Healing of subcutaneous tendons: Influence of the mechanical environment at the suture line on the healing process

Abstract

Tendon ruptures remain a significant musculoskeletal injury. Despite advances in surgical techniques and procedures, traditional repair techniques maintain a high incidence of rerupture or tendon elongation. Mechanical loading and biochemical signaling both control tissue healing. This has led some researchers to consider using a technique based on tension regulation at the suture line for obtaining good healing. However, it is unknown how they interact and to what extent mechanics control biochemistry. This review will open the way for understanding the interplay between mechanical loading and the process of tendon healing.

Keywords: Healing; Mechanical loading; Mechanotransduction; Repair; Rupture; Tendon.

Figure 1

Stress-strain relationship for progressive loading of a tendon showing three distinct regions (toe, linear and partial failure) prior to complete rupture approximate stress forces (MPa) and strain values (% strain) is shown. Reprinted from [40] with permission from the Oxford University Press.

Figure 2

Drawing illustrates repair of the patellar tendon and making of the “suture line tension regulating suture”. A: The modified Kessler suture in the proximal portion of an avulsed patellar tendon; B: The modified Kessler suture and the reinforcement device before tying the threads into a knot; C: The final appearance after tying the threads into knots. Reprinted from [124] with permission from the Springer.

Figure 3

Drawing illustrates repair of the ruptured Achilles tendon. A: Thread of the reinforcement suture when it passes through the osseous tunnel in the calcaneus and by interweaving through the proximal stump of the Achilles tendon; B: Tendon stumps that were held together by Kessler’s suture; C: Final appearance of the reinforcement suture and the repaired Achilles tendon. Reprinted from [125] with permission from the Elsevier.