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Surg+BioMech [all exams] > 11: Tendon Healing and Rupture - Frush > Flashcards

11: Tendon Healing and Rupture - Frush Flashcards

1
Q

define tendon transfer

A

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

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2
Q

define tendon transposition

A

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

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3
Q

define muscle-tendon transplantation

A

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

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4
Q

define tendon suspension

A

Tendon procedures designed to support a structure (AKA tenosuspension)

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5
Q

histology % tendons

A

30% collagen
2% elastin
ECM - 68% water

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6
Q

polypeptide chain –> tropocollagen –>

A

filament –> fibril –> fiber –> subfascicle –> fascicle –> tendon

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7
Q

synovial layer surrounding tendon

A

epitenon

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8
Q

areolar tissue containing n and blood vessels

A

paratenon

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9
Q

epitenon + paratenon

A

mesotenon

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10
Q

when is a tendon sheath present?

A

when tendon angles around structures

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11
Q

paratenon vs. tendon sheath

A

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
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12
Q

point of attachment in mesotenon

A

hilus

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13
Q

what are plicae?

A

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

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14
Q

*** 3 sources vascular supply to tendon

A
  1. Musculotendinous junction
  2. Bone/periosteum
  3. Paratenon by way of hilus (***majority of supply)
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15
Q

where are sharpey fibers

A

at tendon attachment to bone

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16
Q

what happens at impact?

A
  • moment of injury
  • activation of complement cascade
  • vasoconstriction
  • platelet aggregation (intrinsic and extrinsic pathway activation)
  • chemotaxis
17
Q

what happens with inflammation phase?

A
  • 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
Q

proliferative phase tendon healing?

A
  • fibroblasts bridge gap zone
  • collagen synthesis
  • return of function
19
Q

remodeling phase tendon healing?

A
  • Healing

- systematic organization of collagen bundles with anatomic orientation

20
Q

chronology of tendon healing week 1 - 4

A

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
Q

tendon three and four months post injury

A

THREE MONTHS:
-Small collagen bundle
formation with anatomic
orientation

FOUR MONTHS:
-Larger collagen bundle
formation
-Normal tendon

22
Q

m produces greatest force at …

A

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
Q 
*** i want to ... so i put the tendon
limit motion
rotate
stabilize
rotate and stabilize
A
  • close to joint axis
  • 90 degrees to joint axis
  • parallel to bone and away from joint axis
  • 45 degrees to joint axis
24
Q

where are tendon fulcrums located?

A

sesamoids - FHB
cuboid - PL

increases angle of application and improves efficiency of tendon function

25
Q

torque anterior v posterior leg

A

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
Q

how does phase relate to tendon transfer?

A

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
Q

6 principles of tendon transfer

A

improve motor function

eliminate deforming forces

restore lost motor function

increase stability

eliminate need for bracing

improve cosmetic appearance

28
Q 
Muscle Grading System
5
4
4+
4-
3
2
1
0
A 
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
Q

you will lose __ grade with transfer of tendon

A

Loss of 1 muscle grade with transfer of the tendon

30
Q

anastomosis with most physiologic pull

A

side to side anastomosis

31
Q

most common end to end suture repair

A

bunnel repair

  • moderate strength, pull is longitudinal
  • (-) constricts vascular supply to tendon
32
Q

desgined after chinese finger trap

A
  • lateral trap repair
  • grips outside of tendon
  • avoids constricting microcirculation
33
Q

krackow repair

A
  • end to end
  • Interlocking weave stitch
  • Good tensile strength
  • Doesn’t constrict microcirculation
  • Technically easy to perform
34
Q

hibbs tenosuspension

A

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

jones would transfer to head of metatarsal

Surg+BioMech [all exams] (68 decks)

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