Peritendinous Tissue Research Articles

Fibrocartilage in the extensor tendons of the human metacarpophalangeal joints

The extensor tendons of the fingers cross both the metacarpophalangeal (MCP) and interphalangeal joints. Previous studies have shown that where the extensor tendons replace the capsule of the proximal interphalangeal (PIP) joint, they contain a sesamoid fibrocartilage that articulates with the proximal phalanx during flexion. The fibrocartilage labels immunohistochemically for a variety of glycosaminoglycans and collagens. In the current study, we investigate the molecular composition of the extensor tendons at the level of the MCP joints. This is of particular interest because the tendon has a greater moment arm at this location (and might thus be subject to greater compression), but is separated from the joint cavity by the capsule and peritendinous tissue. Six hands were removed from elderly cadavers (39-85 years of age) and the MCP joints were fixed in 90% methanol. The extensor tendons were dissected from all fingers, cryosectioned, and immunolabelled with a panel of monoclonal and polyclonal antibodies for types I, II, III, and VI collagens, chondroitin 4 and 6 sulphates, dermatan, and keratan sulphate and aggrecan. Antibody binding was detected with the Vectastain ABC 'Elite' avidin/biotin/peroxidase kit. The extensor tendons in all the fingers had a metachromatic sesamoid fibrocartilage on their deep surface which immunolabelled for types I, III, and VI collagens, and for all glycosaminoglycans and aggrecan. Labelling for type II collagen was also seen in some fibrocartilages and was a constant feature of all index fingers. This probably relates to the greater use of that digit and the higher loads to which its tendons are subject. Chondroitin 6 sulphate and type II collagen are the most consistent markers of the fibrocartilage phenotype and most of the chondroitin 6 sulphate is probably associated with aggrecan. It is concluded that the labelling profile of the tendon fibrocartilage in the different fingers at the MCP joints is broadly similar to that at the PIP joints. Thus, the potentially greater level of compression on the extensor tendons may be counterbalanced by the lack of fusion of the tendon with the joint capsule. It is suggested that the maintenance of a similar level of fibrocartilage differentiation at two different points along the length of the extensor tendon ensures that the tensile strength is the same in the two regions and that no weak link is present.

The connective-tissue envelope in revascularisation of patellar tendon grafts

Free patellar tendon grafts used for the intra-articular replacement of ruptured anterior cruciate ligaments (ACL) lack perfusion at the time of implantation. The central core of the graft undergoes a process of ischaemic necrosis which may result in failure. Early reperfusion of the graft may diminish the extent of this process. We assessed the role of peritendinous connective tissue in the revascularisation of the patellar tendon graft from the day of implantation up to 24 days in a murine model using intravital microscopy. The peritendinous connective-tissue envelope of the graft was either completely removed, partially removed or not stripped before implantation into dorsal skinfold chambers of recipient mice. Initial revascularisation of the grafts with preserved peritendinous connective tissues began after two days. The process was delayed by five to six times in completely stripped patellar tendons (p < 0.05). Only grafts with preserved connective tissues showed high viability whereas those which were completely stripped appeared to be subvital. The presence of peritendinous connective tissues accelerates the revascularisation of free patellar tendon grafts.

The connective-tissue envelope in revascularisation of patellar tendon grafts.

Free patellar tendon grafts used for the intra-articular replacement of ruptured anterior cruciate ligaments (ACL) lack perfusion at the time of implantation. The central core of the graft undergoes a process of ischaemic necrosis which may result in failure. Early reperfusion of the graft may diminish the extent of this process. We assessed the role of peritendinous connective tissue in the revascularisation of the patellar tendon graft from the day of implantation up to 24 days in a murine model using intravital microscopy. The peritendinous connective-tissue envelope of the graft was either completely removed, partially removed or not stripped before implantation into dorsal skinfold chambers of recipient mice. Initial revascularisation of the grafts with preserved peritendinous connective tissues began after two days. The process was delayed by five to six times in completely stripped patellar tendons (p < 0.05). Only grafts with preserved connective tissues showed high viability whereas those which were completely stripped appeared to be subvital. The presence of peritendinous connective tissues accelerates the revascularisation of free patellar tendon grafts.

Behavior of Tendons During Lower-Leg Lengthening in Dogs Using the Ilizarov Method

Twenty-two dogs were provided with a circular fixator. Lengthening of the right lower leg by 2.5 cm was performed on 18 dogs 5 days after tibial osteotomy using a distraction rate of 0.5 mm, twice per day. Nine dogs with leg lengthening and two dogs of the control group without leg lengthening were sacrificed at the end of the distraction phase of 25 days and the remaining dogs after another 25 days. Post mortem, the tendons of the tibialis anterior, extensor digitorum longus, peroneus longus, and the Achilles tendon were taken from the operated-on right side and the left nonoperated-on control side and were analyzed histologically. The control group showed no histologic changes in the tendons of either side nor in those of the unlengthened left side of the operated-on dogs. Thirty-three tendons (41%) of dogs with leg lengthening were seen to have undergone histomorphological changes. An increase of the peritendinous connective tissue was seen, combined with chronic inflammatory cell infiltration in the tendons and/or the epitendinous tissues, edema, tendon fragmentation, necrosis, scarring of the tendons with dystrophic calcification and/or ossification, and broadening of the tenosynovial sheath. Furthermore, signs of histoneogenesis with growth in the tendons were found. Degenerative changes occurred far more often in the tendons of the ventral side of the lower leg and a slight pes equinus was regularly observed in the lengthened extremity. Therefore, pes equinus prevention and physiotherapy are important in the therapeutic use of lower-leg lengthening to minimize possible stress-induced damage of the ventral tendons.

Flexor digitorum profundus tendongrafting (intrasynovial donor tendons)

Traditional single- and two-stage tendon grafting methods for flexor tendon reconstruction have been unable toconsistently restore satisfactory digital flexion. Although multiple factors may affect the ultimate outcome, the role of the donor tendon graft has only recently been examined. Current methods of flexor tendon grafting for failed zone II tendon repairs and neglected flexor tendon lacerations involve the use of extrasynovial donor grafts. Clinical and histological studies have shown significant adhesion formation as a result of early cellular necrosis and peritendinous tissue ingrowth into the extrasynovial donor graft. The formation of these adhesions may result in poor tendon excursion and limited proximal interphalangeal joint rotation. Recent studies have shown that intrasynovial donor tendon grafts are incorporated to the native tendon site by a unique intrinsic mechanism of repair. Improved functional characteristics of increased tendon excursion and increased digital rotation are primarily caused by this paucity of adhesion formation and will hopefully result in improved overall patient outcomes.

Fibrous architecture of the dorsal aponeurosis of the thumb.

The extensor apparatus of the thumb displays obvious structural variations in its proximo-distal expanse. Its associated tissue comes in close relation to the dorsal aponeurosis that have varying topographical relationships to the extensor apparatus of the thumb. This region is especially important as the location of pathological and repair processes. In this anatomical study using a modified embedding technique a histological description of the fibrous architecture of the dorsal aponeurosis and the peritendinous connective tissue body of the thumb is presented. The dorsal connective tissue of the thumb forms different layers of collagen lamellae as a peritendinous system around the tendons of the long and short extensor tendons of the thumb. This peritendinous laminar system as the main part of the dorsal aponeurosis is connected with both the capsular and the retinacular ligaments of the thumb. It will be shown that the structural variations of the dorsal aponeurosis and peritendinous connective tissue are an expression of different topographical zones of stress along the lines of a balanced musculofibrous stabilization of the interphalangeal joint of the thumb. The expansions in the peritendinous intercellular space act as defined gliding spaces or clefts of the extensor apparatus.

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The giant cell tumor of tendon sheath is a benign histiocytic proliferation of the articular and peritendinous synovial tissue that has only rarely been reported in the dermatologic literature. The lesion manifests as a firm 1 to 3 cm nodule most frequently occurring on the fingers, hands, and wrists, where it is attached to the tendon sheath. Its histopathologic appearance is characterized by the presence of multinucleate giant cells. The author reports a classic example of the giant cell tumor of tendon sheath.

Functional morphology of the deep transverse metacarpal ligament

The deep transverse metacarpal ligament extends in radio-ulnar direction between the palmar plates of the metacarpo-phalangeal joints of the second through fifth finger rays. Continuing along the path of the palmar plates, the ligament divides the spaces between the fingers at the metacarpo-phalangeal border into functional spaces bordered by the ligamentous apparatus of the metacarpophalangeal joint capsules and filled by blood-vessels, nerves and intrinsic hand muscles. Morphometric examinations of the deep transverse metacarpal ligament indicate a greater strain of the radial components between the index and middle finger in the transverse plane as well as an increased stressing of sagittal fiber plates connecting the extending apparatus with the deep transverse metacarpal ligament via the metacarpophalangeal force nucleus. Palmar, sagittally directed collagen fiber bundles representing a location of initial or recurrent connective tissue proliferation can be histologically demonstrated as a connection between peritendinous and perivascular connective tissue of the palmar interdigital space and the palmar aponeurosis.

Diagnosis and therapy of tendinitis exemplified by the athletic horse

This paper reviews the literature and describes our experiences in the diagnosis and treatment of tendinitis in horses. Ultrasonography provides a sensitive tool to diagnose tendinitis and quantitate the degree of damage to the tendon; as well as provide differential diagnoses such as peritendinitis. The principles in therapy of acute tendinitis are: Immediate reduced exercise or rest, physical therapy to reduce inflammation and administration of local and systemic antiinflammatory drugs. The goal is restoration of the tensile strength of the tendon without peritendinous granulation tissue and adhesions. To achieve this goal it is important to maximize the intrinsic healing and to minimize the extrinsic healing. Any form of counterirritation is forbidden because of increase of inflammation. Passive motion and massage will help to increase blood flow and to decrease adhesions. Local injection (peritendinous and intratendinous) of hyaluronic acid seems to increase the intrinsic healing and to decrease adhesions without side effects. Depending on the extent of the tendon damage, which tendon is involved and the progress toward healing controlled ultrasonographically, the healing period can be divided in 4 phases: 1. Immobilisation (Cast), only in severe cases (for 1-2 weeks). 2. Passive motion and massage (starting as soon as possible, usually at once during bandage change). 3. Careful exercise, hand walk or walk under saddle (for 1-6 months, starting as soon as possible, usually about 5 days after initial treatment). 4. Controlled slow and gradual training, no turnout, long or pasture (for 1-6 months, after phase 3). Chronic tendinitis is often caused when the severity of the initial injury is underestimated and the treatment inappropriate. Chronic tendinitis is treated using similar principles starting with phase 2. Tendon splitting and other surgical approaches have been used in selected cases to enhance the prognosis.

Simultaneous Occurrence of Calcium Pyrophosphate Dihydrate and Basic Calcium Phosphate (Hydroxyapatite) Crystals in a Knee

An 82-year-old man developed periarticular roentgenographic calcifications of the knee joint. Fragments of meniscus and peritendinous tissue were collected during total knee arthroplasty. Crystals were released from tissues by collagenase digestion. Calcium pyrophosphate dihydrate crystals were identified in the meniscus, and basic calcium phosphate crystals were identified in the peritendinous tissue. Methods of crystal identification included compensated polarized light microscopy, scanning electron microscopy with X-ray energy dispersive analysis, and X-ray diffraction.

Cell morphology and collagen types in equine tendon scar

The histological appearance of cells and tissues in the reparative scar tissue which forms in the equine superficial flexor tendon following partial rupture was compared to that of normal tendon. The repair fibroblasts were found to be larger and more basophilic than the tenocytes of normal tendon, to have large vesicular nuclei and to resemble the 'myofibroblasts' described in scar tissue elsewhere. The cell to matrix ratio in scarred zones of tendon was found to be increased and the concentration of collagen in these areas was less than in normal tendon. However, the scar tissue collagen was more readily extractable and contained a different pattern of collagen types. Normal equine tendon was found to be composed almost exclusively of type I collagen whereas the scarred tendon had substantial quantities (20 to 30 per cent) of type III collagen in addition to type I. The presence of type III collagen in the scarred tendon was confirmed by indirect immunofluorescence using antibodies to purified type III collagen. These observations suggest that tendon scar tissue is not derived from proliferating tenocytes but from mesenchymal cells resting in peritendinous connective tissue or blood vessels. As a result of the presence of type III collagen, the scarred tendon is also likely to have less tensile strength than normal tendon.

Total, non-nutritional, and nutritional blood volume in isolated dog hindlimb.

ARTICLESTotal, non-nutritional, and nutritional blood volume in isolated dog hindlimbJJ FriedmanJJ FriedmanPublished Online:01 Jan 1966https://doi.org/10.1152/ajplegacy.1966.210.1.151MoreSectionsPDF (2 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByImpaired microvascular perfusion: a consequence of vascular dysfunction and a potential cause of insulin resistance in muscleMichael G. Clark1 October 2008 | American Journal of Physiology-Endocrinology and Metabolism, Vol. 295, No. 4Nutritive blood flow as an essential element supporting muscle anabolismCurrent Opinion in Clinical Nutrition & Metabolic Care, Vol. 9, No. 3Nutritive and non-nutritive blood flow: rest and exercise5 April 2002 | Acta Physiologica Scandinavica, Vol. 168, No. 4Blood flow and oxygenation in peritendinous tissue and calf muscle during dynamic exercise in humans1 April 2000 | The Journal of Physiology, Vol. 524, No. 1Effect of Ischemia on Capillary Pressure and Equivalent Pore Radius in Capillaries of the Isolated Dog Hind LimbCirculation Research, Vol. 35, No. 1Fractional Extraction and Transcapillary Exchange during Continuous and Instantaneous Tracer AdministrationCirculation Research, Vol. 23, No. 2Das Blutvolumen More from this issue > Volume 210Issue 1January 1966Pages 151-156 Copyright & PermissionsCopyright © 1966 by American Physiological Societyhttps://doi.org/10.1152/ajplegacy.1966.210.1.151PubMed5323318History Published online 1 January 1966 Published in print 1 January 1966 Metrics

AN EXPERIMENTAL STUDY OF THE EFFECT OF CORTISONE ON THE HEALING PROCESS AND TENSILE STRENGTH OF TENDONS

1. The daily administration to dogs of ten milligrams of cortisone per kilogram of body weight inhibited excessive formation of peritendinous fibrous tissue. 2. Cortisone administered during the waiting period prior to the delayed suture made approximation of the tendon ends easier than in the control group. 3. The administration of cortisone to dogs in which tendons had been severed and resutured did not prevent end-to-end healing of the tendons. 4. Regeneration of the tendon sheath was delayed during the administration of cortisone. 5. The breaking point of a sutured tendon treated with cortisone was consistently less than in the control tendons. Although the tendons treated with cortisone were 40 per cent. weaker than the controls, healing in both was adequate for function. 6. Gelfilm and gelfoam used locally diminished the peritendinous adhesions during healign of sutured tendons in dogs. 7. Pyromen administered intravenously to dogs diminished the quantity of fibrous tissue around healing tendons.