Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Biomechanics & Surgery Exam 1 > 15. Principles of Tendon Healing > Flashcards

15. Principles of Tendon Healing Flashcards

1
Q

what are the 3 vascular sources to a tendon?

A
  1. musculotendinous junction
  2. bone/periosteum interface
  3. paratenon by way of hilus **majority of supply
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the phases of tendon healing?

A
  1. impact
  2. inflammatory
  3. proliferative
  4. remodeling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

when does bridging of the gap occur?

A

week 2 (10-14 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what tendons are active in the swing phase of gait cycle?

A

tibialis anterior
EHL
EDL
peroneus tertius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how long does it take for an in-phase tendon transfer to regain activity? vs. out-of phase?

A

in phase: 7-8 wks

out of phase: 1-2 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the building blocks of tendon anatomy.

A

tropocollagen –> collagen filament –> fibrils –> fiber –> fasicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what does an endotenon surround?

A

envelopes a group of fasicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does an epitenon surround?

A

the tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is a mesotenon?

A

epitenon + paratenon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is a paratenon?

A

continuous with the epitenon, contains nerve and blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the difference btwn paratenon and tendon sheath?

A

tendon sheaths are found in tendons that change direction

paratenon is found in tendons w/ straight pull aka achilles tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is a hilus?

A

point of attachment of mesotenon to tendon to provide bloodflow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is plicae?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens on a cellular level in the impact phase of tendon healing?

A
  • complement cascade is activated
  • vasoconstriction
  • platelet aggregation
  • chemotaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the timescale for inflammatory phase?

A

48-72 hours

days 2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens on a cellular level in the inflammatory phase of tendon healing?

A
  • cellular infiltration: PMN, macrophage
  • jelly-like serous and granulation tissue at gap zone
  • acidic environment (low O2 tension) stimulates fibroblast and collagen production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the time scale of proliferative phase of tendon healing?

A

5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what occurs in the proliferative phase of tendon healing?

A
  • fibroblasts bridge gap zone
  • collagen synthesis
  • return of function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the timescale for remodeling phase?

A

15-28 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what occurs in the remodeling phase?

A
  • healing

- systematic organization of collagen bundles with anatomic orientation

21
Q

When can you start some active/passive ROM?

A

week 3

22
Q

when can an athlete return to high impact sports?

A

month 4

23
Q

Describe the healing process of tendon on a timeline.

A

Week 1- opposed tendon ends join thru a gelatinous bridge of serous and granulation tissue
Week 2- vascularity is restored and collagen proliferates; gap is bridged
week 3- collagen fibers coalesce and align longitudinally; moderate tendon strength
week 4- reduced edema and vascular proliferation
month 3- small collagen bundle formation
month 4- larger collagen bundle formation

24
Q

a sarcomere at rest is what % of muscle length?

A

60%

25
Q

a sarcomere at max tension is at what % of muscle length?

A

120%

26
Q

At what % of resting length does muscle produce its greatest force?

A

120%

*zero tension is found to be at 60% resting length

27
Q

what is a transposition tendon surgery?

A

rerouting the tendon without detachment

28
Q

What happens when a tendon is close to its joint axis?

A

there is limited motion (the tendon will not move that join)

29
Q

what happens when the tendon is 90 degress to the joint axis?

A

it will rotate that joint

30
Q

what will stabilize a joint?

A
  • when a tendon is parallel to bone

- when a tendon is away from its joint axis

31
Q

what happens when a tendon is 45 deg to joint axis?

A

will rotate and stabilize the axis

32
Q

give two examples of tendon fulcrum in teh body.

A

sesamoids- FHB

cuboid- peroneus longus

33
Q

compare the torque produced by the anterior vs. posterior leg muscles?

A

torque of achilles tendon (posterior muscles) is 4x more than the anterior muscle group.

34
Q

what are teh goals of tendon transfer?

A
  1. improve motor fxn
  2. eliminate deforming forces
  3. restore lost motor fxn
  4. increase stability
  5. eliminate need for bracing
  6. improve cosmetic appearance
35
Q

What are some ways to fixate a tendon?

A
  • side to side anastomosis (gives you the most physiologic pull)
  • end to end
  • tendon to bone
36
Q

give some types of end-to-end repair

A

Bunnell
lateral trap
kessler
krackow

37
Q

what is teh end-to-end bunnell repair?

A

most common end-to-end suture repair

  • allows moderate strength; pull is longitudinal
  • disadvtg: constricts vascular supply to tendon.
38
Q

describe the end-to-end lateral trap repair.

A

grips outside of tendon

*avoids constricting microcirculation (as seen in Bunnell end-to-end repair)

39
Q

describe the end-to-end krackow repair.

A
  • interlocking weave stitch
  • good tensile strength
  • doesn’t constrict microcirculation
  • technically easy to perform.
40
Q

What are the options for tendon to bone repair?

A 
Trephine plug
interference screw
button anchor
screw and washer
suture anchor
41
Q

what is the Z-tendon lengthening commonly used in?

A

EDL for contracted digits

42
Q

Name the tendon augmentation products.

A

graft jacket
restore
pegasus
cadaveric graft

43
Q

what tendon transfer would you use for a contracted digit?

A

split FDL transfer

44
Q

what tendon transfer would you use for PTT dysufnction (flatfoot deformity)?

A

FDL transfer

45
Q

what tendon transfer would you use for an achilles tendon rupture?

A

FHL transfer

46
Q

what foot indications is a Hibbs tenosuspension for?

A

for flatfoot, metatarsal equinus, cavus foot

47
Q

what is the hibbs tenosuspension procedure?

A

EDL detached distally, combined & transferred to base of 3rd Met or 3rd cuneiform, stumps are anastamosed to EDB

48
Q

what is the Jones tenosuspension indicated for?

A

flexible plantarflexed 1st met

49
Q

what is the Jones tenosuspension procedure?

A

EHL transected at IPJ, rerouted medial to lateral, sutured back on itself, with IPJ arthrodesis

Biomechanics & Surgery Exam 1 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions