Healing of subcutaneous tendons: Influence of the mechanical environment at the suture line on the healing process

Abstract

Tendon ruptures remain a significant musculoskeletal injury. Despite advances in surgical techniques and procedures, traditional repair techniques maintain a high incidence of rerupture or tendon elongation. Mechanical loading and biochemical signaling both control tissue healing. This has led some researchers to consider using a technique based on tension regulation at the suture line for obtaining good healing. However, it is unknown how they interact and to what extent mechanics control biochemistry. This review will open the way for understanding the interplay between mechanical loading and the process of tendon healing.

Keywords: Tendon; Healing; Mechanical loading; Mechanotransduction; Rupture; Repair

Core tip: Ruptured tendons heal poorly compared to skin, muscles and bones. Immobilization during repair has been shown to be detrimental for the healing process. Mechanical loading of the tendon callus gives rise to intracellular signaling, increases gene expression and protein synthesis. However, early loading reported clinical complications. A surgical technique based on control of the mechanical environment at the suture line provided satisfactory results. Therefore, understanding the interplay between loading and the healing process seems necessary. This review focuses on the biological processes that regulate tendon repair and timing of mechanical loading during the healing process. How do tendon cells sense mechanical forces?