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Tendinopathies in lower extremities (legs)

Tendons are anatomical structures located between the muscle and the bone, whose function is to transmit the force generated by the muscle to the bone, giving rise to the joint movement.

Tendons are composed mostly of collagen (30%) and water (68%), with a small proportion of elastin (2%). On the other hand, the vascularization of the same is limited, but increases during the exercise and before the healing processes.

The term “tendinitis” itself refers to an inflammatory situation, therefore, currently tend to evolve with the concept of tendinopathies as a general and global entity (in which not always histological studies have shown inflammatory processes with markers of inflammation in the associated injury).

Currently and following the guidelines of the International Rheumatology Association, tendinopathies are classified according to the inflammation process:

  • Inflammatory tendinopathies: Paratendinitis (inflammation of the paratendon, synovial covered or not, where the component of the edema predominates, due to an insult between the tendon and the sliding tissue. The mainly associated clinic is crepitus, pain, local sensitivity and dysfunction) and Tendinitis (tendon degeneration with tendinous and vascular rupture associated with an inflammatory response to repair. It usually occurs with sudden onset of pain, bruising, external inflammatory symptoms and loss of strength and dysfunction).
  • Noninflammatory tendinopathies: Tendinosis (intratendinous degenerative process without signs of inflammatory response with atrophy, mainly due to aging, microtrauma or vascular compromise, which usually presents with pain, loss of strength, dysfunction and painful tendon nodules) and Injuries due to repetitive efforts or overload.

One of the main characteristics associated with the tendon is its modulation capacity, and therefore its potential ability to return to its basal state included after damage. For this it is important to know the intrinsic, individual, genetic, biomechanical and environmental factors that interact with each other and that prevent and optimize the recovery of the tendinopathies.

The influence of genetics on tendon pathologies is increasingly known, which allows a more exhaustive knowledge of the interpretation of genetic variation, not only in the etiopathogenesis but also in other aspects such as susceptibility, prognosis and the individual response to treatments.

ACHILLES TENDINOPATHY

Achilles tendon is the largest and strongest of the body, connecting the sural triceps with the heel, performing plantar flexion of the foot and participating in the knee flexion. Holds a great tension, and therefore, presents a high risk of injury when doing any movement (running, jumping, speed changes, etc.).

The associated risk factors are usually an excessive use, repetition traumatisms, vascular diseases, genetic predisposition, neuropathies and rheumatological diseases that can cause degeneration of the tendon.

INJURY OF QUADRICEPS TENDONS

Femoral quadriceps is a large, powerful muscle found in the anterior part of the thigh. The muscles and tendons that comprise it form contractile units that stabilize the hip and knee and allow their movement.

Injuries of the muscles and tendons of the quadriceps are common among athletes and active adults. The majority of these injuries can be diagnosed through a careful history and physical examination, and conservative management is successful for the vast majority, including rest, physiotherapy and analgesia.

BREAKAGE OF CRUCIATE LIGAMENTS

The stability of the knee is ensured by four ligaments: the anterior and posterior cruciate ligaments and the lateral and internal lateral ligaments.

The cruciate ligaments are two structures that cross the inside of the knee, join the tibia with the femur and provide stability in the movements of extension and flexion.

There are two types of cruciate ligaments:

Anterior cruciate ligament (ACL, prevents the tibia from moving forward with respect to the femur. Its breakage is the most frequent) and the Posterior cruciate ligament (PCL, its function is to prevent the tibia from moving backwards).

The injury of these ligaments occurs after a sudden change of direction of the knee, an exaggerated deceleration or a contusion. It is usually unilateral and the rupture may be complete or partial, and may be combined with the fracture of other related structures (collateral ligaments, posterior cruciate ligament or meniscus).

Gene or region studied

  • COL1A1
  • COL5A1
  • TNC
  • ADAMTS14
  • MMP3
  • TIMP2
  • GDF5
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