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Healing Processes of the Tendon

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Book cover The Lower Limb Tendinopathies

Part of the book series: Sports and Traumatology ((SPORTS))

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Abstract

The biological principles on which the healing process of the tendon is based are quite different from the biological principles that regulate the muscle healing process, although some aspects may be considered as similar. Especially the last stage, namely, the remodeling and maturation phases, is very different especially regarding the temporal length that in the tendon, in respect to the muscle, is much greater. However the healing process between the tendon and the muscle will not only differ in the length time. In effect, the extrinsic and intrinsic healing mechanisms are a peculiar feature of the tendon healing that have no similarity with what occurs in the muscle during its healing process. Therefore it is of fundamental importance, especially after tendon surgical treatment, to know the biological principles that guide the healing process of the tendon.

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Notes

  1. 1.

    Tryptase is a proteolytic enzyme present in mast cell granules.

  2. 2.

    The myofibroblasts are connective tissue cells with contractile capabilities similar to the smooth muscle. Discovered in 1970, at these cells, an important role is recognized in the process of wound healing, tissue fibrosis, and pathological fascia contractures. Their evolution generally occurs from normal fibroblasts to proto-myofibroblasts, until the complete differentiation into myofibroblasts and to end to a terminal apoptosis that is influenced by mechanical tension, cytokines, and specific proteins from the extracellular matrix.

  3. 3.

    NO synthase is an enzyme distributed almost ubiquitously in tissues and in living organism in general that provides to produce NO starting from arginine that is converted to citrulline (intermediate metabolite of the urea cycle).

  4. 4.

    The protein scleraxis (Locus: Chr. 8 q24.3) is a member of the superfamily of transcription factors basic helix-loop-helix (bHLH). It is expressed in mature tendons and ligaments of the limbs and trunk but also in their progenitors. The gene coding for Scx is expressed in all the connective tissues that mediate the connection of the muscle to the bone structure, as well as in their progenitors that are found in primitive mesenchyme.

  5. 5.

    A dimer is a molecule formed by the union of two subunits (called monomers) of an identical chemical nature (homodimer) or of a chemical nature different (heterodimer).

  6. 6.

    An E-box is a DNA sequence that is typically located upstream of a gene in a “promoter region.”

  7. 7.

    In molecular biology and bioinformatics, a “consensus sequence” refers to the most common amino acid or nucleotide in a particular position after more aligned sequences.

  8. 8.

    Somite [from the Greek “soma,” body-ite], in embryology, is each of the segments in which it divides the dorsal mesoderm (or epimer), left and right of the spinal column. The somites give rise to elements that will form the dermis of the skin of the trunk (dermatomes), the muscles (myotomes), and the axial skeleton (sclerotomi).

  9. 9.

    The myogenic regulatory factors are transcription factors belonging to the family “basic helix-loop-helix” (bHLH), because they contain a basic domain involved in binding to the DNA and a domain HLH needed to form homodimers or heterodimers with other proteins containing HLH domains. The bHLH motif is found in many transcription factors that are ubiquitously expressed in a tissue-specific manner.

  10. 10.

    The MyoD gene encoding a transcription factor involved in the differentiation of the muscle, in particular, induces fibroblasts to differentiate into myoblasts.

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Authors and Affiliations

  1. Qatar Orthopaedic and Sports Medicine Hospital, FIFA Center of Excellence, Doha, Qatar

    Gian Nicola Bisciotti

  2. Humanitas Clinical Institute, IRCCS, Rozzano, Milan, Italy

    Piero Volpi

  3. FC Internazionale Medical staff, Milan, Italy

    Piero Volpi

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    Giannicola Bisciotti

  2. Medical Departement FC. Internazionale, Istituto Clinico Humanitas Milano (Italy), Milano, Italy

    Piero Volpi

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Bisciotti, G.N., Volpi, P. (2016). Healing Processes of the Tendon. In: Bisciotti, G., Volpi, P. (eds) The Lower Limb Tendinopathies. Sports and Traumatology. Springer, Cham. https://doi.org/10.1007/978-3-319-33234-5_2

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