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5 Tendon Healing and Repair Anatomy Tendons made of dense, metabolically active connective tissue Collagen bundles arranged in regular spiralling fashion Most Type 3 small amount Type 1 Few cells Tenocytes, synovial cells, fibroblasts Endotenon surrounds tendon, lie in synovial sheaths aratenon loose adventitial layer that surrounds tendons !"T#$%E synovial sheaths&

Zones of flexor tendon injury (Verdan) 'one 1 distal to F%# insertion 'one ( pro)imal tendon sheath F%# 'one 3 fle)or sheath fle)or retinaculum 'one * under fle)or retinaculum 'one + pro)imal to retinaculum 'one ( ,no mans land- . /unnell poor results of repair& Zones of Extensors 'one 1 %$ 0 'one ( Middle phalan) 'one 3 $ 0 'one * ro) phalan) 'one + MC 0 'one 1 between MC 0 and e)t retinaculum 'one 2 under e)t ret 'one 3 between e)t ret and musculotendinous 4unction e!"anism of tendon "ealing Extrinsi! "ealing %epends on fibrous attachments forming between the tendon sheath and the tendon 5istorically believed to be only method immobilisation protocols #ntrinsi! "ealing %epends on blood flow through long and short vinculae 6 diffusion from synovial fluid 7unborg tendons heal if placed in semipermeable membrane to stop cells but allow passage of nutrients& ost op routine can therefore include movement& $"ases of tendon "ealing $nflammation (83 days, inflammatory cells infiltrate wound, secrete growth factors which attract fibroblasts& roliferation 3 days 3 wee9s fibroblasts manufacture and secrete collagen and :;:s Collagen initially randomly arranged and lac9s tensile strength <emodelling 3 wee9s6 collagen homestasis =net amount stays the same>& Collagen organised&

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Early mobilisation limits the formation of fibrous attachments with sheath, promotes intrinsic not e)trinsic healing& Tendons are stronger than e)trinsically healed ones&

$rin!iples of tendon repair % Re"a&ilitation after repair #ee 1(&3&( 5and Therapy

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