment to assist other functions

3

define muscle-tendon transplantation

The detachment of a muscle tendon at both its origin and its insertion and moving it to a new location along with its neurovascular support structures constitute a muscle–tendon transplantation

4

define tendon suspension

Tendon procedures designed to support a structure (AKA tenosuspension)

5

histology % tendons

30% collagen
2% elastin
ECM - 68% water

6

polypeptide chain --> tropocollagen -->

filament --> fibril --> fiber --> subfascicle --> fascicle --> tendon

7

synovial layer surrounding tendon

epitenon

8

areolar tissue containing n and blood vessels

paratenon

9

epitenon + paratenon

mesotenon

10

when is a tendon sheath present?

when tendon angles around structures

11

paratenon vs. tendon sheath

Paratenon:
- Continuous with epitenon
- Contains nerve and blood vessels
- Allows tendon to glide
- Only found on tendons with straight pull, ie: Achilles tendon


Tendon Sheath:
- Tubular structure prevents bowstringing
- Lined with synovial cells
- Allows tendon to glide like a piston in a cylinder
- Epitenon and inner layer of sheath make up mesotenon
- Contains blood and lymphatics

12

point of attachment in mesotenon

hilus

13

what are plicae?

connective tissue doubled over on itself to provide free pistoning motion of the tendon, stretching and folding to protect the vital mesotenon from excessive tension

14

*** 3 sources vascular supply to tendon


1. Musculotendinous junction

2. Bone/periosteum

3. Paratenon by way of hilus (***majority of supply)

15

where are sharpey fibers

at tendon attachment to bone

16

what happens at impact?

- moment of injury
- activation of complement cascade
- vasoconstriction
- platelet aggregation (intrinsic and extrinsic pathway activation)
- chemotaxis

17

what happens with inflammation phase?

- cellular infiltration
- jelly-like serous and granulation tissue at gap zone
- PMN’s and macrophages
- acidic environment with low oxygen tension stimulates fibroblast and collagen production

18

proliferative phase tendon healing?

- fibroblasts bridge gap zone
- collagen synthesis
- return of function

19

remodeling phase tendon healing?

- Healing
- systematic organization of collagen bundles with anatomic orientation

20

chronology of tendon healing week 1 - 4

week 1 = softening, production of jelly-like fibroblastic splint. strength of suture. tx immobilize.

week 2 = increased vascularity and proliferation of fibroblasts. strength suture. tx immobilize.

week 3 = vigorous production of collagen fibers. moderate bond strength. tx: gentle motion or isometric exercises.

week 4 = collagen fiber alignment; cleavage from local tissues. not quite full strenght. tx: progressive muscular foce.

21

tendon three and four months post injury

THREE MONTHS:
-Small collagen bundle
formation with anatomic
orientation

FOUR MONTHS:
-Larger collagen bundle
formation
-Normal tendon

22

m produces greatest force at ...

120% resting length

zero tension found to be at 60% resting length

tension developed by m is related to length of m when contracts

23

*** i want to ... so i put the tendon
limit motion
rotate
stabilize
rotate and stabilize

- close to joint axis
- 90 degrees to joint axis
- parallel to bone and away from joint axis
- 45 degrees to joint axis

24

where are tendon fulcrums located?

sesamoids - FHB
cuboid - PL

increases angle of application and improves efficiency of tendon function

25

torque anterior v posterior leg

Ratio of torque produced by anterior versus posterior leg muscles in controlling foot function is 1:4

This is due in large part to long lever arm of forefoot vs. the short lever arm of triceps surae

26

how does phase relate to tendon transfer?

Muscles transferred in phase regain activity in 7 to 8 weeks
Out-of-phase tendon transfer can be done but takes a lot of retraining. Goal should be to regain function

swing phase: tibialis anterior ; extensor hallucis longus; extensor digitorum longus; peroneus tertius

stance phase: remaining

27

6 principles of tendon transfer

improve motor function

eliminate deforming forces

restore lost motor function

increase stability

eliminate need for bracing

improve cosmetic appearance

28

Muscle Grading System
5
4
4+
4-
3
2
1
0

5 full resistance at end range of motion
4 some resistance at end range of motion
4+ moderate resistance at end range of motion
4 - mild resistance at end range of motion
3 able to move against gravity alone
2 able to move with gravity eliminated
1 can palpate or visualize m contraction
0 no evidence of m contraction

29

you will lose __ grade with transfer of tendon

Loss of 1 muscle grade with transfer of the tendon

30

anastomosis with most physiologic pull

side to side anastomosis

31

most common end to end suture repair

bunnel repair
- moderate strength, pull is longitudinal
- (-) constricts vascular supply to tendon

32

desgined after chinese finger trap

- lateral trap repair
- grips outside of tendon
- avoids constricting microcirculation

33

krackow repair

- end to end
- Interlocking weave stitch
- Good tensile strength
- Doesn’t constrict microcirculation
- Technically easy to perform

34

hibbs tenosuspension

cute EDL tendons and insert into midfoot to limit force on toes

jones would transfer to head of metatarsal

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