SLIDE 1
Tendon Structure and Healing
Philip Holland Consultant Shoulder and Elbow Surgeon South Tees Hospitals
Tendons
- Attach muscle to bone
- Transmits tensile force
- Enable muscle to be optimally positioned
- Store energy
Tendon Structure and Healing Philip Holland Consultant Shoulder - - PowerPoint PPT Presentation
Tendon Structure and Healing Philip Holland Consultant Shoulder - - PowerPoint PPT Presentation
Tendon Structure and Healing Philip Holland Consultant Shoulder and Elbow Surgeon South Tees Hospitals Tendons Attach muscle to bone Transmits tensile force Enable muscle to be optimally positioned Store energy Macroscopic
SLIDE 2
SLIDE 3
Macroscopic Structure
- Two types of tendon:
- Lubricated tendons in synovial sheaths
- Thick paratenon surrounded tendons
SLIDE 4
Blood supply
- Blood supply from muscle insertion
- Paratenon covered tendons
- Paratenon blood supply
- Sheathed tendons - avascular
- Venicuar blood supply
- Nutrition by diffusion
SLIDE 5
Tendon Healing
- Synovial fluid surrounded tendon
- Direct intrinsic healing
- Paratenon surrounded tendons
- Phase 1 inflammatory (hrs) haematoma, polymorphs and
macrophages
- Phase 2 proliferative (weeks) neovascularisation and fibroblasts
(III collagen)
SLIDE 6
Microscopic Structure
- Cells 20% volume
- Mesenchymal stem cell
- Tenocytes
- Fibroblasts
- Extracellular matrix 80% volume
- Elastin
- Collagen
- Ground substance
SLIDE 7
Collagen
- Type 1 collagen 90%
- Type 3 collagen <10%
- Protein structure
SLIDE 8
Collagen
- Primary structure - three amino acid chains
- Secondary structure - left handed helix
- Tertiary structure - right handed triple helix
- Quarternary structure - quarter staggered array
SLIDE 9
Ground Substance
- Hydrophilic spacers
- Proteoglycans
- Glycoproteins
SLIDE 10
Ground Substance
- Proteoglycan
SLIDE 11
Tendon Properties
- Stress
- Strain
- Viscoelastic
SLIDE 12
Tendon Properties
- Stress = force / area
- Strain = change in length / original length
- Viscoelastic = time dependent properties
SLIDE 13
Stress Strain Curve
SLIDE 14
Tendon Properties Viscoelasticity
- Creep
- Stress Relaxation
- Hysteresis
SLIDE 15
Tendon Properties Viscoelasticity
- Creep
SLIDE 16
Tendon Properties Viscoelasticity
- Stress Relaxation
Strain Stress
SLIDE 17
Tendon Properties Viscoelasticity
- Hysteresis
SLIDE 18
Conclusion
- Tendons
- 80% extracellular matrix
- 20% cells
- Blood supply
- Paratenon
- Veniculi and diffusion
SLIDE 19
Conclusion
- Draw a proteoglycan
- Draw stress strain curve
SLIDE 20