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Tendon and Ligament Injury and Healing - Coggle Diagram
Tendon and Ligament Injury and Healing
definitions
ligament
collagenous tissue uniting 2 or more bones
tendon
collagenous tissue uniting muscle to mucle/cartiledge/bone
sprain
types
2nd degree
partial tear
gross evidence of swelling, hemorrhage
3rd degree
complete tear w/ extensive edema and hematoma
avulsion
point of origin/insert pulls off bone
1st degree
minimal tearing
histologic evidence of swelling/hemorrhage
injury of ligament causing some degree of damage to the ligament fibers or their attachments
strain
injury to muscle-tendon unit
factors influencing healing
healing acros gap
less than <1mm gap is ideal
13m gap increases risk of failure
mobilization vs immobilization
etiology
location of injury
infection or foreign bodies
patient
age
nutritional disease
disease status
drugs/radiation
history
traumatic injury vs ligament disease
high vs low E injury
acute vs chronic onset
subtle vs non-weight bearing lamess
consistent vs intermittent lameness
indoors or outdoors
postop care
concurrent disease
cushing's
diabetes
immune mediated disease
stages of healing
wounding
day 0-1
hemorrhage
cleans wound
brings in undifferentiated cells
vasoconstruction leads to clot formation
wound contraction occurs; increased by blunt injury
inflammatory phase
days 0-5
vascular and cellular response
clean wound
brings
inflammatory cells
inflammatory mediators
fibroblastic phase
days 1-14+
won't occur until
inflammatory phase has eliminated contamination
vascular walls are no longer permeable
rapid increase in wound strength
fibroblastis arise from mesenchymal cells
production of ground substance and types 1-III collagen
remodeling
weeks 2-52
collagen x-linking
collagen type III predominating
more embryonic
elastic
50% of strength at 6w
80-90% strength at 1y
PE findings
patient health
neuro status
mechanical vs. painful lameness
swelling
effusion = acute
thickening = chronic
range of motion
characterize muscle atrophy
mild, moderate, severe
generalized, geriatric, neurogenic
unilateral or bilateral
diagnostics
ortho exam
plain and stress radiograph
contrast radiography
ultrasound
MRI/CT
nuclear scintigraphy
treatment options
secondary reconstruction
primary reconstruction
suture material
sutures break in LA
monofilament, non-absorbable, PDS 0 2-0
some surgeons prefer braided for strength
pattern
three loop pulley
locking loop
avoid gap
injury location
good for
common calcaneon tendon
anatomy
mdial and lateral gastrocnemius tendons
superficial digital flexor tendon
common tendon of biceps femoris
gracilis
semitendinosus m
traumatic
complete tear = hyperflexion at hock
flexion of digits if superficial digital flexor intact
traumatic or disease
Dobermans, Laboradors
chronic inflammatory condition
triceps tendon
patellar ligament
collaterals near elbow
poor for
cranial cruciate ligament tears
ligament of head femur
collaterals near knee
postop management
tendon/ligament repairs
weak
take months to regain strength
need add'tl suport
sling. splint
8w exercise restriction
nonsurgical management
component of postop management
post-restriction physical therapy
8w immobilization
cartiledge injury
bandage sores, delayed recovery
rigid vs non-weight bearing sling
8w exercise restriction
poor results with 3rd degree injury
hip and elbow luxations
best for 1st degree
stopped at slide 27