Injury and Healing- Soft Tissue Flashcards
What are the similarities between ligaments and tendons?
Both soft tissue structures
Both are made up of type I collagen
What are ligaments?
Ligaments – connect bone to bone
Restricts joint motion
Stability and proprioception
What are tendons?
Tendons – connect muscle to bone
Transmits forces
What are possible reasons for ligament and tendon injuries?
Sports related
Pivoting forces
Eccentric contraction
Trauma
Laceration
Avulsion injury
How is the severity of ligament and tendon injuries meeasured?
Severity will vary
Grade I – Slight incomplete tear – no notable joint instability
Grade II – Moderate / Severe Incomplete Tear – Some joint instability. One ligament may be completely torn
Grade III – complete tearing of 1 or more ligaments – Obvious instability. Surgery may be required
What is the tissue repair timeline?
What are the stages of healing of tendons and ligaments?
Bleeding
Inflammation
Proliferation
Re-modelling
How long is healing of tendons and ligament?
A longer process
Maximum strength recovery at >6 months
May never fully recover full tensile strength
Healing is not predictable
What is the ACL?
anterior cruciate ligament
Describe the knee’s anatomy.
Bones
Muscles
Ligaments
Cartilage
What is the role of the ACL?
one of the two cruciate ligaments which stabilizes the knee joint by preventing excessive forward movements of the tibia or limiting rotational knee movements
What symptoms might a patient complain of if they have a complete rupture of the ACL?
difficulty running- knee feels unstable “it gives way”
What examination tests can you do to test the rupture of the ACL?
Pivot shift
Anterior drawer test
Lachmann’s test
What is the Lachmann’s test?
An examination
the knee/ tibia should not move up and down as much
The Lachman test is a clinical test used to diagnose injury of the anterior cruciate ligament. It is recognized as reliable, sensitive, and usually superior to the anterior drawer test.
What is the anterior drawer test?
The drawer test is used in the initial clinical assessment of suspected rupture of the cruciate ligaments in the knee. The patient should be supine with the hips flexed to 45 degrees, the knees flexed to 90 degrees and the feet flat on table
What is the pivot shift?
The pivot-shift test is one of the three major tests for assessing anterior cruciate injury or laxity, the other two being the anterior drawer and Lachman test. However, unlike the other two, it tests for instability, an important determinant as to how the knee will function
With an ACL injury if pivoting on knee you can damage other structures like cartilage and meniscus
What is the long and short term management of ruptures?
Protect
Rest
Ice
Compress
Elevate
What are the ways to manage an ACL tear?
Operative and non-operative
Operative= repair or replace
Non-operative= brace
ACL does not heal well (unstable knee)
But some muscles can compensate in some cases
- pre-habilitation
- rehabilitation
What must you consider when considering the management of ruptures?
Functional demands of the patient
Patient factors
Compliance
What is healing dependendent on?
Mechanical environment and biological environment
Mechanical= movement, forces
Biological= blood supply, immune function, infection, nutrition
What must you consider with ACL injury?
Age?
Symptoms: pain or giving way?
- instability
- locking
Activity level?
Has physio been tried?
Other structures involved?
- meniscus
Indications for ACL reconstruction
Graft choice
- autograft= hamstring or patellar tendon
- allograft
- synthetic
What is the most likely tear in the ankle?
achilles
Describe the anatomy of the ankle?
What are risk factors for tears?
30s-50s
Male
Anabolic steroid use
Antibiotics e.g., fluoroquinolone
Weekend warrior (only partakes in activity in their free time)
What would be examination findings for a tear in the achilles?
Difficulty walking / limp.
Unable to perform heel raises (stand on tiptoes)
Thickening, tenderness and swelling on the affected side
When prone with feet off the end of couch the affected side is held in dorsiflexion
What test can be done to check the achilles tear?
Simmonds calf squeeze test
What are the options for management of achilles tear/ rupture?
Operative vs Non operative
Casting Vs Functional Bracing
Open vs percutaneous (through skin)
What is special about the achilles?
It is the biggest and thickest tendon
Who is in the patient’s multidisciplinary team if they have a ligament or tendon issue?
What must you consider for the management of patient with tear?
Functional demands
Patient factors e.g., diabetic, immunocompromised
Injury factors
- based on USS/ MRI
- Acute/ chronic
What are possible operation complications?
General (early or late):
DVT (deep vein thrombosis)
Infection
Prolonged immobility (UTI, chest infections, sores)
Specific:
Neurovascular injury Sural nerve
Tendon re-rupture
Local infection
Ankle stiffness
Pressure sores from plaster or boot Reduced Strength
What are the types of management options?
Operative
Non- operative
Rehabilitation
What are the operative options?
Open vs Percutaneous
Primary repair
Augmentation of repair
What are the non-operative options?
Functional Bracing in Equinus
Gradual removal of wedges to plantigrade
What are the rehabilitative options?
Range of motion
Strength
Proprioception
