Basic Science of Tendons

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Abstract
Summary: Collagen in tendons is arranged in parallel primary, secondary, and tertiary bundles, so as to distribute muscular tensions equally to all parts of the insertions, at whatever position of the joint. The outer surface of each fascicle is covered by a uniform layer of collagen: this coating permits individual fascicles to move independently of each other. A normal tendon is able to bear a load of 50 to 100 N/m2 and can be stretched to approximately 4% of its total length before microscopic evidence of rupture of some collagen fibers. Tendons have a low metabolic rate and a low vascularity, which may explain their poor healing capability. Tendons have an intrinsic and an extrinsic capacity to heal, and the relative contribution of each depends on the type of injury, the site of the injury, and the method of management of the injury. Much research is now concentrating on rehabilitation, planning more aggressive rehabilitation programs, especially in young athletes, and on the role of growth factors in tendon healing. Gene transfer could improve the management of tendon injuries, particularly when used as the vehicle for the targeted delivery of growth factors. It is likely that genes encoding the structural proteins of the matrix could be delivered directly to the tendon and enhance its healing in a programmed manner. However, their introduction in routine clinical practice is not imminent.

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