Tendon
Encyclopedia
A tendon is a tough band of fibrous connective tissue that usually connects muscle
to bone
and is capable of withstanding tension. Tendons are similar to ligament
s and fasciae
as they are all made of collagen except that ligaments join one bone to another bone, and fasciae connect muscles to other muscles. Tendons and muscles work together.
arrays of collagen
fibers closely packed together. The dry mass of normal tendons, which makes up about 30% of the total mass with water, is composed of about 86% collagen, 2% elastin
, 1–5% proteoglycans, and 0.2% inorganic components such as copper
, manganese
, and calcium
. The collagen portion is made up of 97-98% type I collagen, with small amounts of other types of collagen. These include type II collagen in the cartilaginous zones, type III collagen in the reticulin fibres of the vascular walls, type IX collagen, type IV collagen in the basement membranes of the capillaries, type V collagen in the vascular walls, and type X collagen in the mineralized fibrocartilage near the interface with the bone. Collagen fibres coalesce into macroaggregates. After secretion from the cell, the terminal peptides are cleaved by procollagen N- and C-proteinases, and the tropocollagen molecules spontaneously assemble into insoluble fibrils. A collagen molecule is about 300 nm long and 1-2 nm wide, and the diameter of the fibrils that are formed can range from 50-500 nm. In tendons, the fibrils then assemble further to form fascicles, which are about 10 mm in length with a diameter of 50-300 μm, and finally into a tendon fibre with a diameter of 100-500 μm. Groups of fascicles are bounded by the epitendon and peritendon to form the tendon organ.
The collagen in tendons are held together with proteoglycan components, including decorin
and, in compressed regions of tendon, aggrecan
, which are capable of binding to the collagen fibrils at specific locations. The proteoglycans are interwoven with the collagen fibrils - their glycosaminoglycan
(GAG) side chains have multiple interactions with the surface of the fibrils - showing that the proteoglycans are important structurally in the interconnection of the fibrils. The major GAG components of the tendon are dermatan sulfate
and chondroitin sulfate
, which associate with collagen and are involved in the fibril assembly process during tendon development. Dermatan sulfate is thought to be responsible for forming associations between fibrils, while chondroitin sulfate is thought to be more involved with occupying volume between the fibrils to keep them separated and help withstand deformation. The dermatan sulfate side chains of decorin aggregate in solution, and this behavior can assist with the assembly of the collagen fibrils. When decorin molecules are bound to a collagen fibril, their dermatan sulfate chains may extend and associate with other dermatan sulfate chains on decorin that is bound to separate fibrils, therefore creating interfibrillar bridges and eventually causing parallel alignment of the fibrils.
The tenocytes produce the collagen molecules, which aggregate end-to-end and side-to-side to produce collagen fibrils. Fibril bundles are organized to form fibres with the elongated tenocytes closely packed between them. There is a three-dimensional network of cell processes associated with collagen in the tendon. The cells communicate with each other through gap junctions, and this signalling gives them the ability to detect and respond to mechanical loading.
Blood vessels may be visualized within the endotendon running parallel to collagen fibres, with occasional branching transverse anastomoses
.
The internal tendon bulk is thought to contain no nerve fibres, but the epi- and peritendon contain nerve endings, while Golgi tendon organs are present at the junction between tendon and muscle.
Tendon length varies in all major groups and from person to person. Tendon length is practically the discerning factor where muscle size and potential muscle size is concerned. For example, should all other relevant biological factors be equal, a man with a shorter tendons and a longer biceps muscle will have greater potential for muscle mass than a man with a longer tendon and a shorter muscle. Successful bodybuilders
will generally have shorter tendons. Conversely, in sports requiring athletes to excel in actions such as running or jumping, it is beneficial to have longer than average Achilles tendon
and a shorter calf muscle.
Tendon length is determined by genetic predisposition, and has not been shown to either increase or decrease in response to environment, unlike muscles, which can be shortened by trauma, use imbalances and a lack of recovery and stretching.
The mechanical properties of the tendon are dependent on the collagen fiber diameter and orientation. The collagen fibrils are parallel to each other and closely packed, but show a wave-like appearance due to planar undulations, or crimps, on a scale of several micrometers. In tendons, the collagen I fibres have some flexibility due to the absence of hydroxyproline and proline residues at specific locations in the amino acid sequence, which allows the formation of other conformations such as bends or internal loops in the triple helix and results in the development of crimps. The crimps in the collagen fibrils allow the tendons to have some flexibility as well as a low compressive stiffness. In addition, because the tendon is a multi-stranded structure made up of many partially independent fibrils and fascicles, it does not behave as a single rod, and this property also contributes to its flexibility.
The proteoglycan components of tendons also are important to the mechanical properties. While the collagen fibrils allow tendons to resist tensile stress, the proteoglycans allow them to resist compressive stress. The elongation and the strain of the collagen fibrils alone have been shown to be much lower than the total elongation and strain of the entire tendon under the same amount of stress, demonstrating that the proteoglycan-rich matrix must also undergo deformation, and stiffening of the matrix occurs at high strain rates. These molecules are very hydrophilic, meaning that they can absorb a large amount of water and therefore have a high swelling ratio. Since they are noncovalently bound to the fibrils, they may reversibly associate and disassociate so that the bridges between fibrils can be broken and reformed. This process may be involved in allowing the fibril to elongate and decrease in diameter under tension.
s. When stretched, tendons have a soft tissue mechanical behavior.
or tendon injuries due to overuse. These types of injuries generally result in inflammation and degeneration or weakening of the tendons, which may eventually lead to tendon rupture. Tendinopathies can be caused by a number of factors relating to the tendon extracellular matrix, and their classification has been difficult because their symptoms and histopathology often are similar.
The first category of tendinopathy is paratenonitis, which refers to inflammation of the paratenon, or paratendinous sheet located between the tendon and its sheath. Tendinosis
refers to non-inflammatory injury to the tendon at the cellular level. The degradation is caused by damage to collagen, cells, and the vascular components of the tendon, and is known to lead to rupture. Observations of tendons that have undergone spontaneous rupture have shown the presence of collagen fibrils that are not in the correct parallel orientation or are not uniform in length or diameter, along with rounded tenocytes, other cell abnormalities, and the ingrowth of blood vessels. Other forms of tendinosis that have not led to rupture have also shown the degeneration, disorientation, and thinning of the collagen fibrils, along with an increase in the amount of glycosaminoglycans between the fibrils. The third is paratenonitis with tendinosis, in which combinations of paratenon inflammation and tendon degeneration are both present. The last is tendinitis, which refers to degeneration with inflammation of the tendon as well as vascular disruption.
Tendinopathies may be caused by several intrinsic factors including age, body weight, and nutrition. The extrinsic factors are often related to sports and include excessive forces or loading, poor training techniques, and environmental conditions.
It was believed previously that tendons could not undergo matrix turnover and that tenocytes were not capable of repair. However, it has been shown more recently that, throughout the lifetime of a person, tenocytes in the tendon actively synthesize ECM components as well as enzymes such as matrix metalloproteinases (MMPs) can degrade the matrix. Tendons are capable of healing and recovering from injuries in a process that is controlled by the tenocytes and their surrounding extracellular matrix. However, the healed tendons never regain the same mechanical properties as they had before the injury.
The three main stages of tendon healing are inflammation, repair or proliferation, and remodeling, which can be further divided into consolidation and maturation. These stages can overlap with each other. In the first stage, 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. 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. The inflammation stage usually lasts for a few days, and the repair or proliferation stage then begins. In this stage, which lasts for about six weeks, 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. After about six weeks, the remodeling stage begins. The first part of the remodeling stage is 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. 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 a time period of about one year, the tissue will turn from fibrous to scar-like.
Matrix metalloproteinases or MMPs have a very important role in the degradation and remodeling of the ECM during the healing process after a tendon injury. Certain MMPs including MMP-1, MMP-2, MMP-8, MMP-13, and MMP-14 have collagenase activity, meaning that, unlike many other enzymes, they are capable of degrading collagen I fibrils. The degradation of the collagen fibrils by MMP-1 along with the presence of denatured collagen are factors that are believed to cause weakening of the tendon ECM and an increase in the potential for another rupture to occur. In response to repeated mechanical loading or injury, cytokines may be released by tenocytes and can induce the release of MMPs, causing degradation of the ECM and leading to recurring injury and chronic tendinopathies.
A variety of other molecules are involved in tendon repair and regeneration. There are five growth factors that have been shown to be significantly upregulated and active during tendon healing: insulin-like growth factor 1
(IGF-I), platelet-derived growth factor
(PDGF), vascular endothelial growth factor
(VEGF), basic fibroblast growth factor
(bFGF), and transforming growth factor beta (TGF-β). These growth factors all have different roles during the healing process. IGF-1 increases collagen and proteoglycan production during the first stage of inflammation, and PDGF is also present during the early stages after injury and promotes the synthesis of other growth factors along with the synthesis of DNA and the proliferation of tendon cells. The three isoforms of TGF-β (TGF-β1, TGF-β2, TGF-β3) are known to play a role in wound healing and scar formation. VEGF is well known to promote angiogenesis and to induce endothelial cell proliferation and migration, and VEGF mRNA has been shown to be expressed at the site of tendon injuries along with collagen I mRNA. Bone morphogenetic proteins (BMPs) are a subgroup of TGF-β superfamily that can induce bone and cartilage formation as well as tissue differentiation, and BMP-12 specifically has been shown to influence formation and differentiation of tendon tissue and to promote fibrogenesis.
Several mechanotransduction
mechanisms have been proposed as reasons for the response of tenocytes to mechanical force that enable them to alter their gene expression, protein synthesis, and cell phenotype, and eventually cause changes in tendon structure. A major factor is mechanical deformation of the extracellular matrix
, which can affect the actin cytoskeleton and therefore affect cell shape, motility, and function. Mechanical forces can be transmitted by focal adhesion sites, integrins, and cell-cell junctions. Changes in the actin cytoskeleton can activate integrins, which mediate “outside-in” and “inside-out” signaling between the cell and the matrix. G-proteins, which induce intracellular signaling cascades, may also be important, and ion channels are activated by stretching to allow ions such as calcium, sodium, or potassium to enter the cell.
. Some specific uses include using sinew as thread
for sewing, attaching feathers to arrows (see fletch), lashing tool blades to shafts, etc. It is also recommended in survival guides as a material from which strong cordage can be made for items like traps or living structures. Tendon must be treated in specific ways to function usefully for these purposes. Inuit
and other circumpolar people utilized sinew as the only cordage for all domestic purposes due to the lack of other suitable fiber sources in their ecological habitats.
The elastic properties of particular sinews were also used in composite recurved bows
favoured by the steppe nomads of Eurasia. The first stone throwing artillery also used the elastic properties of sinew.
Sinew makes for an excellent cordage material for three reasons: It is incredibly strong, it contains natural glues, and it shrinks as it dries, doing away with the need for knots.
Tendon (in particular, beef
tendon) is used as a food in some Asian cuisines (often served at Yum Cha
or Dim Sum
restaurants). One popular dish is Suan Bao Niu Jin, where the tendon is marinated in garlic. It is also sometimes found in the Vietnamese noodle dish phở
.
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
to bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
and is capable of withstanding tension. Tendons are similar to ligament
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...
s and fasciae
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...
as they are all made of collagen except that ligaments join one bone to another bone, and fasciae connect muscles to other muscles. Tendons and muscles work together.
Structure
Normal healthy tendons are composed mostly of parallelParallel
-Mathematics and science:* Parallel , an imaginary east-west line circling a globe* Parallel circuits, as opposed to series* Parallel * Parallel evolution* Parallel transport* Parallel of declination, used in astronomy-Computing:...
arrays of collagen
Collagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
fibers closely packed together. The dry mass of normal tendons, which makes up about 30% of the total mass with water, is composed of about 86% collagen, 2% elastin
Elastin
Elastin is a protein in connective tissue that is elastic and allows many tissues in the body to resume their shape after stretching or contracting. Elastin helps skin to return to its original position when it is poked or pinched. Elastin is also an important load-bearing tissue in the bodies of...
, 1–5% proteoglycans, and 0.2% inorganic components such as copper
Copper
Copper is a chemical element with the symbol Cu and atomic number 29. It is a ductile metal with very high thermal and electrical conductivity. Pure copper is soft and malleable; an exposed surface has a reddish-orange tarnish...
, manganese
Manganese
Manganese is a chemical element, designated by the symbol Mn. It has the atomic number 25. It is found as a free element in nature , and in many minerals...
, and calcium
Calcium
Calcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...
. The collagen portion is made up of 97-98% type I collagen, with small amounts of other types of collagen. These include type II collagen in the cartilaginous zones, type III collagen in the reticulin fibres of the vascular walls, type IX collagen, type IV collagen in the basement membranes of the capillaries, type V collagen in the vascular walls, and type X collagen in the mineralized fibrocartilage near the interface with the bone. Collagen fibres coalesce into macroaggregates. After secretion from the cell, the terminal peptides are cleaved by procollagen N- and C-proteinases, and the tropocollagen molecules spontaneously assemble into insoluble fibrils. A collagen molecule is about 300 nm long and 1-2 nm wide, and the diameter of the fibrils that are formed can range from 50-500 nm. In tendons, the fibrils then assemble further to form fascicles, which are about 10 mm in length with a diameter of 50-300 μm, and finally into a tendon fibre with a diameter of 100-500 μm. Groups of fascicles are bounded by the epitendon and peritendon to form the tendon organ.
The collagen in tendons are held together with proteoglycan components, including decorin
Decorin
Decorin is a proteoglycan on average 90 - 140 kilodaltons in size.It belongs to the small leucine-rich proteoglycan family and consists of a protein core containing leucine repeats with a glycosaminoglycan chain consisting of either chondroitin sulfate or dermatan sulfate .Decorin is a small...
and, in compressed regions of tendon, aggrecan
Aggrecan
Aggrecan also known as cartilage-specific proteoglycan core protein or chondroitin sulfate proteoglycan 1 is a protein that in humans is encoded by the ACAN gene. This gene is a member of the aggrecan/versican proteoglycan family...
, which are capable of binding to the collagen fibrils at specific locations. The proteoglycans are interwoven with the collagen fibrils - their glycosaminoglycan
Glycosaminoglycan
Glycosaminoglycans or mucopolysaccharides are long unbranched polysaccharides consisting of a repeating disaccharide unit. The repeating unit consists of a hexose or a hexuronic acid, linked to a hexosamine .-Production:Protein cores made in the rough endoplasmic reticulum are posttranslationally...
(GAG) side chains have multiple interactions with the surface of the fibrils - showing that the proteoglycans are important structurally in the interconnection of the fibrils. The major GAG components of the tendon are dermatan sulfate
Dermatan sulfate
Dermatan sulfate is a glycosaminoglycan found mostly in skin, but also in blood vessels, heart valves, tendons, and lungs....
and chondroitin sulfate
Chondroitin sulfate
Chondroitin sulfate is a sulfated glycosaminoglycan composed of a chain of alternating sugars . It is usually found attached to proteins as part of a proteoglycan. A chondroitin chain can have over 100 individual sugars, each of which can be sulfated in variable positions and quantities...
, which associate with collagen and are involved in the fibril assembly process during tendon development. Dermatan sulfate is thought to be responsible for forming associations between fibrils, while chondroitin sulfate is thought to be more involved with occupying volume between the fibrils to keep them separated and help withstand deformation. The dermatan sulfate side chains of decorin aggregate in solution, and this behavior can assist with the assembly of the collagen fibrils. When decorin molecules are bound to a collagen fibril, their dermatan sulfate chains may extend and associate with other dermatan sulfate chains on decorin that is bound to separate fibrils, therefore creating interfibrillar bridges and eventually causing parallel alignment of the fibrils.
The tenocytes produce the collagen molecules, which aggregate end-to-end and side-to-side to produce collagen fibrils. Fibril bundles are organized to form fibres with the elongated tenocytes closely packed between them. There is a three-dimensional network of cell processes associated with collagen in the tendon. The cells communicate with each other through gap junctions, and this signalling gives them the ability to detect and respond to mechanical loading.
Blood vessels may be visualized within the endotendon running parallel to collagen fibres, with occasional branching transverse anastomoses
Anastomosis
An anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
.
The internal tendon bulk is thought to contain no nerve fibres, but the epi- and peritendon contain nerve endings, while Golgi tendon organs are present at the junction between tendon and muscle.
Tendon length varies in all major groups and from person to person. Tendon length is practically the discerning factor where muscle size and potential muscle size is concerned. For example, should all other relevant biological factors be equal, a man with a shorter tendons and a longer biceps muscle will have greater potential for muscle mass than a man with a longer tendon and a shorter muscle. Successful bodybuilders
Bodybuilding
Bodybuilding is a form of body modification involving intensive muscle hypertrophy. An individual who engages in this activity is referred to as a bodybuilder. In competitive and professional bodybuilding, bodybuilders display their physiques to a panel of judges, who assign points based on their...
will generally have shorter tendons. Conversely, in sports requiring athletes to excel in actions such as running or jumping, it is beneficial to have longer than average Achilles tendon
Achilles tendon
The Achilles tendon , also known as the calcaneal tendon or the tendo calcaneus, is a tendon of the posterior leg. It serves to attach the plantaris, gastrocnemius and soleus muscles to the calcaneus bone.- Anatomy :The Achilles is the tendonous extension of 3 muscles in the lower leg:...
and a shorter calf muscle.
Tendon length is determined by genetic predisposition, and has not been shown to either increase or decrease in response to environment, unlike muscles, which can be shortened by trauma, use imbalances and a lack of recovery and stretching.
Function
Tendons have been traditionally considered to simply be a mechanism by which muscles connect to bone, functioning simply to transmit forces. However, over the past two decades, much research focused on the elastic properties of tendons and their ability to function as springs. This allows tendons to passively modulate forces during locomotion, providing additional stability with no active work. It also allows tendons to store and recover energy at high efficiency. For example, during a human stride, the Achilles tendon stretches as the ankle joint dorsiflexes. During the last portion of the stride, as the foot plantar-flexes (pointing the toes down), the stored elastic energy is released. Furthermore, because the tendon stretches, the muscle is able to function with less or even no change in length, allowing the muscle to generate greater force.The mechanical properties of the tendon are dependent on the collagen fiber diameter and orientation. The collagen fibrils are parallel to each other and closely packed, but show a wave-like appearance due to planar undulations, or crimps, on a scale of several micrometers. In tendons, the collagen I fibres have some flexibility due to the absence of hydroxyproline and proline residues at specific locations in the amino acid sequence, which allows the formation of other conformations such as bends or internal loops in the triple helix and results in the development of crimps. The crimps in the collagen fibrils allow the tendons to have some flexibility as well as a low compressive stiffness. In addition, because the tendon is a multi-stranded structure made up of many partially independent fibrils and fascicles, it does not behave as a single rod, and this property also contributes to its flexibility.
The proteoglycan components of tendons also are important to the mechanical properties. While the collagen fibrils allow tendons to resist tensile stress, the proteoglycans allow them to resist compressive stress. The elongation and the strain of the collagen fibrils alone have been shown to be much lower than the total elongation and strain of the entire tendon under the same amount of stress, demonstrating that the proteoglycan-rich matrix must also undergo deformation, and stiffening of the matrix occurs at high strain rates. These molecules are very hydrophilic, meaning that they can absorb a large amount of water and therefore have a high swelling ratio. Since they are noncovalently bound to the fibrils, they may reversibly associate and disassociate so that the bridges between fibrils can be broken and reformed. This process may be involved in allowing the fibril to elongate and decrease in diameter under tension.
Mechanics
Tendons are viscoelastic structures and are more stretchable than ligamentLigament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...
s. When stretched, tendons have a soft tissue mechanical behavior.
Pathology
Tendons are subject to many types of injuries. There are various forms of tendinopathiesTendinopathy
Tendinopathy refers to a disease of a tendon. More specifically, it can refer to:* Tendinitis* TendinosisTendon 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...
or tendon injuries due to overuse. These types of injuries generally result in inflammation and degeneration or weakening of the tendons, which may eventually lead to tendon rupture. Tendinopathies can be caused by a number of factors relating to the tendon extracellular matrix, and their classification has been difficult because their symptoms and histopathology often are similar.
The first category of tendinopathy is paratenonitis, which refers to inflammation of the paratenon, or paratendinous sheet located between the tendon and its sheath. Tendinosis
Tendinosis
Tendinosis, sometimes called chronic tendinitis, tendinosus, chronic tendinopathy or chronic tendon injury, is damage to a tendon at a cellular level . It is thought to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells...
refers to non-inflammatory injury to the tendon at the cellular level. The degradation is caused by damage to collagen, cells, and the vascular components of the tendon, and is known to lead to rupture. Observations of tendons that have undergone spontaneous rupture have shown the presence of collagen fibrils that are not in the correct parallel orientation or are not uniform in length or diameter, along with rounded tenocytes, other cell abnormalities, and the ingrowth of blood vessels. Other forms of tendinosis that have not led to rupture have also shown the degeneration, disorientation, and thinning of the collagen fibrils, along with an increase in the amount of glycosaminoglycans between the fibrils. The third is paratenonitis with tendinosis, in which combinations of paratenon inflammation and tendon degeneration are both present. The last is tendinitis, which refers to degeneration with inflammation of the tendon as well as vascular disruption.
Tendinopathies may be caused by several intrinsic factors including age, body weight, and nutrition. The extrinsic factors are often related to sports and include excessive forces or loading, poor training techniques, and environmental conditions.
Healing
The tendons in the foot are highly complex and intricate. If any tendons break, the healing process is long and painful, not to mention the intricacy of the repairing (if fully severed) process. Most people that do not receive medical attention within the first 48 hours of the injury will suffer from severe swelling, pain, and an on-fire feeling where the injury occurred. They are very painful when they are inflamed or not in use.It was believed previously that tendons could not undergo matrix turnover and that tenocytes were not capable of repair. However, it has been shown more recently that, throughout the lifetime of a person, tenocytes in the tendon actively synthesize ECM components as well as enzymes such as matrix metalloproteinases (MMPs) can degrade the matrix. Tendons are capable of healing and recovering from injuries in a process that is controlled by the tenocytes and their surrounding extracellular matrix. However, the healed tendons never regain the same mechanical properties as they had before the injury.
The three main stages of tendon healing are inflammation, repair or proliferation, and remodeling, which can be further divided into consolidation and maturation. These stages can overlap with each other. In the first stage, 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. After the release of vasoactive
Vasoactive
A vasoactive is a pharmaceutical agent that has the effect of either increasing or decreasing blood pressure and/or heart rate. Typically used in a setting where a patient has the blood pressure and heart rate monitored constantly, vasoactive drug therapy is typically "titrated" to achieve a...
and chemotactic factors, angiogenesis
Angiogenesis
Angiogenesis is the physiological process involving the growth of new blood vessels from pre-existing vessels. Though there has been some debate over terminology, vasculogenesis is the term used for spontaneous blood-vessel formation, and intussusception is the term for the formation of new blood...
and the proliferation
Cell growth
The term cell growth is used in the contexts of cell development and cell division . When used in the context of cell division, it refers to growth of cell populations, where one cell grows and divides to produce two "daughter cells"...
of tenocytes are initiated. Tenocytes then move into the site and start to synthesize collagen III. The inflammation stage usually lasts for a few days, and the repair or proliferation stage then begins. In this stage, which lasts for about six weeks, 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. After about six weeks, the remodeling stage begins. The first part of the remodeling stage is 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. 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 a time period of about one year, the tissue will turn from fibrous to scar-like.
Matrix metalloproteinases or MMPs have a very important role in the degradation and remodeling of the ECM during the healing process after a tendon injury. Certain MMPs including MMP-1, MMP-2, MMP-8, MMP-13, and MMP-14 have collagenase activity, meaning that, unlike many other enzymes, they are capable of degrading collagen I fibrils. The degradation of the collagen fibrils by MMP-1 along with the presence of denatured collagen are factors that are believed to cause weakening of the tendon ECM and an increase in the potential for another rupture to occur. In response to repeated mechanical loading or injury, cytokines may be released by tenocytes and can induce the release of MMPs, causing degradation of the ECM and leading to recurring injury and chronic tendinopathies.
A variety of other molecules are involved in tendon repair and regeneration. There are five growth factors that have been shown to be significantly upregulated and active during tendon healing: insulin-like growth factor 1
Insulin-like growth factor 1
Insulin-like growth factor 1 also known as somatomedin C is a protein that in humans is encoded by the IGF1 gene. IGF-1 has also been referred to as a "sulfation factor" and its effects were termed "nonsuppressible insulin-like activity" in the 1970s.IGF-1 is a hormone similar in molecular...
(IGF-I), platelet-derived growth factor
Platelet-derived growth factor
In molecular biology, platelet-derived growth factor is one of the numerous growth factors, or proteins that regulate cell growth and division. In particular, it plays a significant role in blood vessel formation , the growth of blood vessels from already-existing blood vessel tissue. Uncontrolled...
(PDGF), vascular endothelial growth factor
Vascular endothelial growth factor
Vascular endothelial growth factor is a signal protein produced by cells that stimulates vasculogenesis and angiogenesis. It is part of the system that restores the oxygen supply to tissues when blood circulation is inadequate....
(VEGF), basic fibroblast growth factor
Basic fibroblast growth factor
Basic fibroblast growth factor, also known as bFGF, FGF2 or FGF-β, is a member of the fibroblast growth factor family.- Function :...
(bFGF), and transforming growth factor beta (TGF-β). These growth factors all have different roles during the healing process. IGF-1 increases collagen and proteoglycan production during the first stage of inflammation, and PDGF is also present during the early stages after injury and promotes the synthesis of other growth factors along with the synthesis of DNA and the proliferation of tendon cells. The three isoforms of TGF-β (TGF-β1, TGF-β2, TGF-β3) are known to play a role in wound healing and scar formation. VEGF is well known to promote angiogenesis and to induce endothelial cell proliferation and migration, and VEGF mRNA has been shown to be expressed at the site of tendon injuries along with collagen I mRNA. Bone morphogenetic proteins (BMPs) are a subgroup of TGF-β superfamily that can induce bone and cartilage formation as well as tissue differentiation, and BMP-12 specifically has been shown to influence formation and differentiation of tendon tissue and to promote fibrogenesis.
Effects of activity on healing
In animal models, extensive studies have been conducted to investigate the effects of mechanical strain in the form of activity level on tendon injury and healing. While stretching can disrupt healing during the initial inflammatory phase, it has been shown that controlled movement of the tendons after about one week following an acute injury can help to promote the synthesis of collagen by the tenocytes, leading to increased tensile strength and diameter of the healed tendons and fewer adhesions than tendons that are immobilized. In chronic tendon injuries, mechanical loading has also been shown to stimulate fibroblast proliferation and collagen synthesis along with collagen realignment, all of which promote repair and remodeling. To further support the theory that movement and activity assist in tendon healing, it has been shown that immobilization of the tendons after injury often has a negative effect on healing. In rabbits, collagen fascicles that are immobilized have shown decreased tensile strength, and immobilization also results in lower amounts of water, proteoglycans, and collagen crosslinks in the tendons.Several mechanotransduction
Mechanotransduction
Mechanotransduction refers to the many mechanisms by which cells convert mechanical stimulus into chemical activity.- Tendon :The process of is explained for the lay-reader at http://bjsm.bmj.com/content/43/4/247.full- Ear :...
mechanisms have been proposed as reasons for the response of tenocytes to mechanical force that enable them to alter their gene expression, protein synthesis, and cell phenotype, and eventually cause changes in tendon structure. A major factor is mechanical deformation of the extracellular matrix
Extracellular matrix
In biology, the extracellular matrix is the extracellular part of animal tissue that usually provides structural support to the animal cells in addition to performing various other important functions. The extracellular matrix is the defining feature of connective tissue in animals.Extracellular...
, which can affect the actin cytoskeleton and therefore affect cell shape, motility, and function. Mechanical forces can be transmitted by focal adhesion sites, integrins, and cell-cell junctions. Changes in the actin cytoskeleton can activate integrins, which mediate “outside-in” and “inside-out” signaling between the cell and the matrix. G-proteins, which induce intracellular signaling cascades, may also be important, and ion channels are activated by stretching to allow ions such as calcium, sodium, or potassium to enter the cell.
Ossified tendons
In some organisms, notable ones being birds and ornithischian dinosaurs, portions of the tendon can become ossified. In this process, osteocytes inflitrate the tendon and lay down bone as they would in sesamoid bone such as the patella. In birds, tendon ossification primarily occurs in the hindlimb, while in ornithischian dinosaurs, ossified axial muscle tendons form a latticework along the neural and haemal spines on the tail, presumably for support.Uses of sinew
Sinew was widely used throughout pre-industrial eras as a tough, durable fiberFiber
Fiber is a class of materials that are continuous filaments or are in discrete elongated pieces, similar to lengths of thread.They are very important in the biology of both plants and animals, for holding tissues together....
. Some specific uses include using sinew as thread
Yarn
Yarn is a long continuous length of interlocked fibres, suitable for use in the production of textiles, sewing, crocheting, knitting, weaving, embroidery and ropemaking. Thread is a type of yarn intended for sewing by hand or machine. Modern manufactured sewing threads may be finished with wax or...
for sewing, attaching feathers to arrows (see fletch), lashing tool blades to shafts, etc. It is also recommended in survival guides as a material from which strong cordage can be made for items like traps or living structures. Tendon must be treated in specific ways to function usefully for these purposes. Inuit
Inuit
The Inuit are a group of culturally similar indigenous peoples inhabiting the Arctic regions of Canada , Denmark , Russia and the United States . Inuit means “the people” in the Inuktitut language...
and other circumpolar people utilized sinew as the only cordage for all domestic purposes due to the lack of other suitable fiber sources in their ecological habitats.
The elastic properties of particular sinews were also used in composite recurved bows
Composite bow
A composite bow is a bow made from horn, wood, and sinew laminated together. The horn is on the belly, facing the archer, and sinew on the back of a wooden core. Sinew and horn will store more energy than wood for the same length of bow...
favoured by the steppe nomads of Eurasia. The first stone throwing artillery also used the elastic properties of sinew.
Sinew makes for an excellent cordage material for three reasons: It is incredibly strong, it contains natural glues, and it shrinks as it dries, doing away with the need for knots.
Tendon (in particular, beef
Beef
Beef is the culinary name for meat from bovines, especially domestic cattle. Beef can be harvested from cows, bulls, heifers or steers. It is one of the principal meats used in the cuisine of the Middle East , Australia, Argentina, Brazil, Europe and the United States, and is also important in...
tendon) is used as a food in some Asian cuisines (often served at Yum Cha
Yum cha
Yum cha , also known as Ban ming , is a Chinese style morning or afternoon tea, which involves drinking Chinese tea and eating dim sum dishes...
or Dim Sum
Dim sum
Dim sum refers to a style of Chinese food prepared as small bite-sized or individual portions of food traditionally served in small steamer baskets or on small plates...
restaurants). One popular dish is Suan Bao Niu Jin, where the tendon is marinated in garlic. It is also sometimes found in the Vietnamese noodle dish phở
PHO
PHO may refer to:* Primary Health Organisation* Potentially hazardous object, an asteroid or comet that could potentially collide with Earth...
.