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PTH9111 Test 2 > Lecture 28 - Tendon and Ligament > Flashcards

Lecture 28 - Tendon and Ligament Flashcards

1
Q

Ligament

A

Connect bone to bone

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2
Q

3 functions of a ligament

A

1) Hold skeleton together
2) Provide stability to joints
3) Limit freedom of movement

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3
Q

What are the 2 structural components of ligaments

A

1) Cells
2) ECM composed of Type I collagen and elastin

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4
Q

T or F: Type I collagen fibrils are densely packed in ligaments

A

T

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5
Q

What are 2 methods of attachment for ligaments

A

1) Direct: Fibers attach directly to bone
2) Indirect: Ligaments attach to superficial (blend into periosteum) or deep fibers (attach directly to bone)

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6
Q

Do ligaments have blood supply

A

Yes, but vascularization varies by ligament

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7
Q

What are the 2 types of nerves that innervate ligaments

A

1) Mechanoreceptors
2) Pain

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8
Q

Stress strain curve of a ligament

A
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9
Q

What are the 3 grades of ligament sprains

A
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10
Q

4 phases of ligament injury healing

A
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11
Q

What are 4 structural changes that occur to ligaments after healing

A

1) Altered proteoglycan and ratio of collagen fiber types
2) Failure of collagen cross-link maturation
3) Persistence of small collagen fibril size
4) Abnormal innervation

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12
Q

What 4 factors effect ligament healing

A

1) Grade of injury (size of gap)
2) If the injury was isolated (heals better)
3) Type of ligament as some heal better than others due to different vasculature
4) Whether contact was made between ligament ends (ACL vs MCL injury)

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13
Q

What are the 2 phases of healing with a patellar tendon graft following an ACL reconstruction and describe them

A

1) Intra-articular healing: Necrosis, vascularization, cell proliferation, collagen formation, and remodeling and maturation occur
2) Bone to tendon healing within the bone tunnel: Bone plugs to bone tunnel and tendon to bone tunnel form

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14
Q

Tendon

A

Connect muscle to bone

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15
Q

What are 2 functions of tendons

A

1) Force transmission between muscle and bone
2) Energy storage

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16
Q

What 3 cells make up the tendon and their function

A

1) Tenoblasts: Immature tenocytes
2) Tenocytes: Synthesize collagen and all components of ECM
3) Chondrocytes: At bone insertion

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17
Q

What are the 2 components of the ECM of tendons and what is found within these components

A
  1. Fibrillar Component: Type I and III collagen, elastin
  2. Interfibrillar Component: Proteoglycans, glycosaminoglycans
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18
Q

Glycosaminoglycans function

A

Allows for greater tensile loading

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19
Q

What is the hieararical order of tendons

A

1) Endotenon
2) Epitenon
3) Paratenon
4) Synovial tendon sheaths

20
Q

Endotenon

A

Covers primary, secondary and tertiary fibre bundles

21
Q

Epitenon

A

Loose connective tissue sheath that covers whole tendon and contains vascular, lymphatic and nerve supply to tendon

22
Q

Paratenon

A

Loose connective tissue that consists of type I and III collagen, and elastin that acts as an inner lining for synovial tissue

23
Q

Synovial Tendon Sheath

A

Found in areas of increased mechanical stress because it provides lubrication to reduce friction

24
Q

What are 2 points of attachment for tendons

A

1) Bones: Can be direct (bone) or indirect (periosteal)
2) Muscle: Blending of collagen fibers and muscle cells

25
Q

Where is the structurally weakest site mechanically for the muscle-tendon unit

A

Where the muscle attaches to tendon

26
Q

What is the consequence of tendons having a low metabolic rate

A

They heal slower with injury

27
Q

T or F: Tendons have vasculature in all 4 of its layers

A

T

28
Q

Where would we find reduced blood flow in tendons

A

Around bony prominences

29
Q

Where can we find tendons that have hypovascularity

A

1) Supraspinatus
2) Achlles tendon

30
Q

What are 3 types of mechanoreceptors for tendons and their function

A

1) Pacinian corpuscles: pressure and vibration
2) Ruffini endings: stretch
3) GTO: pressure and tension (at insertion of tendons into muscles)

31
Q

Tensile strength of tendons is related to

A

thickness and collagen content

32
Q

T or F: Strenuous activities place high demand on tendon, with eccentric contractions generating the highest force on a tendon

A

T

33
Q

Stress-strain curve for a tendon

A
34
Q

What are 2 types of tendon injury and how they occur

A

1) Tendon rupture: laceration, degeneration
2) Tendinopathy: overuse

35
Q

What are the 4 phases of healing for a tendon injury

A
36
Q

For a quadriceps tendon tear describe how and where it occurs and its signs/symptoms

A
37
Q

Treatment of a quadriceps tendon tear depends on what 3 factors

A
  1. Size of tear
    2) Activity level
    3) Age of individual
38
Q

When would we do surgical treatment vs conservative treatment for quadriceps tenon tear

A

Surgical: Complete tear
Conservative: Partial tear

39
Q

T or F: A quadriceps tendon tear results in a 50% decrease in weakness of the quad

A

T

40
Q

T or F: After remodeling, biomechanical and mechanical properties always return back to normal

A

F, the tendon tissue nerve matches intact tendon tissue

41
Q

What is a common site for a chronic tendon rupture

A

Supraspinatus

42
Q

What are 3 irreversible changes of a tendon rupture on muscle tissue

A

1) Atrophy
2) fatty infiltration
3) Loss of muscle strength

43
Q

Describe surgical repair effects on a tendon rupture

A

Tendon to bone healing does not result in normal tendon-bone insertion site and frequent re-separation occurs that can fill in with scar tissue causing loss of function

44
Q

What are 3 terms that are used to describe overused tendons

A
  1. Tendinopathy: Tendon overuse
  2. Tendinosis: Describes the extracellular matrix imbalances in tendinopathy
  3. Tendinitis/Tendonitis: Inflammatory condition
45
Q

What are 3 age-related changes that affect tendon and ligament tissue

A
  1. Loss of water content from matrix reduces ROM
    2) Increased cross-linking increases stiffness and reduces ROM
  2. Loss of elastic fibers cause less give to tendons and ligaments
46
Q

What are 4 effects of immobilization of ligaments and tendons

A

1) Decreased collagen content
2) Decreased cross-linking of collagen making weaker biomechanically
3) Subperiosteal bone resorption at ligament insertion site
4) Decrease in tensile strength of ligament

47
Q

What are 3 effects of exercise on tendons and ligaments

A

1) Increased collagen concentration and cross linking resulting in increase tensile strength and stiffness
2) Tendon hypertrophy from chronic increased loading
3) Structural and mechanical changes

PTH9111 Test 2 (16 decks)

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