The vasculature and its role in the damaged and healing tendon

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Abstract

Tendon pathology has many manifestations, from spontaneous rupture to chronic tendinitis or tendinosis; the etiology and pathology of each are very different, and poorly understood. Tendon is a comparatively poorly vascularised tissue that relies heavily upon synovial fluid diffusion to provide nutrition. During tendon injury, as with damage to any tissue, there is a requirement for cell infiltration from the blood system to provide the necessary reparative factors for tissue healing. We describe in this review the response of the vasculature to tendon damage in a number of forms, and how and when the revascularisation or neovascularisation process occurs. We also include a section on the revascularisation of tendon during its use as a tendon graft in both ligament reconstruction and tendon–tendon grafting.

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Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions.

E Grood, Aodhán Butler, Frank R. Noyes … (1984)

Virtually all types of collagenous tissues have been transferred in and around the knee joint for intra-articular and extra-articular ligament reconstructions. However, the mechanical properties (in particular, strength) of such grafts have not been determined in tissues from young adult donors, where age and disuse-related effects have been excluded. To provide this information, we subjected ligament graft tissues to high-strain-rate failure tests to determine their strength and elongation properties. The results were compared with the mechanical properties of anterior cruciate ligaments from a similar young-adult donor population. The study indicated that some graft tissues used in ligament reconstructions are markedly weak and therefore are at risk for elongation and failure at low forces. Grafts utilizing prepatellar retinacular tissues (as in certain anterior-cruciate reconstructions) and others in which a somewhat narrow width of fascia lata or distal iliotibial tract is utilized are included in this at-risk group. Wider grafts from the iliotibial tract or fascia lata would of course proportionally increase ultimate strength. The semitendinosus and gracilis tendons are stronger, having 70 and 49 per cent, respectively, of the initial strength of anterior cruciate ligaments. The bone-patellar tendon-bone graft (fourteen to fifteen millimeters wide, medial or central portion) was the strongest, with a mean strength of 159 to 168 per cent of that of anterior cruciate ligaments. Patellar tendon-bone units, based on grip-to-grip motions, were found to be three to four times stiffer than similarly gripped anterior cruciate ligaments, while gracilis and semitendinosus tendon preparations had values that were nearly identical to those of anterior cruciate ligaments.(ABSTRACT TRUNCATED AT 250 WORDS)