Biomechanics of Tendons and Tendon Failure

ABSTRACT

Research into the biomechanical properties of tendons had led to a better understanding of the functional and pathophysiologic processes that occur in vivo, particularly in the setting of tendon injury and failure. Increasingly, biomechanical information is being utilized in the clinical setting, guiding patient management in certain circumstances. Differentiating minor and self-limiting abnormalities from those in which specific treatment may prevent further disability from altered biomechanics may become an important role for imaging. This article examines normal tendon anatomy and its relationship to tendon biomechanics under both physiological and pathologic conditions. Imaging characteristics of tendons in the physiologic and pathologic states are discussed. We have focused primarily on MRI, as this modality has been studied most intensively and has been shown to offer additional information regarding unsuspected pathology.

KEYWORDS

Tendon biomechanics - tendon failure - tendon anatomy

REFERENCES

• 1 Jozsa L, Kannus P, Balint B J. Three-dimensional ultrastructure of human tendons.  Acta Anat . 1991;  142 306
• 2 Kastelic J, Galeski A, Baer E. The multicomposite structure of tendon.  Connect Tissue Res . 1978;  6 11
• 3 Elliott D H. Structure and function of mammalian tendon.  Biol Rev . 1965;  40 392
• 4 O'Brien M. Structure and metabolism of tendons.  Scand J Med Sci Sports . 1997;  7 55
• 5 Jozsa L, Lehto M, Kvist M. Alterations in dry mass content of collagen fibers in degenerative tendonopathy and tendon rupture.  Matrix . 1989;  9 140
• 6 Tidball J G, Daniel T L. Myotendinous junction of tonic muscle cells: structure and loading.  Cell Tissue Res . 1986;  245 315
• 7 Tidball J G. Myotendinous junction injury in relation to junction structure and molecular composition.  Exerc Sport Sci Rev . 1991;  19 419
• 8 Jarvinen M, Kannus P, Kvist M. Macromolecular composition of the myotendinous junction.  Exp Mol Pathol . 1991;  55 230
• 9 Jozsa L, Kannus P. Human Tendons. Anatomy, Physiology, and Pathology Champaign, IL: Human Kinetics 1997
• 10 Petersen W, Stein V, Tillman B. Blood supply of the tibialis anterior tenbdon.  Arch Orthop Trauma Surg . 1999;  119 371-375
• 11 Butler D L, Grood E S, Noyes F R. Biomechanics of ligaments and tendons.  Exerc Sport Sci Rev . 1978;  6 125
• 12 Best T M, Garrett W E. Basic science of soft tissue: muscle and tendon. In: DeLee JC, Drez D, eds. Orthopaedic Sports Medicine Philadelphia: WB Saunders 1994: 1
• 13 Hubbard R P, Chun K J. Mechanical responses of tendons to repeated extensions and wait periods.  J Biomech Eng . 1988;  110 11-19
• 14 O'Brien M. Functional anatomy and physiology of tendons.  Clin Sports Med . 1992;  11 505
• 15 Fung Y. Stress-strain-history relations of soft tissue in simple elongation. In: Fung YC, Perrone N, Anliker M, eds. Biomechanics: Its Foundations and Objectives Englewood Cliffs, NJ: Prentice-Hall 1993: 181-208
• 16 Pradas M M, Calleja R D. Nonlinear viscoelastic behaviour of the flexor tendon of the human hand.  J Biomechanics . 1990;  23 773-781
• 17 Clark R A, Henson P M. The Molecular and Cellular Biology of Wound Repair New York: Plenum Press 1988
• 18 Leadbetter W B. Cell-matrix response in tendon injury.  Clin Sports Med . 1992;  11 533-577
• 19 Frank C, Amiel D. Normal ligament properties and ligament healing.  Clin Orthop . 1985;  196 15-25
• 20 Hamada K, Tomonaga A, Gotoh M. Intrinsic healing capacity and tearing process of torn supraspinatus tendons: in situ hybridization study of (1(I) procollagen mRNA.  J Orthop Res . 1997;  15 24
• 21 Oxlund H. Relationships between the biomechanical properties, composition and molecular structure of connective tissues.  Connect Tissue Res . 1986;  15 65-72
• 22 Frey C, Shereff M. Tendon injuries about the ankle in athletes.  Clin Sports Med . 1988;  7 103
• 23 Plecko M, Passi R. Ruptures of the Achilles tendon: causes and treatment.  J Finn Orthop Trauma . 1991;  14 201
• 24 Kannus P, Jozsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients.  J Bone Surg Am . 1991;  73 1507
• 25 Kannus P, Natri A, Jozsa L. Aetiology and pathogenesis of chronic tendon injuries in sports.  Clin Orthop . 1997;  2 25
• 26 Amadio P C. Tendon and ligament. In: Cohen IK, Diegelmann RF, Lindblad WJ, eds. Wound Healing: Biochemical and Clinical Aspects Philadelphia: WB Saunders 1992: 384
• 27 Woods L, Leach R E. Posterior tibial tendon ruptures in athletic people.  Am J Sports Med . 1991;  19 495-498
• 28 Nirschl R P. The etiology and treatment of tennis elbow.  Am J Sports Med . 1974;  2 308-319
• 29 Goldie I. Epicondylitis lateralis.  Acta Chir Scand . 1964;  339 77-113
• 30 Mann R A, Casillas M M, Coughlin, M J. The foot and ankle tendons. In: Garrett WE Jr, Speer KP, Kirkendall DT, eds. Principles and Practice of Orthopaedic Sports Medicine Philadelphia: Lippencott Williams and Wilkins 2000: 979-1010
• 31 Stone D, Green C, Rao U. Cytokine-induced tendinitis: a preliminary study in rabbits.  J Orthop Res . 1997;  17 168-177
• 32 Goncalves-Neto J, Witzel S S, Teodoro W R. Changes in collagen matrix composition in human posterior tibial tendon dysfunction.  Joint Bone Spine . 2002;  69 189-194
• 33 Mosier S M, Pomeroy G, Manoli A. Pathoanatomy and etiology of posterior tibial tendon dysfunction.  Clin Orthop . 1999;  365 12-22