Question

Brad was hiking last weekend. he tripped and tore one of the tendons surronding his ankle. he was in a lot of pain and went to urgent care. he asked the doctor how quickly he could expect his ankle to heal. what do you think the doctors response was? explain your answer. HINT: be sure to include the type of tissue tendons are made out of. think about the characteristics of this type of tissue and how they might impact the rate of healing.

Answer 1

TENDON:

A tendon is also known as "sinew" which is a tough band of fibrous connective tissue that usually connects muscle to bone and it is capable of withstanding the tension.they are similar to ligaments; both are made of collagen. Histologically tendons consist os dense regular connective tissue fascicles encased in a dense irregular connective tissue sheaths. normally healthy tendons are composed mostly of parallel arrays of collagen fibres closely packed together. they are anchored to bone by "sharpey's fibres"  

The dry mass of normal tendons, which makes up about 30% of their total mass, is composed of following,

1. 86 % collagen
2. 2 % elastin
3. 1-5 % proteoglycans
4. 0.2 % inorganic components such as, copper, manganese, and calcium

HEALING MECHANISM AND IMPACTS OVER IT:

There are generally three stages of tendon healing, they are ,

• inflammation
• repair or proliferation
• remodelling is sub-divided into two types they are, consolidation and maturation

FIRST STAGE: (INFLAMMATION)

              inflammatory cells such as neutrophils are recruited to the injury site, along with erythrocytes. Monocytes and macrophages are recruited within the first 24 hours, and phagocytosis of necrotic materials at the injury site occurs

SECOND STAGE:(PROLIFERATION)

After the release of vasoactive and chemotactic factors, angiogenesis and the proliferation of tenocytes are initiated. Tenocytes then move into the site and start to synthesize collagen III. After a few days, the repair or proliferation stage begins. In this stage, the tenocytes are involved in the synthesis of large amounts of collagen and proteoglycans at the site of injury, and the levels of GAG and water are high.

THIRD STAGE: (REMODELLING)

Sub-stages are,

CONSOLIDATION: which lasts from about six to ten weeks after the injury. During this time, the synthesis of collagen and GAGs is decreased, and the cellularity is also decreased as the tissue becomes more fibrous as a result of increased production of collagen I and the fibrils become aligned in the direction of mechanical stress.

MATURATION: The final maturation stage occurs after ten weeks, and during this time there is an increase in crosslinking of the collagen fibrils, which causes the tissue to become stiffer.

Gradually, over about one year, the tissue will turn from fibrous to scar-like.

DOCTOR RESPONSE:

• The doctor says that at six weeks patients are usually allowed full weight-bearing out of the cast or boot.
• Physical therapy is started and is aimed at restoring ankle range of motion.
• Strengthening of the calf muscles and Achilles is gradually allowed as the tendon heals.
• Patients are usually able to return to full activity by six months.

So the doctor respond to brad is that the rupture can be healed over 6 weeks upon physical therapy