Therapeutic Interventions Week 4 - Flexibility and Therapeutic Exercise Framework
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Questions and Answers

During which phase of tendon healing do fibroblasts align parallel to the lines of force applied to the tissue?

  • Inflammatory
  • Proliferative (correct)
  • Remodeling
  • None of the above

    • What is the primary characteristic of the inflammatory phase in both tendon and ligament healing?

  • Removal of damaged tissue by phagocytic cells (correct)
  • Orientation of collagen along lines of stress
  • Collagen maturation and alignment
  • Fibroblast proliferation and extracellular matrix production

    • Which of the following is NOT a characteristic of the remodeling phase of tendon healing?

  • Phases happen at the same time in different places of the tissue and overlap
  • Collagen content increases
  • Collagen matures and assumes functional linear alignment
  • Fibroblasts align parallel to lines of force (correct)

    • What is the PRIMARY difference between the proliferative phases of tendon and ligament healing?

    <p>Ligament healing involves a greater degree of collagen orientation along lines of stress during this phase. (B)</p> Signup and view all the answers

    How long does the inflammatory phase typically last in ligament healing?

    <p>Approximately 5 days (D)</p> Signup and view all the answers

    Why is there no spontaneous healing in the avascular zone of fibrocartilage?

    <p>The avascular zone lacks a blood supply, preventing cell migration and nutrient delivery. (B)</p> Signup and view all the answers

    Which of the following statements about the remodeling phase in ligament healing is TRUE?

    <p>The tissue's structure becomes more organized and able to resist greater stress during this phase. (D)</p> Signup and view all the answers

    Which of these tissues DOES NOT have a distinct inflammatory phase in its healing process?

    <p>Fibrocartilage (A)</p> Signup and view all the answers

    What is the primary characteristic of the proliferative phase of articular cartilage healing?

    <p>Production of type II collagen, proteoglycans, type I collagen, and non-collagenous proteins. (B)</p> Signup and view all the answers

    Which of these is NOT a characteristic of indirect fracture healing?

    <p>Requires anatomical reduction of fractured ends. (D)</p> Signup and view all the answers

    What is the significance of the recruitment of mesenchymal stem cells (MSCs) during the inflammatory phase of indirect fracture healing?

    <p>MSCs differentiate into osteoblasts, which lay down new bone tissue. (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the remodeling phase of indirect fracture healing?

    <p>Formation of a soft callus of spongy bone. (A)</p> Signup and view all the answers

    During which phase of articular cartilage healing does the matrix primarily consist of type II collagen, proteoglycans, type I collagen, and non-collagenous proteins?

    <p>Proliferative phase. (B)</p> Signup and view all the answers

    Which type of fracture healing requires intimate contact of the fractured ends?

    <p>Direct healing. (C)</p> Signup and view all the answers

    What is the primary difference between chondral and osteochondral injuries in terms of healing potential?

    <p>Osteochondral injuries involve the underlying bone, which has a blood supply and promotes healing. (B)</p> Signup and view all the answers

    During which phase of indirect fracture healing does angiogenesis occur?

    <p>Inflammatory phase. (A), Reparative phase. (B)</p> Signup and view all the answers

    Which of the following processes does NOT contribute to the formation of a soft callus during the reparative phase of indirect fracture healing?

    <p>Mineralization of the cartilaginous callus. (D)</p> Signup and view all the answers

    Which stage of indirect fracture healing peaks at approximately 7-9 days post-trauma?

    <p>Reparative phase. (B)</p> Signup and view all the answers

    Flashcards

    Tendon Healing Phases

    Stages of healing in tendons: Inflammatory, Proliferative, Remodeling.

    Inflammatory Phase of Tendon Healing

    First phase (~1 week) where macrophages clean damaged tissue and granulation tissue forms.

    Proliferative Phase of Tendon Healing

    Middle phase (~1-5 weeks) where fibroblasts align parallel, collagen increases.

    Remodeling Phase of Tendon Healing

    Final phase (~2-4 months) where collagen matures and aligns functionally.

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    Ligament Healing Phases

    Stages of healing in ligaments: Inflammatory, Proliferative, Remodeling.

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    Inflammatory Phase of Ligament Healing

    First phase (~5 days) where damaged tissue is removed and fibroblast activity stimulated.

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    Proliferative Phase of Ligament Healing

    Middle phase (~Day 5 - Week 6) where fibroblasts multiply and collagen is produced.

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    Fibrocartilage Healing

    Healing process for fibrocartilage (e.g., meniscus) is challenging; no spontaneous healing in avascular zones.

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    Phases of Wound Healing

    Inflammatory, Proliferative, and Remodeling phases describe healing.

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    Chondral Injury

    A defect in articular cartilage that does not heal due to no blood vessels.

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    Osteochondral Injury

    A defect in both bone and cartilage that can heal due to blood vessel proximity.

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    Indirect Fracture Healing

    Common healing type requiring micro-motion and blood supply, without rigid stability.

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    Direct Fracture Healing

    Requires anatomical reduction and intimate contact between fractured ends.

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    Inflammatory Phase of Healing

    Initial response involving hematoma formation and macrophage activity.

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    Reparative Phase

    Formation of cartilaginous callus and revascularization at the injury site.

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    Remodeling Phase

    Final phase where bone is gradually rebuilt over months to years.

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    Role of MSCs

    Mesenchymal stem cells are crucial for new bone cell formation.

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    Healing Time for Bones

    Small bones take 3-6 weeks; large bones 8-12 weeks to heal.

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    Study Notes

    Tissue Healing Mechanisms and Timelines

    • Tendon Healing:

      • Inflammatory Phase (~1 week): Macrophages clear damaged tissue, new blood vessels (capillaries) and fibroblasts proliferate, laying down new tissue. Fibroblasts initially align perpendicular to the tendon's fibers, followed by the parallel alignment that aligns with directional forces.
      • Proliferative Phase (~1-5 weeks): Fibroblasts align parallel to the direction of the tendon's forces. Collagen content dramatically increases in the collagen fibers.
      • Remodeling Phase (~2-4 months): Collagen matures and assumes functional alignment, ultimately becoming suited to the stresses placed on the tendon. Phases overlap and occur concurrently in different parts of the tissue.

    • Ligament Healing:

      • Inflammatory Phase (~5 days): Phagocytic cells remove injured tissues. Chemicals are released to stimulate fibroblast activity.
      • Proliferative Phase (~Day 5 – Week 6): Fibroblasts multiply, producing extracellular matrix and collagen. Initially, collagen is immature and randomly organized, but develops sufficient strength (to resist forces) within 2-3 weeks. Normal collagen levels are reached by week 6.
      • Remodeling Phase (~4+ weeks): Collagen reorganizes along stress lines. The structure becomes more organized to withstand more significant stress.

    • Fibrocartilage (Meniscus) Healing:

      • Inflammatory and Proliferative (~ up to 10 weeks): No spontaneous healing in the avascular zone (no blood supply). Within the vascular zone, fibrin clot formation and macrophage activity occurs to clear damaged tissue. Undifferentiated mesenchymal cells migrate, proliferate and fill the lesion with fibrovascular scar tissue.
      • Remodeling Phase (~Weeks 10+): Remodeling to the normal meniscal structure takes several months.

    • Articular Cartilage Healing:

      • Chondral vs. Osteochondral Injuries: Chondral (cartilage alone) injuries rarely heal due to lack of blood vessels (avascular). Osteochondral injuries (involving underlying bone) might heal due to the proximity of blood vessels in the bone.
      • Inflammatory Phase (~0-2 weeks): Blood vessels from the bone defect extend into cartilage forming a fibrin clot. Undifferentiated mesenchymal cells migrate and form new tissue matrices.
      • Proliferative Phase (~2-6 weeks): Matrix composition includes type II collagen, proteoglycans, type I collagen, and non-collagenous proteins.
      • Remodeling Phase (~6+ weeks): Forms a structure between fibrocartilage and hyaline cartilage. However, long-term healing may not completely recover and show proteoglycan depletion and cartilage damage over time.

    • Bone Healing:

      • Types of Fracture Healing:

        • Indirect (Secondary): Most common, no precise anatomical reduction needed, heals via micro-motion and weight-bearing.
        • Direct: Requires precise anatomical reduction, tight contact of bone ends, and rigid stability.

      • General Stages:

        • Inflammatory: Hematoma formation, macrophage activity, angiogenesis (blood vessel formation). Mesenchymal Stem Cells are recruited. (Duration: ~0-7 days, peak in 24 hours)
        • Reparative: Soft callus formation (cartilage and periosteal), vascularization, mineralisation and conversion to hard callus. (~7-14 days)
        • Remodeling: Hard callus resorption, formation of lamellar bone, and medullary cavity formation. (Duration: Several weeks to years depending on size and location of the fracture) Stimulated by piezoelectric effect (pressure-induced electrical polarity).

      • Healing Time:

        • Small bones: 3-6 weeks
        • Large bones: 8-12 weeks (children and adults, roughly)

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    Description

    Explore the intricate processes involved in tendon and ligament healing through their distinct phases. This quiz delves into the inflammatory, proliferative, and remodeling phases, highlighting the cellular activities and timelines associated with each. Test your knowledge on how tissues recover and adapt to stress.

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