Reticular Fibers- thin, delicate fibers that form lace-like networks around smooth muscle cells, sarcolemma of striate muscle, and endoneurium of peripheral nerves
Elastic Fibers-occur at varying quantities in CT and contain the protein Elastin; elastic fibers are abundant in some ligaments, large arteries, the trachea, and the dermis of the skin
Connective Tissue Cells
Collagen producing cells
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Fibroblasts
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Myofibroblasts
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Fibroblasts in CT proper
Chondroblasts/Chondrocytes in cartilage
Osteoblasts in bone
Skeletal muscle cells in skeletal muscle
Smooth muscle cells in blood vessels and some organs
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Produce elastic and collagen fibers
Produce glycosaminoglycans which form proteoglycans
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Have properties of fibroblasts and smooth muscle
Produce collagen but contain myofilaments
Abundant at sites of inflammation
Involved in wound closing
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Ground Substance
Contains water, GAGs and Proteoglycans
GAGs are polymers of disaccharide units
GAGs
*attach at one end to a protein core and radiate out from core
*arrangement forms a proteoglycan monomer
*proteoglycan monomers attach to hyaluronic acid to form a proteoglycan aggregate
*GAGs produce negative charge over periphery of proteoglycan monomers which repels adjacent negatively charged monomers as they approach which results in increased tissue stiffness
*GAGs of proteoglycans are also hydrophilic so they attract and hold water which delivers nutrients to cartilage and produces compressive stiffness of cartilage
Major GAGs in CT
Hyaluronic Acid
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CT proper, cartilage and synovial fluid
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Chondroitin 6 sulfate
Chondroitin 4 sulfate
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hyaline and elastic cartilage, bone large blood vessels, and the nucleus pulposus
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Dermatan Sulfate
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tendon, ligament, Fibrocartilage, nerve, arteries and the dermis
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Keratin sulfate
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cornea, cartilage, nucleus pulposus and annulus fibrosus
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Heparin Sulfate
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basal lamina, aorta, lung, liver, smooth muscle, and endoneurium
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Types of Connective Tissue Proper
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Loose (areolar)
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Fibers
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Few loosely arranged collagen fibers
Few reticular and elastic fibers
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Cells
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Fibroblasts, myofibroblasts, macrophages, plasma cells, mast cells, eosinophils, basophils, lymphocytes, fat cells
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Locations
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Superficial fascia, epimysium, myofascia, papillary layer of dermis, tunica adventia of blood vessels
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Functions
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Movement of neurovascular bundles during limb and trunk movement
Movement of adjacent muscles to contract individually
Enlargement of blood vessels
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Dense Irregular
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Fibers
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Densely packed collagen bundles arranged in many different directions
Some elastic fibers
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Cells
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Few fibroblasts
Macrophages
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Locations
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Dermis of skin, periosteum, perichondrium, joint capsules, capsules around organs, aponeurosis
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Functions
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Resists multidirectional tensile and shear forces
Stabilizes joints
Protection
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Dense Regular
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Fibers
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Densely packed collagen bundles in parallel rows running in same direction
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Cells
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Few fibroblasts
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Locations
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Tendons, ligaments, fascia, aponeuroses
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Functions
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Transmit unidirectional tensile forces
Stabilizes joints
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Elastic Connective Tissue
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Fibers
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Mostly elastic fibers interwoven among collagen fibers
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Cells
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Fibroblasts
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Locations
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Ligamentum flavum, ligamentum nuchael, wall of large arteries, vocal ligaments of larynx
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Functions
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Dampen high pressure in arteries
Return structures to resting position
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Biomechanics of Fibers
Collagen
-shows very little elongation in tension but bends in compression
-greater resistance to shear stress than elastic fibers
-structures such as tendons that transmit muscular forces and ligaments that provide joint stability are composed mainly of collagen fibers making them strong and stiff in tension
Elastic
-less stiff than collagen fibers
-easily elongate 1.6-2.0 times when tension is applied
Tendon/Ligament Stress-Strain Curve
-Toe region: collagen fibers on slack so that small stresses produce great deformation as fibers tighten
-Linear/Elastic region: collagen fibers tightening and as they tighten greater stress is needed to produce deformation/strain
-Progressive failure: some collagen fibers break and then material is damaged and permanently deformed; small increase in stress results in proportionately large deformation
-major failure: most of the collagen fibers are broken and the material is weak and permanently deformed; maintained or decreased stress continues to produce a proportionately large deformation
-rupture: all collagen fibers are broken
Tendon/Ligaments response to rate of stress
As rate of applied tension on a tendon/ligament increases, increased stiffness and decreased elongation result
Suggests that elongation of ligaments/tendons is best obtained by applying low force for long durations
As magnitude of stress increases with time, tendon/ligament may respond by adding collagen and increasing the number of cross-links which = increased strength
Tension on tendons/ligaments at sub-failure levels stimulates fibroblasts to produce new collagen fibers
Surgically repaired tendons/ligaments show accelerated healing with tension, increased strength of CT scar at repair site and direction of orientation of collagen fibers along the direction of stress
Additional new collagen fibers results in increased thickness and stiffness of that structure
Body strengthens tendons/ligaments to match the demands of increased muscle force and increased joint straction that occur with resistive exercise, increased workloads, and with growth
Stiffness of collagen in tension changes with temperature- cold makes collagen brittle; heat makes collagen extensible; cold with low tensile loads breaks prematurely/heat with low tension elongate farther than normal before breaking
Creep and Load Relaxation
-tendons and ligaments are viscoelastic materials and thus show phenomena for creep and load relaxation
-creep is an increase in deformation that occurs over time when the load is constant
-load relaxation is a decrease in stress over time when the magnitude of the deformation is constant
-both creep and load relaxation are the result of reorganization of the collagen and proteoglycans in the material
Tendon and Ligament Injury
-high levels of tension applied to tendons and ligaments will not produce failure of all collagen fibers at the same time…there will be microfailure (some collagen fibers fail)
-microgailutrs cause some pain and weakness in the tendon/ligament but do not cause instability
-where enough collagen is damaged and the tendon passes it’s yield point and there is permanent deformation and noticeable inflammation and joint instability
-when all fibers fail= rupture
-laxity of ligaments causes hypermobility which creates a joint instability. This can causes subluxation or dislocation. Hypermobility exposes the joint surfaces to abnormal forces which produce abnormal wear and degeneration leading to pain and inflammation at both the joint and the soft tissues associated with movement at that joint.
Days 2-4
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Clot forms
Infiltration of macrophages and fibroblasts
Weak and unstable type III collagen produced
Connection is cellular and fragile
Stretching tears connection
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Days 5-21
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Still cellular
Increased collagen production
High collagen synthesis and degradation
Collagen remodeling
Increase ROM and joint function during rehab
Tension helps direct collagen fiber direction, increase strength of connection and increase rate of healing and completeness of healing
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Days 21-60
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Well organized collagen
Fibrous rather than cellular
Increased strength of connection
Increased number of stable bonds or cross links
Decreasing tissue response to treatment with time
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Days 60-360
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Large type I collagen mostly
Connection is mainly collagen
Stable connection
Poor response to treatment
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Tension is important during fibroplasias and consolidation
*activates fibroblast production of collagen
*controls direction of collagen fiber alignment
*produces large collagen bundles
*increases scar strength by increasing alignment, amount, size and stability of collagen
*increases healing rate and completeness of healing
*DAYS 2-21= collagen increases in amount and strength of scar increases
*DAYS 21-60= collagen amount levels off and is fairly constant but strength of the scar increases…fiber alignment, large bundles of collagent forming and increase in cross link formation contribute to strength
*ligament and tendon replacements may need several weeks before they can be loaded in tension…replacement degenerates initially and then starts to heal. New collagen is produced at this point and tension becomes important to align collagen fibers and strengthen and heal the replacement as in regular tendon/ligament healing.
IMMOBILIZATION
~ loss of tissue stiffness and strength
~ 7 weeks of immobilization does not affect ligament or capsule if there is no inflammation
~ if there is inflammation, adhesions and joint involvement occur within 4 weeks of immobilization
~ prevent and quickly elimate joint inflammation when a joint is immobilized
AGING
Stiffness of tendons/ligaments changes with age
Young collagen will elongate more with less force than mature collagen because young collagen is less stiff in tension
As collagen matures, strength and stiffness increase because of increased collagen production and cross-link formation
Advancing age will decrease tensile strength and elasticity of ligaments/tendons
Amount of collagen decrease
Number of large bundles of collagen decreases
Elastic fibers are damaged
Slight until 70 years old (decreases 5% up to 50, another 5% from 50-70, 10% after 70)
With aging, these changes are greater for ligaments than for tendons
CARTILAGE
Typically avascular
Chondrocytes lie in lacuna
Ground substance contains H2O, proteoglycans and collagen
H20 and proteoglycans give cartilage its hardness and its resistance to compression
Collagen provides cartilage’s ability to resist tension
Compaction of ground substance squeezes water from articular cartilage as it deforms. A s cartilage loses water, proteogylcans are compacted. Repelling negative ionic forces occur among the proteogylcans and the rigidity of the ground substance increases.
When articular cartilage is unloaded, proteoglycans draw water back into cartilage and return to it’s pre-loading stiffness.
Proteogylcans interact with H2O to produce stiffness so maintenance of proteoglycans is crucial for normal articular cartilage function.
Loss of proteogylcans greatly reduces the loading capability of the cartilage.
Hyaline cartilage
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Fibers: fine network of type II collagen fibers
Cells: chrondrocytes
Locations: costal cartilage, articular cartilage of joints, epiphyseal growth plate, trachea, skeleton of larynx, nasal septum
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Elastic cartilage
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Fibers: abundance of densely packed elastic fibers interwoven among type II collagen fibers
Cells: chondrocytes
Locations: auricle of ear, epiglottis, Eustachian tube, wall of external auditory canal
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Fibrocartilage
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Fibers: dense network of type I collagen fibers
Cells: chondrocytes
Locations: menisci (knee, SC, TMJ, etc), IVD, disk at pubic symphysis, tendo-osseous junction
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Superficial Tangential zone:
Surface 10-20% of articular cartilage
Collagen fibers parallel to articular surface and tightly interwoven
Tough and durable
Smooth and slippery
Contains proteogylcans within articular cartilage
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Middle Zone:
Middle 40-60% of articular cartilage
Collagen fibers arranged randomly and loosely
High concentration of proteoglycans between loosely arranged fibers
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Deep Zone:
Bottom 30% of articular cartilage
Larger than in superficial and middle zones
Fibers vertical, perpendicular to surface of bone
Penetrate into subchondral bone
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Nutrition:
Articular cartilage is avascular
Nutrition and removal of waste comes from joint loading and unloading
Leave with compression, return with unloading
When superficial zone is damaged, water and proteoglycans are loast and nutrition to the cartilage is decreased
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TENDON STRESS STRAIN RELATIONSHIP
TOE REGION- COLLAGEN FIBERS ARE SLACK BUT BEING LOADED IN TESNION AND ALIGNING IN A DIRECTION TO RESIST TENSION
LINEAR REGION- COLLAGEN FIBERS ARE STRETCHING AND BECOMING MORE AND MORE TENSE AS STRESS INCREASES
FAILURE- COLLAGEN FIBERS BREAK AND CARTILAGE TEARS
TYPE II COLLAGEN IN ARTICULAR CARTILAGE IS LESS DENSE AND FIBERS ARE SMALLER THAN TYPE I COLLAGEN OF LIGAMENTS/TENDONS
WATER AND PROTEOGLYCANS GREATER IN ARTICULAR CARTILAGE THAN IN LIGAMENTS/TENDONS
ARTICULAR CARTILAGE TENDS TO FAIL WITHOUT A YIELD POINT AND PLASTIC REGION
Creep and Stress Relaxation
Articular cartilage is a viscoelastic material and thus undergoes creep and stress relaxation
Creep occurs after initial compression and extrusion of water
Further deformation of articular cartilage in time when constant stress is being applied= creep
Results from collagen and proteoglycans reorganizing to teach an equilibrium state
Load relaxation occurs after initial compression and extrusion of water and when stresses are high toward the surface of the articular cartilage and low at the bottom
With deformation of the articular cartilage remaining constant with time, redistribution of water, proteoglycans and reorganization of collagen occurs
Even redistribution of stresses from surface to bottom of articular cartilage occurs producing a stress equilibrium state
SYNOVIAL JOINT LUBRICATION
Boundary lubrication
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Lubricant/Glycoprotein is in surface layer of articular cartilage
With extreme loading conditions, lubricant is extruded to lubricant articular surface
Last method for protection of articular surface when other methods fail
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Hydrodynamic lubrication
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Used in joints where opposing joint surfaces are not parallel to each other
Synovial fluid drawn between surfaces as opposing articular surfaces move on each other
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Squeeze film lubrication
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Used in joints where opposing surfaces are parallel to each other
Synovial fluids tend to pool in concave surface of joint and are squeezed out between the joint surfaces when the joint is compressed
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ARTICULAR CARTILAGE WEAR
Interfacial wear
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Adhesive wear
Chronic inflammation and disease may result in adherence of the opposing joint surfaces
Movement pulls and tears at these adhesive areas causing surface wear
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Abrasive wear
Particles of cartilage or bone lying between opposing joint surfaces
Movement compresses particles between joint surfaces and causes abrasion
Crepitus is result of this type of wear
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Fatigue wear
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Repeated stresses of articular cartilage producing tissue failure with time
Generally occurs with age
Can result from low loads of high reps for a long time as with aging
Also results from high loads of high reps of a short time as with sports or occupations
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Impact wear
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Rapid , very high impact loading of joint
Few reps involved
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Articular Cartilage Degeneration
Fibrillation
Early articular cartilage degeneration
Result of fraying of collagen fibers in superficial layer
Cavitation
Cavities form in cartilage between collagen bundles
Vertical splitting
Cavities deepen, clefts in cartilage
Clefts extend as vertical splits from superficial to deep and even to subchondral bone
Continued erosion
Final stage
Cartilage erosion continues in split areas
Articular Cartilage Repair
Natural repair
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Limited due to avascularity
Superficial damage may be repaired but transient (2-3 weeks)
Complete thickness tears extend to subchondral bone- blood from subchondral bone fills split and forms fibrous clot- fibrous scar matures and forms Fibrocartilage-like plug- may last for years
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Surgical drilling
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Imitates natural repair
Modification would be to draw blood from patient and centrifuge it into firbrous paste and spread it over the cavities and splits in articular cartilage rather than drill holes
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Cartilage transplant
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Small amount of healthy cartilage and subchondral bone removed from donor site and ground into paste
Natural growth factors are mixed with paste and it’s spread over damaged area
Patient is NWB for 4wks and uses CPM 6hr/day to allow new cartilage to grow and mature
Forms hyaline-like articular cartilage
Good results
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Joint lubricants
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Hyalgen, orthovisc, synvisc injected into joints for lubrication and to stimulate production of synovial fluid
May also stimulate cartilage growth
Mainly for osteoarthritis
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Fibrocartilage (IVD)
contains gel like nucleus pulposus surrounded by 8-10 rings of Fibrocartilage
innermost rings have loose arrangement of collagen to allow deformation of NP
middle rings are dense collagen with fibers running in one direction
fiber directions of sequential rings are perpendicular
outermost rings are dense and show herrningbone pattern which indicates material is strong in tension and shear
tensile strength
NP- 3kg/m2
Inner rings- 45kg/m2
Middle rings- 53 kg/m2
Outer rings- 80kg/m2
Menisci
Fibrocartilage
Superficial collagen fibers are crossed in herringbone pattern to resist tension and shear
Deep fibers run circumferentially to strength menisci in anteriorposteriorly direction tension
With compression, proteogylcans can resist compression but shear and anterioposterior and med/later tension is resisted by collagen
Function
Increase surface area for force distribution which decreases unit forms on femoral head and tibial condyles
Increase surface area for lubrication of condyles
Joint proprioception because anterior and posterior horns are innervated
Blood supply
Only in peripheral 10-30% in teens and adults
Central 70-90% is avascular
Stress/Strain Properties and Aging
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