SOFT TISSUES: TENDON, LIGAMENT & CARTILAGE PATHO

Question 1

Acute injury of tendon, cartilage & ligament

Answer 1

Tendon: tear & rupture
Cartilage: osteochondral lesion & acute tear
Ligament: tear (grade I-III)

Question 2

Overuse injuries of tendon, cartilage & ligament

Answer 2

Tendon: tendinopathy
Cartilage: chondropathy, degenerative tear
Ligament: inflammation

Question 3

Overuse tendon injuries: name, ≠ types, most common, tendon cells

Answer 3

• Tendinopathy
• Paratendinitis, tenosynovitis, tendinosis, tendinitis
  «itis» = inflammatory
• tendinosis
• mechanoresponsive

Question 4

Acute tendon injuries: 3 ≠ parts & characteristics

Answer 4

Inflammation: increase vascularisation, platelets, neutrophils, monocytes, erythrocytes, mesenchymal stem cells & growth factors / swelling

Proliferation = repair: increase extra cellular matrix production, collagen III production, tenoblast activity, proliferation of nerve cells & blood vessel

Consolidation = remodeling: decrease ECM production, collagen III production / increase collagen I production

Question 5

Tendon morphology: connection & characteristics

Answer 5

• connects muscle to bone, skin , fascia, eyes & subcutaneous tissue
• aneural & avascular
• stretch up 4% of normal length

Question 6

Biomechanical behavior

Answer 6

Schema

Question 7

Relation pain, structure & fct: pain / patho / poor fct / patho + poor fct / pain + patho + poor fct

Answer 7

Pain : imaging normal painful tendon, rare & differential diagnosis
Pathology: degenerative non painful tendon with good function, can rupture
Poor function: unload tendon with low capacity, susceptible to overload resulting in pathology pain
Patho + poor fct: degenerative non painful tendon with poor function, can rupture
Pathology + poor fct + pain: patho & pain with loss of fct

Question 8

Clinical presentation of tendinopathies

Answer 8

• pain after exo or in morning
• warm up phenomenon : pain disappear after warm up, returning after exo
• able to train during early stages
• local tenderness & thickening present
• crepitation present

Question 9

Model of continuum tendon pathology: def, schema & def of component

Answer 9

Models uses 3 ≠ stages to explain cascades of events leading to tendinopathy

Schema

LOAD: key factor in model representing primary stimulus driving tendon forward or back along continuum

REACTIVE TENDINOPATHY: short term adaptation, tendon becomes thicker & reduce stress, tendon revert to normal if overload reduced & sufficient time between loading sessions

TENDON DYSREPAIR: attempt of tendon healing with ECM breakdown, cell proliferation resulting in disorganized ECM, nerve & vessels in growth

DEGENERATIVE TENDINOPATHY: areas of apoptosis, large areas of ECM disorganized, large vessels present, heterogenous structure of tendon, focal nodular areas, high risk factor for tendon rupture, often leads to surgery

Question 10

Patho & healing of ligaments

Answer 10

• Tightly packed bundles of collagen
• Bone-to-bone (across joints) to resist tensile forces, provide stability or cartilage-to-bone or cartilage-to-cartilage
• Biomechanical behavior under load similar to tendon * Crimped fibers
• Stiffness increases has strain increases
• Histological characteristics similar to tendons
• Mostly type I collagen
• Blood vessels & nerve endings located in epiligament (outer layer)
• Ligament function differs from the tendon

Question 11

Acute ligament injuries: grading

Answer 11

Grade I: minor nb of fiber affected, minimal tenderness on palpation, minimal swelling, normal endfeel, minimal fct deficit

Grade II: disruption considérable nb of fibers, significant tenderness on palpation, significant swelling, increased laxity but end point present, moderate fct deficit

Grade III: complete disruption of all fibers, immediate painful but pain reduce quickly afterwards, immediate & significant swelling, abnormal ROM no clear end point, significant fct deficit

Question 12

Sprains / tear of ligaments

Answer 12

Related to traumatic events
Classified in grade I to III depending on severity
Grade I & II treated conservatively
Grade III require surgery, in conservative treatment = option

Question 13

Ligament healing: ≠ phases & characteristics & duration to return to sport

Answer 13

INFLAMMATION: 48-72h: haemorrhage, clotting, swelling, increase growth factors, neutrophils, monocytes, mesenchymal stem cells

PROLIFERATION: repair: 4-8 weeks: increase fibroblasts, proteoglycans, glycoprotein, collagen III, ECM turnover, scar tissue formed

CONSOLIDATION: remodeling: months-years: decrease ECM turnover, collagen III & increase collagen I, remodeling of scar tissue

Return to sport: 3-6 weeks in mild injuries & 8-12 weeks in moderate to severe injuries

Question 14

Fct of cartilage

Answer 14

Increase surface of contact between bones
Provides joint stability
Promote joint lubrication
Contributes to shock absorption
Provides smoother surface for joint
Facilitates joint gliding
Facilitates absorption & distribution of load

Question 15

Acute injuries of articular cartilage: characteristics, most common sites, risk factors, limits

Answer 15

Result of acute trauma
Chondral injuries
Osteochondral injuries
Classified according to depth & size of injury
Difficult to diagnose not visible in X-ray
MRI necessary
Be caution when simple joint sprains to be painful & swollen for long period

Femur condyles, talus & patella

Early osteoarthritis

Limited repair & regeneration capacity, poor vascularisation

Question 16

≠ types of cartilage

Answer 16

Fibrous cartilage
Hyaline cartilage
Elastic cartilage

Question 17

Tears of knee menisci: signs & symptoms, healing

Answer 17

Pain & Time of injury, swelling, popping/locking sound, loss of fct, decrease ROM & joint stability

Healing depend on blood supply, occurs by migration of cells from synovial membrane