Annual Review of Biomedical Engineering 2000; Vol. 2; pp. 83–118

Savio L-Y Woo, Richard E. Debski, Jennifer Zeminski, Steven D Abramowitch, Serena S Chan Saw, and James A Fenwick: from the Department of Orthopaedic Surgery, University of Pittsburgh. This study cites 121 references.

In the intricate landscape of musculoskeletal health, tendons and ligaments play pivotal roles, providing both motion and stability to joints. When these soft connective tissues sustain injuries, the journey to healing is a nuanced and complex process, influenced by various factors. This exploration delves into the key points from recent studies, unraveling the phases of ligament healing, shedding light on tendon injuries, and examining the crucial role of controlled mobilization in the rehabilitation process.

1. Ligament Healing: A Multifaceted Process

  • Ligament healing is a protracted and intricate process influenced by both local and external factors.
  • Phases include the acute inflammatory response, regenerative repair, and tissue remodeling, extending up to a year or longer.

2. Surgical Repair and Immobilization

  • Surgical intervention becomes necessary when torn ligament ends are not in close proximity.
  • Immobilization post-surgery aims to protect tissues but may lead to detrimental side effects, including synovial adhesions.
  • Clinical studies highlight favorable responses to conservative treatment without immobilization.

3. Challenges of Multiple Ligament Injuries

  • The clinical outcome of multiple ligament injuries tends to be less successful, presenting challenges in rehabilitation.

4. Intrinsic Healing Capacity of Ligaments and Tendons

  • Some ligaments demonstrate poor intrinsic healing capacity, failing to heal after rupture, while others heal with inferior properties.
  • Tendons are frequently injured, with tendinitis accounting for a significant portion of occupational and sports-related issues.

5. Tendinitis: Balancing Conservative Treatment and Surgery

  • Conservative treatment, including rest and therapeutic exercises, proves effective for the majority in tendinitis cases.
  • Surgical intervention becomes necessary for those not recovering satisfactorily with conservative protocols.

6. Tendon Overload and Inflammatory Response

  • Tendon overload can increase insulin-like growth factor-1 (IGF-1) expression, contributing to tendinitis development.
  • Repetitive overloading causes micro-injuries with subsequent inflammatory responses, primarily driven by inflammatory mediators.

7. Controlled Early Mobilization in Tendon Healing

  • Controlled early mobilization of injured tendons reduces adhesion formation and accelerates healing.
  • Prolonged immobilization results in adhesion formation, decreased range of motion, and lower stiffness and strength in repaired tendons.

8. Postoperative Management and Rehabilitation

  • Postoperative management involves splinting and controlled mobilization, with early passive mobilization showing positive outcomes.
  • Unrestricted active postoperative rehabilitation does not adversely affect healing when compared with passive mobilization.

9. Achilles’ Tendon Repair and Ligament Injury Treatment

  • Nonsurgical Achilles’ tendon repair carries a high incidence of re-rupture compared to surgical treatment.
  • Ligament injuries, when stable, are generally treated nonoperatively with early controlled mobilization and rehabilitation.

10. MRI in Tendon Assessment and the Role of Mobilization

  • MRI proves effective in determining tendon ruptures and detecting tendinosis, indicating tendon degeneration.
  • Controlled passive mobilization enhances the quality of repair and stimulates intrinsic healing capabilities.

As science continues to illuminate the intricacies of tendon and ligament healing, the importance of individualized and evidence-based approaches to rehabilitation becomes paramount. From the acute phases of injury to the controlled mobilization crucial for optimal recovery, these insights pave the way for more effective management strategies, ensuring individuals can navigate the path to recovery with improved outcomes and restored functionality.