Alphonsus Chong's Personal Wiki

1. 1700s: John Hunter early work
2. 1940s?: Bunnell – no man's land
3. 1967 ASSH Kleinert's paper (Singh 2015) – clinical before experimental work

1. Structure and function (Leong 2019) - differences between the two may be semantic and degrees

1. 3 phases (Leong 2019)
   1. early – pro-inflammatory cytokines:
      1. “Platelets and cells within the clot release transforming growth factor-β (TGF-β), insulin-like growth factor-I (IGF-I), and platelet-derived growth factor (PDGF), causing local inflammation.21,25” &
      2. “1 TGF‐β is responsible for regulating proteinase activity, stimulating collagen production, and later, recruiting of fibroblasts.21,22,27 Similarly, IGF‐I functions to stimulate ECM production and recruit fibroblasts to the area28,29 and, PDGF enhances DNA and protein synthesis, and therefore the expression of other growth factors.21 These factors work synergistically to initiate the healing process” (Leong 2019)
      3. “While most vascularized tendons and ligaments have at least some capacity to heal and the ability to form scar that gets remodeled over time, avascular tendon such as the rotator cuff and intra‐articular ligaments generally do not have healing capacity”
2. extrinsic and intrinsic: TSPC (see Bi 2007 quoted in Leong 2019)
3. M1 and M2 macrophages
4. extrinsic –> adhesions
5. exercise increases tendon strength, immobilization decreases; rest is important
6. aging reduces strength, size, and increases risk of rupture

1. suture type, size
2. technique of repair
3. surgical handling
4. gapping at repair site – Gelbermann's work on rupture; Silverskoild's - may not affect outcome

1. important –> Move to active
2. Both motion and tension (Kubota in Singh 2015)

Singh 2015:

Current data suggests good or excellent outcomes in over 75% of flexor tendon repairs.54 Rupture occurs in 4-10% of finger flexor repairs and 4-17% of long thumb flexor repairs.54 Modern tissue engineering approaches and focused rehabilitation protocols are the future avenues for further improving recovery.

• . Singh, R., Rymer, B., Theobald, P., & Thomas, P. B. M. (2015). A review of current concepts in flexor tendon repair: Physiology, biomechanics, surgical technique and rehabilitation. Orthopedic Reviews, 7(4). https://doi.org/10.4081/or.2015.6125
• Leong, N. L., Kator, J. L., Clemens, T. L., James, A., Enamoto‐Iwamoto, M., & Jiang, J. (2020). Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration. Journal of Orthopaedic Research, 38(1), 7–12. https://doi.org/10.1002/jor.24475

1. created: 2021-04-11