Composition of Tendon and Ligament

Most tendons and ligaments are made of protein (collagen and elastin) and polysaccharide (proteoglycans). The composition allows them to stretch significantly when they move, such as when the elbow is bent or straightened. The main cell type found in tendon and ligament tissue is the fibroblast. Fibroblasts have a spindle-shaped morphology, are sparsely distributed throughout the tissue, and align in columns along the direction of the collagen fibers (see Fig. 6.14) [165].

Diseases of Tendon and Ligament

Achilles tendon rupture is a frequent injury with an increasing incidence. Surgical treatment of tendon ruptures is currently the most common therapeutic modality. Until now, there is no consensus regarding optimal treatment of tendon ruptures [166]. Tendon repair is a slow process in order to reestablish the tendon fiber continuity and the normal tissue function. The low cell density (5%), scarce oxygen and nutrient supply, and abnormal collagen deposition lead to scar tissue formation and adhesion [167, 168].

Relationship between a collagen bundle and fibroblasts

Fig. 6.14 Relationship between a collagen bundle and fibroblasts. The collagen bundle is comprised of individual collagen fibrils that tightly surround the cells [165] (Copyright permission from Elsevier Science Ltd)

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