Tendon Injury and Tendinopathy: Healing and Repair

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Tendon Injury and Tendinopathy: Healing and Repair에 관한 재미있는 논문

엄청 재미있는 논문이넹

The dry mass of human tendons:30%(Collagen type I: 65~80%, elastin: 2%), water 70%.

참고) tendinopathy와 tendinitis

Tendinitis (informally also tendonitis), meaning inflammation of a tendon (the suffix -itis denotes diseases characterized by inflammation), is a type of tendinopathy often confused with the more common tendinosis, which has similar symptoms but requires different treatment.^[1] The term tendinitis should be reserved for tendon injuries that involve larger-scale acute injuries accompanied by inflammation. Generally tendinitis is referred to by the body part involved, such as Achilles tendinitis (affecting theAchilles tendon), or patellar tendinitis (jumper's knee, affecting the patellar tendon).

Tendon injury arise from a combination of intrinsic and extrinsic factors; acute tendon injuries may be predominantly caused by extrinsic factors, whereas in overuse syndromes as in the case of tendinopathy. it may be caused by multifactorial combinations of both intrinsic and extrinsic factors. An example of an intrinsic factor for tendinopathies are: poor biomechanics such as limb malaligments and hyperpronation that may cause increased traction loads acting on the foot and ankle that may increase the incidence of Achilles, flexor hallucis longus and posterior tibialis tendinopathies. 

The exact etiology of tedinopathies has not been fully elucidated and different stresses may induce varying responses. There are multifactorial theories such as tensile overload, tenocyte related collagen synthesis disruption, tendon load induced ischemia, neural sprouting, and histological adaptive compressive responses seen as some of the causative factors that give rise to activity disruption and disability due to tendinopathies. The most commonly accepted cause for this condition however is seen to be an overuse syndrome in combination with intrinsic and extrinsic factors leading to what may be seen as a progressive interference or the failing of the innate healing response

This article describes the function and structure of tendons, reviews the pathophysiology of tendon injury and the phases of tendon healing, and reviews possible strategies for optimizing tendon healing and repair.

- 이 논문은 힘줄의 구조와 기능에 대해 설명함.

- 힘줄 손상의 병리, 치유과정, 힘줄 치유와 회복을 위한 최적의 전략에 대해서 토의함.

1. 건의 구조(Tendon structure)

The oxygen consumption of tendons and ligaments is 7.5 times lower than that of skeletal muscles.

- 건과 인대는 산소사용량이 근육보다 7.5배가 더 낮음. 

The low metabolic rate and well-developed anaerobic energy-generation capacity are essential to carry loads and maintain tension for long periods, reducing the risk of ischemia and subsequent necrosis. However, a low metabolic rate results in slow healing after injury.

- 힘줄은 대사비율이 낮고, 비산소에너지 능력이 장력을 유지하고 부하를 견디게 하는데 필수임 

- 낮은 대사비율은 손상후 치유과정을 느리게 함. 

Tendon Injury and Tendinopathy. Healing and Repair.pdf

- 힘줄은 2가지 혈액공급을 받음.

- intrinsic system - myotendinous junction and osteotendinous junction

- extrinsic system - paratenon or synovial sheath

- 예를 들어 아킬레스 건은 extrinsic system에서 혈액공급의 35%를 받음. 

- myotendinous junction에서 근육으로부터의 perimysial vessel이 힘줄의 fascicle까지 이어짐. 

A. Tendon structure

•brilliant white in color and have a fibroelastic texture

•tenoblasts & tenocytes(90~95%), chondrocytes, synovial cells of the tendon sheath, and vascular cells(5~10%)

•Tenocytes synthesize collagen and all components of the extracellular matrix network

•With increasing age, metabolic pathways shift from aerobic to more anaerobic energy production.

•산소 소비: tendon & ligaments x 7.5 < skeletal musle

•low metabolic rate and well-developed anaerobic energy-generation capacity ⇛ carry loads and maintain tension for long periods, reducing the risk of ischemia and subsequent necrosis, 그러나,slow healing

•The dry mass of human tendons:30%(Collagen type I: 65~80%, elastin: 2%), water 70%.