Tendon Problems

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This review highlights the structure, blood supply, and biomechanics of tendons. The basic science, diagnosis, and treatment of Achilles tendinosis and rupture are presented. Literature of the past year supports that diagnostic ultrasonography and treatment with steroid iontophoresis are cost effective. Data support the hypothesis that open repair of the Achilles tendon with early restricted plantar flexion range of motion and weight bearing shortens rehabilitation time. Percutaneous Achilles tendon lengthening in the adult stiff ankle is effective. Magnetic resonance imaging of posterior tibial tendinosis is reviewed. In the rheumatoid foot, there is a high correlation between flatfoot deformity and subtalar (sinus tarsi) synovitis, but low correlation to posterior tibial rupture. Several papers report that medial displacement calcaneal osteotomy and lateral column lengthening decrease forces on the medial column in the cadaver foot. The association of peroneus longus tendinosis with zones of compression around the fibula, calcaneus, and cuboid were reported. Magnetic resonance imaging studies correlate abnormalities of the ostrigonum, lateral talar tubercle, and flexor hallucis longus synovitis to posterior ankle impingement. Immunofluorescent antibody techniques quantitate that the anterior tibial tendon has an avascular area, on the anterior compressed half of the tendon, that corresponds to the area of clinical rupture. Lastly, three articles are presented that review the fields of tendon tissue engineering and collagen molecular biomechanics.





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Department of Surgery, Department of Surgery Faculty

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