The Process of Tendon Repair

Mason, Michael L.

doi:10.1001/archsurg.1932.01160220003001

Cited by 110 publications

(11 citation statements)

References 7 publications

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“…Viering19 was the first to demonstrate that tendon healing was influenced by motion of the tendon. He reported that fibers of the repaired tendon lined up in a row parallel to the line of pull.…”

Section: Discussionmentioning

confidence: 99%

Outcome of early active mobilization after extensor tendon repair

Saini

Sharma

et al. 2008

Indian J Orthop

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Background:Traditionally the repaired extensor tendons have been treated postoperatively in static splints for several weeks, leading to formation of adhesions and prolonged rehabilitation. Early mobilization using dynamic splints is common, but associated with many shortcomings. We attempted to study the results of early active mobilization, using a simple static splint, and easy-to-follow rehabilitation plan.Materials and Methods:In a prospective study 26 cases of cut extensor tendons in Zone V to VIII were treated with primary or delayed primary repair. Following this, early active mobilization was undertaken, using an easy-to-follow rehabilitation plan. The results were assessed according to the criteria of Dargan at six weeks and one year.Results:All the 26 patients were followed up for one year. 20 out of 26 patients were below 30 years of age, involving the dominant hand more commonly (16 patients, 62%). Agriculture instruments were the most common mode of injury (13 patients, 50%). The common site for injury was extensor zone VI (42%, n = 11).Conclusion:Rehabilitation done for repaired extensor tendon injuries by active mobilization plan using a simple static splint has shown good results.

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Section: Discussionmentioning

confidence: 99%

Outcome of early active mobilization after extensor tendon repair

Saini

Sharma

et al. 2008

Indian J Orthop

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“…Earlier workers, notably Flynn & Graham (1962), from experimental work carried out on extensor tendons, suggested that active invasion of a free graft by tenoblasts occurred from the extremities and that the graft merely acted as a scaffolding whilst the invasion took place. Mason & Shearon (1932) He also observed that the proliferation of the synovial layer of the sheath that took place at the proximal and distal extremities of the digital sheath sealed it off and restored its structure as a closed tube. Adhesions immediately beyond the wound site only occurred where the integrity of the tendon surface had been broken by sutures.…”

Section: Blood Supplymentioning

confidence: 98%

Problems of restoration of tendon movements after repair and grafts

M¹

1970

Plastic and Reconstructive Surgery

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Repair of flexor tendons by direct suture or tendon graft is not a difficult operation but, unlike most operations on the hand, the results are frequently unpredictable.The commonest cause of failure is adhesion formation at the site of tendon suturing or grafting. This results in very little, if any, movement of the finger occurring on voluntary contraction. Worse still, a previously mobile digit may be converted into a semi-rigid hook.The prevention of adhesions has taxed the ingenuity of the hand surgeon for many years and has resulted in a host of operative and some nonoperative measures designed to counteract this tendency.In spite of the excellent experimental work studies that have been done on tendon healing by such men as Mason & Allen (1941), Potenza (1964 and others, we seem to disbelieve, distrust or simply disregard the implications of their work. Tendon RepairIt has been shown conclusively that when tendon ends are apposed by suture the healing process takes place from without inwards. The tendon itself has a purely passive role. From the neighbouring tissues there is an ingrowth of fibroblast and capillary buds resulting in the laying down of delicate new collagen fibres. There is no evidence of tenoblastic activity in the stumps. The anatomical environment of a damaged tendon contributes significantly to the process of repair.There can be no justification for surrounding a tendon junction by a permeable or semipermeable membrane in order to prevent adhesions. Adhesions must occur for a while at any rate if the tendon is to heal.When healing has occurred and mobilization starts, in the normal course of events adhesions gradually disappear as the full range of movement develops. The range of movement of a tendon before adhesions have disappeared will, therefore, depend to a certain extent on its anatomical surroundings. Thus, repair at the level of the wrist or in the palm of the hand poses no great problems but the confines of the carpal tunnel and the digital sheath can and do impose restriction of movement. The tendon graft in the finger and the 'bridge graft' in the carpal tunnel were evolved to overcome this anatomical difficulty. Blood SupplyThe blood supply of a flexor tendon is extremely limited and there seems little doubt that part of a tendon's nourishment is derived from the synovial fluid that bathes it. The blood supply of a profundus tendon varies throughout its length. It is richest at the musculotendinous junction, at its insertion and where the vincula join it in the sheath. The level of section may therefore influence healing, depending on the relative vascularity of the stumps. An avascular stump encourages adhesions during attempted revascularization.Flexor pollicis longus has no vincular attachments throughout its length, so it must be as-I 67

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“…Exclusive and true regeneration from the tendon proper (i.e. the tenocytes) is suggested in older studies (see Hesse 1932 andShearon 1932). Thomson 1960 andFlynn &Graham 1965 state that fibroblasts can be derived from both endotenon, paratenon, including the sheath, and the tendon proper.…”

Section: Cellular Reactionmentioning

confidence: 98%

“…The nature of the processes underlying tendon healing is far from understood. For exellent literature surveys in this field up to 1932 the reader is referred to Hesse 1932 andShearon 1932. Part of the differences of opinion among the authors can be ascribed to the difficulties in interpreting a truly dynamic function with the aid of snapshots (for instance in the form of histological preparations). Tendon healing might also be species specific or even differ between tendons in different parts of the body of the same species (Lipscomb & Wakim 1961).…”

Section: The Healing Tendonmentioning

confidence: 99%