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77 Cards in this Set
- Front
- Back
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tensile strenth of tendon is equal to what
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bone
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what is the majority of tendon weight
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water
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tendon fasicles are enveloped by what
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endotendon
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what surrounds tendons
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epitendon
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where is tendon sheath found
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when tendons angle around structures
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what structure contains nerves and blood vessels to the tendon
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paratenon
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where does blood supply to proximal 1/3 of the tendon come from
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myotendinous jct
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where does blood supply to the distal 1/3 of the tendon come from
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tendo-osseous jct
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where does blood supply to the middle 1/3 of the tendon come from
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mesotendon
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what are the two main goals for tendon healing
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reestabilshment of the continuity of the tendon fibers
reestablishment of the gliding mechanism |
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what do you want to expose the tendon to to get it to heal in the correct position
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external stimuli
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what are the three phases of tendon healing
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inflammatory phase 2-4 days
proliferative phase 5-14 days remodeling phase 2-14 weeks |
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what happens in the inflammatory stage of healing
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inflitrate of inflammatory cells
fibroblasts synthesis ECM vascular network initiated |
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what happens in proliferative phase of healing
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continue recruitment of fibroblasts
revascularization collagen oriented perpendicular to the long axis of the tendon |
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what is still needed throughout the proliferative phase of healing
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protection because there is still decreased tensile load
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what happens in the remodeling phase of healing
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increase in collagen 1 synthesis
decreased type 3 reorganization of collagen fibers longitudinally due to physiological stress |
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what is final phase of remodeling
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maturation
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what happens with scar remodeling
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cross linking between collagen fibrils is broken down and reforms
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what is the gliding mechanism and strength of tendon dependent on
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successful alignment of the collagen fibers in a relatively parallel arrangement
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what is state of tendon healing at 1 wk
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jelly like bridge of serous and granulation tissue across the cut ends
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what is tendon healing like at 2 weeks
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vascularity increases
gap bridges in 10-14 days collagen proliferates |
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what is tendon healing like at 3 weeks
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longitudinal alignment leads to 60% tensile strength
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what is tendon healing like at 4 weeks
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continued resolution and vascularity
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what is tendon healing like at 12 wks
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anatomic orientation of small collagen bundles
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what is tendon healing like at 16 weeks
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larger collagen bundle formation and normal tendon
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when should physical therapy be initiated
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week 3
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what needs to be ruled out with spontaneous rupture
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RA
steroid use repetitive mtions fluroquinolones |
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what is #1 thing that should be evaluated with tendon injury
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neurovascular status
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eccentric
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contracting but lengthening
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concentric
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contracting but shortening
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muscle strain
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indirect injury producing tension overload in the passive muscle or eccentric overload in actively contracting muscles
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what is most common cause of partial or complete rupture of a tendon
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eccentric overload
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how are most tendon injuries treated
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sx and post op immobilization
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when are sutures the most important
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first 10 days following sx
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what does the tensile strength of the tendon rely on for the first 10 days following surgery
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the suture and technique of the repair
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what are the three tendon repair stiches
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bunnel
kessler krackow |
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where do you put the sutures in a rupture
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1-1.5 in from rupture site
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where does ideal suturing put the tendon after repair
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apposes the tendon and allows early passive motion without gapping
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do not do this to the tendon during repair
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encircle the tendon
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achilles tendon can store and release what types of energy
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elongation and elastic recoil
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what age group has the most achilles tendon ruptures
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those 30-40
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what diseases contribute to spontaneous rupture
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SLE, RA, DM, Xanthoma, Gout
secondary hyperparathyroidism due to dialysis chronic acidosis due to lead neuropathy fluoroquinolones |
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ultimate diagnostic tool for ruptures
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MRI
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magic angle
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when tendon is oriented 55 degrees from main magnetic field
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above what percent of strain do we start to see microscopic tears in tendons
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4%
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inflammation of surrounding tissues not effecting the tendon
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peritendinitis
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pure degenerative process within the tendon
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tendonosis
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what are some predisposing factors to achilles rupture
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excessive pronation of the foot
ankel equinus osseous deformity dystrophic calcifications arthritic conditions |
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what type of steroids should be used around the achilles
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phosphates
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what should you do with patient if you inject steroids around achilles
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NWB for 2 wks
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what are the mechanims of injury to achilles rupture
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psuing off with weightbearing forefoot and knee extended
extreme sudden dorsiflexion of plantarflexed foot |
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how do patients present with achilles rupture
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difficultly walking but without severe pain
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what is a clinical test you can do
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single or double limb heel rise
thompsons test |
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what are some clinical signs of achilles rupture
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escessive passive dorsiflexion of the foot
palpable dell at rupture site |
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when is thompsons test positive
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when you squeeze calf and there is no plantarflexion
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when are radiographs indicated with achilles ruptures
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when calcaneal fx is suspected
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calcaneal fracture is more likely when rupture occurs where
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more distal to the watershed area
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non surgical repair is limited to who
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those with limited functional goals or conditions that preclude good wound healing
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what are disadvantages of non-surgical repair
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rerupture
decreased fxn due to weakness |
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what is basis for non-surgical repair of achilles
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rigid casting and functional bracing
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what type of rigid immobilization is used in non-surgical repair of achilles tendon
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plaster cast placedin gravity equinus position
AK cast for 4wks with foot in equinus position the sequential BK casts with gradual reduction of equinus for 12 wks of immobilization |
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what happens with conservative care after you remove casting
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shoe gear with 2cm heel lift for 2-4 months
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what is another option for conservative care of achilles rupture
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8 wks bk casting in gravity equinus position allowing weigthbearing to tolerance followed by 1 in heel lift for 4 wks
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what are surgical options for achilles rupture repair
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percutaneous
end to end turn down flaps gastroc recession |
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4 parameters for functional results following AT repair
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return to preinjury activity levels
calf circumference strength and power dorsiflexion of ankle |
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where is incision made with achilles repair
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just medial to midline or at medial border of AT
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what should be done with frayed ends
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should be collected and sutured with an absorbable suture to reestablish a more definite structure before tendon approximation
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what should you do when you done with repair intraoperatively
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preform thompsons test it should be negative
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what can you do for further reinforcemnt if needed
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plantaris weave
turndown gastrocnemius flaps fascia lata free graft peroneus brevis aumentation with synthetic graft materials |
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when will patients returen to full sporting activity
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6-9 months
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how big are defects with neglected ruptures
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3-6cm depending on length of delay
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what are delayed ruptures filled with
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loosely formed hemorrhagic tissue or fibroadipose tissue
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what are options with neglected tendon rupture
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polantaris tendon
peroneus brevis FHL V-Y tendon advancement graft |
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why is FHL most preferable
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fires in phase with achilles
ease of access maintains normal muscle balance of ankle |
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neglected gaps of 2-5 cm usually close with what
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gastroc recession or v-y gastroplasty
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neglected gaps greater than 5cm are closed with what
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a turndown flap
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neglected gaps greater than 10 cm are best closed with what
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achilles allograft
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