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ANAT2012 > Ligament & Tendon > Flashcards

Ligament & Tendon Flashcards

1
Q

Tendons & ligaments are what kind of connective tissue?

A

dense, regular

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2
Q

How do the superficial & deep layers differ in both the anterior & posterior longitudinal ligament?

A

the superficial layers span multiple spinal levels whereas the deep only cross adjacent vertebra attaching to the annulus fibrosis

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3
Q

Where are the anterior & posterior longitudinal ligaments thickest?

A

in the thoracic region

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4
Q

Why is the ligamentum flavum so important to posture?

A

it lines the vertebral canal and is under constant tension which prevents the spine from buckling during movement

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5
Q

How many archs do we have underfoot?

A

3 (2 longitudinal & 1 transverse)

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6
Q

What determines the arrangement of the archs?

A

bony arrangement of the foot, plantar ligaments & plantar aponeurosis

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7
Q

What is the purpose of the arch underfoot?

A

shock absorption

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8
Q

What does the ACL resist?

A

anterior tibial translation & rotation

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9
Q

What is the function of a tendon?

A

transmit force from muscle to bone
absorb, store & release energy
power amplification
protect muscle from damage

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10
Q

What are the two predominant energy storing tendons?

A

patellar & achilles

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11
Q

At what percentage of strain do tendons fail? When does an achilles fail?

A

3-8%, achilles up to 12%

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12
Q

How much does the achilles tendon contribute to total body work through energy storage and release during a single leg hopping task?

A

16%

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13
Q

What is buffering of a tendon?

A

a protective feature whereby the tendon lengthens before a muscle during an eccentric contraction

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14
Q

What is amplification (as performed by the achilles during gait)?

A

during stance the Achilles tendon slowly stores and quickly releases energy during push-off to propel to the next step

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15
Q

What is electro-mechanical delay? What affect does stiffness/compliance have on this delay?

A

the delay between the activation of a muscle and its production of force around a joint

a more compliant tendon will have a bigger delay, stiffer will have a smaller delay

this is because it takes more time to take up the slack in a compliant tendon before force around a joint can occur

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16
Q

What is the enthesis? How does it differ from the muscle-tendon junction?

A

the gradual insertion site of the tendon/ligament to bone which allows load transfer between the elastic tendon/ligament and rigid bone

muscle-tendon junction is the abrupt transition from muscle to tendon whereby collagen fibers and muscle cell membrane interdigitate to increase surface area and reduce stress

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17
Q

Name the cells and 3 main components of ECF present in tendons

A

Tenocytes, collagen, elastic & proteoglycans

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18
Q

What collagen types are present in tendons?

A

Type 1 (90%) & type 3 (10%)

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19
Q

Where are there relatively more proteoglycans found within a tendon and why?

A

towards the insertional regions of tendons because that is where tendons are most subjected to compression and the PG’s attract water to resist this compression

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20
Q

Is collagen arrangement linear or variable in ligaments?

A

variable

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21
Q

Describe the tendon hierarchical structure

A

collagen > microfibril > sub-fibril > fibril > fascicle > tendon

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22
Q

Are ligaments & tendons highly vascularised?

A

No- hence slower to recover than muscles

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23
Q

Mechanical behavior of tendons/ligaments depends on what two factors?

A

direction and type of forces (i.e. compressive vs tensile)

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24
Q

What is the difference between ‘stiffness’ & Young’s modulus of a ligament/tendon?

A

stiffness refers to the structural properties of a particular tendon/ligament whereas Young’s modulus refers to the material properties of the actual ligament/tendon material despite its size/shape

25
Q

How much strain do normal physiological movements put on tendons?

A

0-3%

26
Q

At what percentage of strain do most tendon overuse injuries occur?

A

between 3% & 8%

27
Q

At what point of strain do tendons typically fail?

A

8% (Achilles is the exception at 12%)

28
Q

What are some key differences between tendons & ligaments?

A

tendons have a much smaller toe region, stiffer linear region

but mainly:
tendons fail abruptly while ligaments fail progressively

this is due to the alignment of the collagen fibrils which are varied in ligaments & linear in tendons

29
Q

What is creep?

A

when a tissue is constantly loaded the length of that tissue will gradually increase with time (so it has a non-linear recovery)

30
Q

How might creep impact upon joint stability

A

creep within ligaments due to a sustained posture (i.e. bending over) will cause slack in the ligaments and therefore a decrease in stability

31
Q

What is stress-relaxation?

A

if tissue is stretched to a fixed length, over time the force will dissipate

32
Q

What is hysteresis?

A

as a tissue is loaded & unloaded, some energy is lost as heat

33
Q

What kind of injury is more likely from a tendon under a low-loading rate?

A

avulsion fracture

34
Q

What kind of injury is more likely from a tendon under a high-loading rate?

A

mid-substance tear

35
Q

What effect does heat have on the stress-relaxation of tendons/ligaments

A

it will increase the stress-relaxation (at over 40 degrees)

36
Q

Why are adolescents more prone to tendon-bone insertional problems compared to adults?

A

there is an asynchronous maturation of mid-substance and bone-tendon junction so prior to skeletal maturity, tendons are stronger mid-substance than at the bone-tendon junction which makes avulsion fracture more likely than a mid-substance injury

37
Q

What is Sever’s disease?

A

calcaneal apophysitis (irritation of the growth plate at the heel) affecting children 8-11 years, seen in kids with a sudden increase in activity

38
Q

What is Osgood Schlatter disease?

A

tibial tuberosity apophysitis affecting children 11-14 years, seen in children who play alot of sport

39
Q

True or false… tendons are just as good at self-renewal as muscles

A

false

40
Q

Do achilles become more or less stiff with age?

A

less- more compliant

41
Q

Do muscles become more or less stiff as we age?

A

more stiff

42
Q

What factors need to be considered when attempting to increase the stiffness of a tendon with exercise?

A

type/direction of loading (isometric at length, concentric, eccentric & plyometric)
magnitude of loading (needs to induce 3-5% strain in order to see alternations in stiffness without injury)
length of exercise intervention (at least 8 weeks, 14 weeks ideal)

43
Q

What are the 3 grades of ligament injury?

A

Grade 1: damage to some collagen fibres
Grade 2: extensive number of fibres damaged
Grade 3: complete rupture

44
Q

What are the 3 overlapping healing phases of a ligament?

A
  1. Inflammation
  2. Proliferation
  3. Remodelling
45
Q

What mechanical defects are seen in healed ligaments?

A

decreased stiffness, decreased load at failure, failure often seen at midsubstance (as the entire ligament is now weakened)

46
Q

Does the cross section of a ligament increase or decrease during/after healing? What affect does healing have on the laxity?

A

laxity increases despite the CSA increasing

47
Q

How does the different healing capacity of intra-articular & extra-articular ligament injuries influence the treatment choice?

A

extra-articular have a higher healing capacity and are often treated conservatively, intra-articular have a lower healing capacity and are often treated surgically

48
Q

What other injuries are ligament injuries often associated with?

A

bone bruising, OA & instability

49
Q

What are the 5 mechanisms of tendon injury?

A
  1. excessive force
  2. repeated overload
  3. normal forces applied to a weakened tendon (i.e. after a period of immobilisation or detraining)
  4. stress-shielding (where some fibres and overloaded while others are underloaded)
  5. force applied at unusual direction
50
Q

What is paratendinitis?

A

Damage to the tendon sheath from where a tendon rubs over a bony protuberance (i.e. flexor hallicus longus over medial maleolus)

51
Q

What is occuring on a cellular level during an overuse tendinopathy?

A

increased cellularity
hypervascularity
increased proteoglycans & water content
disorganised collagen

52
Q

How does a patellar tendinopathic tendon differ mechanically from a healthy tendon? How about an achilles tendinopathic tendon?

A

patellar tendon gets stiffer while an achilles tendon gets more compliant

53
Q

Why should we immobilise injured tendons/ligaments? What positioning is important with immobilising?

A

allow the inital healing to commence but it must be done under tension to minimise negative affects of immobilisation (decreased stiffness and decreased load to failure)

54
Q

Are midsubstance or insertional injuries slower to recover?

A

insertional

55
Q

How does the anatomy at musculotendinous junctions provide protection against injury?

A

the interdigitation of collagen fibres and muscle cell membrane increase the surface area of the junction allowing load to be distributed better and reduce stress

56
Q

How does the arrangement of collagen fibres within ligaments & tendons differ? How does this relate to the shape of its load-deformation curve?

A

tendon: uniaxial arrangement, results in an abrupt failure
ligament: multiaxial arrangement, results in a progressive failure

57
Q

Describe the changes in ligament cross-sectional area post-rupture

A

collagen alignment is altered, vascularity increases & more cells are present

58
Q

What types of loads are most likely to cause mid-substance tendinopathy vs insertional tendinopathy?

A

insertional: compressive loads

mid-substance: tensile loads

ANAT2012 (10 decks)

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