PROLOTHERAPY

Prolotherapy Which Helps People with Damage to Tendons & Ligaments

Prolotherapy Which Helps People with Damage to Tendons & Ligaments

Answer a)

Ligaments and tendons are soft collagenous tissues. Ligaments connect bone to bone and tendons connect muscles to bone. Ligaments and tendons play a significant role in musculoskeletal biomechanics. They represent an important area of orthopaedic treatment for which many challenges for repair remain. A good deal of these challenges have to do with restoring the normal mechanical function of these tissues. Again, as with all biological tissues, ligaments and tendons have a hierarchical structure that affects their mechanical behavior.

Ligaments and tendons are bands of dense connective tissue designed to transmit forces and facilitate joint movement. The knee has four major ligaments: the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL). All four are subjected to large loads during sports- and work-related activities and can be frequently injured. For the ACL, around 100,000 to 200,000 tears occur in the United States each year [19]. It is well known that an ACL midsubstance tear does not heal and the success of nonsurgical management is limited. Thus, surgical reconstruction of the ACL using autografts, such as the bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autografts, is needed to prevent knee instability, which is commonly thought to result in osteoarthritis [1, 2].

Tendons are tough, fibrous cords of connective tissue that link skeletal muscles to bones. Within them, Sharpey's fibres pass through the bone covering (periosteum) to embed in the bone. Tendons in the hands and feet are enclosed in self-lubricating sheaths to protect them from rubbing against the bones. From the hand bones, tendons extend upwards to muscles near the elbow.

Answer b)

Over the years, the BPTB autograft has been often used because it has advantages over other grafts, such as improved knee stability [3,4]. However, complications associated with the donor site, including a persistent defect in the patellar tendon (PT), anterior knee pain, extension deficit, arthrofibrosis, and PT adhesion to adjacent tissues (i.e., the fat pad) [5,6], have resulted in the increased use of HT autografts by surgeons. Yet, many problems are also associated with HT autografts, including slow healing, reduced long-term stability of the knee [7], significant hamstring muscle weakness [8], and bone tunnel enlargement after reconstruction [9]. Thus, reducing the severity of these complications should lead to improved patient outcomes [10]. Interestingly, there is a high propensity for healing of the MCL within the same knee joint. Both clinical and laboratory studies have shown that injuries to the MCL require nonsurgical management [11, 12]. Although the structural properties of the femur-MCL-tibia complex (FMTC) can be restored within weeks, the mechanical properties, histomorphological appearance, and biochemical composition of the healed MCL remain much different from those of the normal MCL [13,14]. Thus, there is a need to improve the healing response over time; once this is accomplished, the findings can be applied to other ligaments and tendons.

Answer c)

Inflammation is always the first response to ...