Do Tendon Tears Fix Themselves Adequately?

                   If you have recently suffered from a partially or completely torn tendon then you may be wondering which treatment options have the most desirable outcome. Deciphering between Operative versus Non-operative treatment for tendon tears has been an ongoing debate for many years. However, in order to fully understand the physiology behind the treatment and repair processes, we must first discuss some background information about tendons.

                  

                   Tendons are fibrous connective tissue that connect muscle to bone and exemplify high tension strength due to their dense, parallel Type-1 collagen fiber composition. The strength and stiffness of a tendon enables you to experience the positive mechanical advantage of transferring load to your bone, resulting in bone movement during a muscle contraction. Injuries to tendons are usually the result of an acute injury, such as immediate trauma or chronic injury, such as tendon degeneration from failure to repair repetitive micro tears to the tendon.

                  

                   As with any type of connective tissue, tendons are capable of self-repair, however many factors play a significant role in tissue healing and repair. Unlike muscles, tendons typically have relatively poor blood supply, which is an extremely important factor during the healing and repair process. Tendon healing usually follows three main stages:

 

1) Inflammation - Inflammatory cells rush in to the injury site in order to initiate the healing process, stimulate repair cells, and get rid of the damaged tissue.

 

2) Repair - This is where the Tenocytes (tendon cells), which are responsible for synthesizing new collagen, begin to proliferate, synthesize and lay down new strands of collagen along the torn ends of the tendon.

 

3) Maturation/Remodeling - The newly synthesized collagen matures into strong fibers that begin aligning themselves in the direction of mechanical stress that is experienced at the injury site. Further remodeling and cross-linking takes place in order to form a strong bond between the torn ends of the tendon.

                  

                   The non-surgical approach may be successful in healing a torn tendon, as would be randomly placing a piece of duct tape on a torn piece of paper; however we do not consider this to be the only goal when "adequately" healing your injury. Our definition of "adequate" healing must include restoring the function of the new tendon as close as possible to the function of the old, healthy tendon. The self-repair process does not account for the full extent of the injury, which may include excess scar formation, degenerative tissue, adhesion factors and misalignment of the collagen fibers, which can ultimately all affect the overall function. During a surgical repair, we look to not only repair the injury, but will take all of the factors mentioned above into consideration in order to achieve the most favorable outcome for you. Surgical repair often will decrease the likelihood for a re-rupture and increase the endurance and strength of the tendon. We utilize OrthoBiologic products to ensure and maximize excellent healing of tendon repairs (Platelet-Rich Plasma, Stem Cells). 

                   As with any surgery, there may be potential post-surgical complications, but office consultations with us will provide more control and insight on the overall recovery process. Your doctor will be able to assess your stage of recovery in order to assign the best rehabilitative procedures that will maximize the likelihood of your tendon reaching its full, pre-injury potential. Regardless of the severity your tendon tear, it is always wise to make an appointment with an Austin Foot and Ankle Specialist in order to evaluate the injury and possible treatment options that are available for you.

Dr. Shine John, DPM, FACFAS
Podiatric Physician, Surgeon, Specialist at Austin Foot and Ankle Specialists
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