Tendon and Ligament Injuries

Question 1

What are ligaments?

Answer 1

Soft tissue structure connecting bone to bone
- restrict joint motion —> stability and proprioception

Question 2

What are tendons?

Answer 2

Soft tissue structure connecting muscle to bone
- transmit forces —> enable motion

Question 3

How do tendons/ligaments get injured? (3)

Answer 3

1. Sport - pivoting forces
   - eccentric contraction
2. Trauma
3. Laceration

Question 4

What are the 3 grades of tendon/ligament injury?

Answer 4

Grade I —> slight incomplete tear
- no joint instability

Grade II —> moderate/severe incomplete tear
- some joint instability

Grade III —> complete tear
- instability —> may need surgery

Question 5

What are the 4 stages of tendon/ligament healing?

Answer 5

1. Bleeding
2. Inflammation
3. Proliferation
4. Re-modelling

Question 6

How long do tendon/ligament injuries take to heal?

Answer 6

6 months to never

Question 7

What is an example of a ligament injury?

Answer 7

Torn ACL (anterior cruciate ligament - knee)
- snap noise
- knee swells
- diagnosis: MRI scan

Question 8

What are the 5 ligaments of the knee?

Answer 8

1. ACL (anterior cruciate)
2. PCL (posterior cruciate)
3. LCL (lateral collateral)
4. MCL (medial collateral)
5. Patellar

Question 9

What are the 3 clinical tests for a torn ACL?

Answer 9

1. Lachmann’s - bend knee —> bottom back and forth
2. Anterior drawer - knee bent —> pull and push top
3. Pivot shift - lift leg —> twist —> bend

Question 10

How are tendon/ligament injuries managed short-term? (PRICE)

Answer 10

Protect (from further injury)
Rest
Ice
Compress
Elevate

Question 11

How is an ACL rupture managed long-term? (2)

Answer 11

Non-operative —> brace
Operative —> repair/replace

Question 12

What are the 3 factors that must be considered when making a management plan for tendon/ligament injuries?

Answer 12

1. Functional demands
2. Patient factors
3. Compliance

Question 13

What are the 6 factors influencing the healing of a tendon/ligament injury?

Answer 13

Mechanical factors:
1. Movement
2. Forces

Biological factors:
3. Blood supply
4. Immune function
5. Infection
6. Nutrition

Question 14

What are the 3 types of graft?

Answer 14

1. Autograft —> graft from patient
2. Allograft —> graft from donor
3. Synthetic

Question 15

What is an example of a tendon injury?

Answer 15

Torn achilles (ankle)
- snap sound
- severe pain in ankle

Question 16

What are the 5 risk factors for a torn achilles?

Answer 16

1. Age —> 30-50
2. Male
3. Anabolic steroid use
4. Fluroquinolone use (antibiotic)
5. ‘Weekend Warrior’ —> sport on weekend only

Question 17

What are the symptoms of a torn achilles?

Answer 17

1. Limping
2. Can’t perform heel raises (tip toes)
3. Swollen and tender ankle
4. Dorsiflexion (foot flexed up)

Question 18

What is the clinical test for a torn achilles?

Answer 18

Simmonds calf squeeze test

Question 19

What are the 9 operation complications for a torn achilles?

Answer 19

General:
1. DVT (deep vein thrombosis)
2. Infection
3. Prolonged immobility (secondary) - eg. UTI, chest
infection, sored

Specific:
4. Neurovascular injury —> sural nerve (back of leg)
5. Tendon re-rupture
6. Local infection (site of surgery)
7. Ankle stiffness
8. Pressure sores —> because of plaster/boot
9. Weaker

Question 20

What are the 3 management options for a torn achilles?

Answer 20

1. Operative - open or percutaneous (through skin)
   - primary repair vs augmentation of
   repair (making tendon stronger)
2. Non-operative - bracing (equinous position —> tilt
   down)
   - use wedge in shoe —> remove —>
   plantigrade (sole on floor)
3. Rehabilitation - range, strength, proprioception