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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 4, 557-564.
doi: 10.1302/0301-620X.91B4.21580  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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The influence of the mechanical environment on remodelling of the patellar tendon

A. P. Rumian, MA, FRCS(Tr and Orth), Specialist Registrar1; E. R. C. Draper, PhD, Principal Orthopaedic Bioengineering Fellow2; A. L. Wallace, PhD, FRACS, Consultant Orthopaedic Surgeon and Honorary Clinical Senior Lecturer3; and A. E. Goodship, BVSc, PhD, MRCVS, Professor of Orthopaedic Science2

1 St Mary’s Hospital, Praed Street, Paddington, London W2 1NY, UK.
2 Institute of Orthopaedics and Musculoskeletal Science, University College, London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
3 Shoulder Unit Hospital of St John and St Elizabeth, 60 Grove End Road, London NW8 9NH, UK.

Correspondence should be sent to Mr A. P. Rumian; e-mail: adam.rumian{at}yahoo.co.uk

An understanding of the remodelling of tendon is crucial for the development of scientific methods of treatment and rehabilitation. This study tested the hypothesis that tendon adapts structurally in response to changes in functional loading. A novel model allowed manipulation of the mechanical environment of the patellar tendon in the presence of normal joint movement via the application of an adjustable external fixator mechanism between the patella and the tibia in sheep, while avoiding exposure of the patellar tendon itself. Stress shielding caused a significant reduction in the structural and material properties of stiffness (79%), ultimate load (69%), energy absorbed (61%), elastic modulus (76%) and ultimate stress (72%) of the tendon compared with controls. Compared with the material properties the structural properties exhibited better recovery after re-stressing with stiffness 97%, ultimate load 92%, energy absorbed 96%, elastic modulus 79% and ultimate stress 80%. The cross-sectional area of the re-stressed tendons was significantly greater than that of stress-shielded tendons.

The remodelling phenomena exhibited in this study are consistent with a putative feedback mechanism under strain control. This study provides a basis from which to explore the interactions of tendon remodelling and mechanical environment.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General