Affections of Tendons and Ligaments
Common Affections of Tendons and Ligaments is usually caused by trauma or by surgical tenotomy. Medical conditions that affect collagen (e.g., iatrogenic or naturally occurring Cushing’s disease) also can promote tendon rupture.
Injection of steroid into or around tendon or ligament has substantial effect on tendons and ligaments tensile strength, elasticity and healing; injection into tendon causes necrosis. In addition to decreasing the strength of tendon, corticosteroids mask the symptoms, gives the patient false sense of security during exercise.
Healing of tendon and ligament
Healing of tendon and ligament follows the same general pattern. Healing is influenced by several variables that are significant, including
- Healing across a gap versus apposition by suture
- Mobilization versus immobilization of the injured site
- The causes (trauma versus injection of corticosteroids
- The location of the injury
Common surgical affections of tendons
- Muscle tendon unit laceration: lacerations are tears within the muscle-tendon unit. Lacerations are usually the result of penetration of muscle-tendon unit by sharp object. These injuries are commonly involve the tendon near carpometacarpal and tarsometatarsal joints.
- Muscle-tendon unit rupture: complete or partial loss of integrity of muscle-tendon unit caused by extreme overstretching
Surgical technique and suture patterns for tendon repair
Tendons of greatest surgical significance in canine surgery are the deep gluteal tendo, triceps tendon and Achilles tendon. Because of the collagen fibers that compose these tendons are arranged almost exclusively in parallel bundles oriented along the long axis, there are few crossing collagen fibers to prevent suture from slipping toward the tenotomy when a load is applied. The result is failure to heal or formation of gap each time when load is applied, resulting in scar tissue formation with associated elongation and impaired function.
Three suture patterns hold the tendon effectively and prevent gapping–
- Three loop pulley
- The Kessler (Locking loop)
- The Krackow suture pattern
The krackow and kessler suture pattern best applied for flat tendons, whereas the three loop pulley suture is best applied to round tendons.
Post operative care and Rehabilitation
Post operative care is important to promote to promote primary healing. Post operative care includes restriction of active motion to avoid re-injury or gap formation across.