Principles of Tendon Structure, Healing, and the Microenvironment

Tendon is a strong viscoelastic tissue, responsible for conducting force from muscle to bone. In the hand, flexor tendons course through fibro-osseous sheaths, composed of an intricate tenosynovium and fibrocartilaginous pulley system. After flexor tendon laceration, changes occur in tendon force transduction as well as vascularity , affecting tendon healing on a tissue and cellular level. Tendon healing occurs through intrinsic and extrinsic mechanisms, which in combination with local anatomy , can predispose to adhesion formation. Understanding the relationship between microenvironmental cues and tendon healing on the cellular and tissue level will improve our knowledge and treatment of flexor tendon injuries .