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Healing of various Tissues Review of tissue Injuries Ligament Sprains A ligament is a tough ,relatively inelastic band of tissue that connects bone to bone Function three fold To provide stability To provide control of position To provide proprioceptive input sense of its position Ligament Sprains Ligament is torn - ends are frayed , approximation of these ends will help to determine healing Sprained Extra-articular ligaments bleeding will occur in a subcutaneous space Sprained intra-articular ligaments bleeding will occur inside the joint capsule Remodeling 6 weeks – 12 months , normal strength can take up to a year to be restored Factors Affecting Ligament Healing Actively exercised ligaments are stronger than immobilized ligaments Therefore it is important to minimize immobilization periods It is not likely that the inherent stability of the joint will be regained Therefore other surrounding structures must be strengthened Fractures to Bone Extremely common in sports, classified as either OPEN or CLOSED Varieties of fractures Greenstick Transverse Oblique Spiral Comminuted Impacted Avulsed Stress Bone Healing Time required for healing is variable 3-4 months fracture healed but remodeling still occurring 12 weeks normal strength attained Healing does depends on location , severity of fracture, age of patient Cartilage Damage Arthrosis is primarily a degeneration process with destruction of the cartilage Chondromalacia- is the non-progressive transformation of cartilage with irregular surfaces and areas of softening Cartilage Healing Cartilage has a relatively limited healing capacity Depends on three variables -depth of defect -maturity of cartilage -Location of defect Poor vascular supply Reparative procedures – clean the joint – repair the joint – restore the joint Replace the joint Muscle strains Muscle is Elastic Extensible Excitable Contractible Damage may occur in the muscle, at the musculotendinous junction or in the tendon Three grades Muscle healing Muscle does have unique ability to regenerate if damage small enough Larger muscle injuries unable to regenerate must resort to scar tissue Remodeling 6-weeks to 6 months for 90 % healing Incapacitating muscle strains often occur in large force producing muscles ( quads , hamstrings) Hamstrings may require at least 6- 8 weeks and considerable amount of patience Attempts to return to soon frequently cause re-injury to the area and then the healing process must start again Tendinitis Most common overuse problem is tendinitis Tendinitis is a catch all term used to describe many different pathological conditions of a tendon It essentially describes any inflammatory response with in the tendon Tendon healing Formation of a scar , important that it does not become thick , and dense, this may limit the gliding of the tendon The resulting scar tissue must be able to allow normal ROM and muscle activity Remodeling 40 – 50 weeks for 85-95 % healing