4 min read Maybe you're a weekend warrior who injured your tendon or ligament while playing a lively game of basketball. Individual tendons and ligaments have unique morphological properties adapted for specific roles. Steven Carlow, MD. OBJECTIVE. The feet are made up of many bones, muscles, and ligaments. The insertion site or “enthesis” The enthesis is defined as the area where tendon, ligament, or joint capsule inserts into bone and acts to transmit tensile load from soft tissues to bone2. Tendons. When using lemongrass, do not apply to open cuts or wounds as it will irritate the raw skin. ACL reconstruction. See More. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. An inversion injury to the ankle may thus not only produce ligament damage to the anterior talofibular and calcaneofibular ligaments but also injury. However, after surgery, there are still many problems that affect healing. Aftercare Outlook What is tendon repair surgery? Tendon repair is surgery done to treat a torn or otherwise damaged tendon. A tendon is a cord of strong, flexible tissue, similar to a rope. Our goal is to get you back in the game. Understanding the development and function of the enthesis organ has implications for surgical repair, particularly in regards to healing and the regulation of tendon to bone engraftment. A bicep tear occurs when one of these tendons becomes either partially or completely severed. This procedure involves replacing the torn ligament with a tendon graft. Orthopedics at L+M Hospital means specialized surgical and non-surgical care to meet each patient’s individual musculoskeletal needs. In this review, we look at. Eight rats in each group were sacrificed with high-dose anesthesia on Day 15 and Day 30. If your extensor tendons are damaged, you'll be unable to straighten 1 or more fingers. The American Academy of Orthopaedic Surgeons estimates about 2. Tendon lesions are in 2nd position (29%), whereas fractures are 1st (42%) and skin lesions 3rd of all patients treated for hand injuries. Tendons and ligaments are connective tissues that help support muscles and bones. -Actions: Actual Tendon & Ligament repair & knitting, removes stasis from damaged areas, promote circulation. Elbow tendonitis is common with many professions. read more. Whatever your needs, our experts work with you to create personalized care plans and provide comprehensive support throughout your treatment. 5 million people suffer from a serious Achilles tendon injury each year, and some 200,000 experience ACL (anterior cruciate ligament) damage in the knee. 1 Introduction. The American Academy of Orthopaedic Surgeons estimates about 2. Project has been submitted: Tendon injuries are common, impacting athletes, laborers, and everyday individuals alike. They have blood vessels and cells to maintain tendon health and repair injured tendon. Care is taken to move muscles, tendons and nerves out of the way. Three key conditions must be present for ligaments to properly remodel or heal: 2osity. The remaining 5–10% consists of chondrocytes, synovial cells (outer sheath), capillary endothelial cells, and arteriolar smooth muscle cells . 5 million people suffer from a serious Achilles tendon injury each year, and some 200,000 experience ACL (anterior cruciate ligament) damage in the knee. Numbness. Tingling. Whatever your needs, our experts work with you to create personalized care plans and provide comprehensive support throughout your treatment. 5 million people suffer from a serious Achilles tendon injury each year, and some 200,000 experience ACL (anterior cruciate ligament) damage in the knee. the tendon crimp, decreases the number of fascicles, and increases the thickness of the endotenon. 17 The authors concluded that scarless repair ability is intrinsic to fetal tendon itself, suggesting that the adult environment is not an impediment to scarless repair. Tendon and ligament are hierarchical structures with an organization that builds from the nanoscale to the centimeter scale, based primarily on the built-up form of type I collagen (Fig. , pain, muscle atrophy, and tendonitis) may still limit the clinical application of TSPCs in regenerating tendon tissue in vivo. 4, overview of tendon structure), early studies showed that rabbit MSCs contract collagen type I carrier gels and that the delivery of these constructs to patellar and Achilles tendon defects improved the biomechanical properties of the repair tissue as compared to acellular controls [375]. 40 Years Experience. In the early '90s, amateur athlete David Graston introduced a variation of this technique in the United States. Come Visit Us: 726 Cowper Street. These well-known dietary supplements are responsible for joint, tendon, and ligament health. 5 million people suffer from a serious Achilles tendon injury each year, and some 200,000 experience ACL (anterior cruciate ligament) damage in the knee. Call: (925) 397-8992. Learn more about our services in Soquel and how we partner with you to create personalized care. 4. Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). In some cases, a tendon (or tendons) is taken from a part of your body that has two tendons but can function with only one. -Tendon & Ligament Healing, Tendon & Ligament Injury, Damage, and Tear Recovery. Abstract. When your muscles can't absorb force, that force has to go -somewhere-! 5. Graft selection in anterior cruciate ligament (ACL) reconstruction is critical, as it remains one of the most easily adjustable factors affecting graft rupture and reoperation rates. It typically requires a relaxing incision and careful dissection near the femoral. A tear can also be complete or partial. [4]. Tendon and/or ligaments such as the rotator cuff tendons (shoulder), the anterior cruciate ligament (ACL; knee), and the Achilles tendon (ankle) are some of the more common sites of musculoskeletal injuries during both competitive and recreational sporting activities. The American Academy of Orthopaedic Surgeons estimates about 2. Because of this, it is also known as a regenerative joint injection or non-surgical ligament and tendon reconstruction. We will finally focus on T/L repair after injury and on genetic diseases responsible for T/L defects. Tendons are tough, stretchy tissues that join muscles to bone. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. Autologous conditioned plasma as therapy of tendon and ligament lesions in seven horses. Understanding of these topics could lead to. Type I collagen from tendon and ligaments was surveyed for prolyl 3-hydroxylation content, as specific substrate sites for this rare modification have been uniquely localized to tendons [15], [31]. . Tenderness when you touch the ankle. Rotator cuff repair. For ligaments and tendons undergoing larger deformations, a single integral finite strain (SIFS) theory has been implemented and used for the patellar tendon and ACL . The control rats received no medication after primary tendon repair. 1. Regenerative Medicine and Rehabilitation for. (View Map) Call Us: 250-383-3413. Glucosamine and Chondroitin. Primary surgical repair is the gold standard modality of care; however, it is highly dependent on the extent of injuries. They have a very high collagen content, mostly Type I collagen [], arranged in a cross-linked triple-helix structure [2,3]. Foot bones. 1]; P ≥ . 2017; 7:11–18. 2 Advances in repair processes and biomaterials for tendon and ligament rupture If a tendon or ligament breaks, the repair process is relatively slow compared with other musculoskeletal tissues. The American Academy of Orthopaedic Surgeons estimates about 2. He graduated from Brown University Alpert Medical School in 1985. 5 million people suffer from a serious Achilles tendon injury each year, and some 200,000 experience ACL (anterior cruciate ligament) damage in the knee. Following surgical repair, physical therapy is almost always recommended. Muscles are shock absorbers. This injury is nearly certain to result in a complete tear of the quadriceps tendons. 3 Teaching Points Ligaments are elastic bands of tissue that connect bones to each other and provide stability and strength to the joint. Tendon and ligament fibers can become damaged from trauma or overuse injuries and are slower to heal than muscle fibers due. Lateral ankle ligament reconstruction is a surgery to tighten and firm up one or more ankle ligaments on the outside of your ankle. Our goal is to get you back in the game. , 2011). Orthopedic Surgery. Flexor tendons can also be injured when a finger or thumb is violently pulled away from you while you are attempting to grasp something, such as the jersey of an opposing player in sports. Sutter network surgeons offer a number of different tendon and ligament repair surgeries, such as: Achilles tendon repair. Aftercare Outlook What is tendon repair surgery? Tendon repair is surgery done to treat a torn or otherwise damaged tendon. Background: Tendon and ligament injuries accounted for 30% of all musculoskeletal consultations with 4 million new incidences worldwide each year and thus imposed a significant burden to the society and the economy. As dense connective tissues connecting bone to muscle and bone to bone, respectively, tendon and ligament (T/L). Our goal is to get you back in the game. The natural healing process of tendon injury is complex. However, specific genes have not been suggested to be associated with rotator cuff or anterior cruciate ligament injuries. Scaffolds have been used for mechanical and biologic reinforcement of repair and regeneration with mixed results. Enhanced tendon and ligament repair would have a major impact on orthopaedic surgery outcomes, resulting in reduced repair failures and repeat surgeries, more rapid return to function, and reduced health care costs. Foot. 15 Fascicles are sur-Introduction . Ligaments and tendons are both made of connective tissue and both can be torn or overstretched, but they differ in function. Overview of Tendon Mending Pills. Ligaments are defined as the connective tissue that connects bone to bone. Email: Info@OldTownStrings. -Essential for all tendon and sinew injuries, tear, or damage to be take for 3+ weeks to heal, strengthen & full recovery. The American Academy of Orthopaedic Surgeons estimates about 2. Initially, 1 to 5 days post-injury, an inflammatory response occurs in which. These cords are called tendons. Ligaments are fairly similar to tendons in both structure and physiology; however, ligaments and tendons differ in function. 7. ligament injuries—both affect soft tissues, but what is the difference? Click here to find out. Any supplements or foods used to promote ligament and tendon healing must consequently support collagen synthesis and repair. Tendon development involves multiple germ layer, as well as the regulation of diversity transcription factors (Scx et al. (701) 746-7521. The elbow is a complex joint whose stability is imparted by osseous and soft-tissue constraints. Surgical T echnique. Not surprisingly, playing tennis or other racquet sports can cause this condition. Tendinopathy is a disease entity which can cause significant pain and functional limitations for individuals and collectively places a tremendous burden on society through high healthcare costs (Hopkins et al. This article provides a review of anterior cruciate ligament (ACL) reconstruction procedures and their normal postoperative appearance. Tendons vary in size and are somewhat elastic and attach bones to muscles. ACL reconstruction (ACLR) is commonly indicated to restore the knee stability, prevent anterior–posterior translation, and reduce the risk of developing post-traumatic osteoarthritis. Tendons contain 60 to 80 percent collagen type I, while ligaments contain around 95 percent. Tendon consists of 55–70% water, and a substantial part of this is associated with proteoglycans in the ECM (187, 307, 546, 659, 660). 5. For a long time, chronic painful tendons have. The aim of this study was to evaluate the effects of HILT on injured tendon and ligament repair in horses. Even although only 2% of the patients are hospitalized, hand injuries, especially tendon lesions, play a key role in. 3, 4 Clinical approaches to tendons rupture often involve surgical. In addition, Dr. Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved. Carpal tunnel procedures. 5 million people suffer from a serious Achilles tendon injury each year, and some 200,000 experience ACL (anterior cruciate ligament) damage in the knee. Tendon and ligament injuries remain a clinical challenge. In most cases, your healthcare provider will recommend at-home treatments such as RICE to manage foot tendon pain: Rest: Stop physical activity to avoid further damaging the tendons in your foot. Tendons are tough, stretchy tissues that join muscles to bone. focusing on biologically‐based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. The enthesis displays gradients in tissue organization, composition and mechanical. Posted by The Horse Staff. The American Academy of Orthopaedic Surgeons estimates about 2. 10. Tears can occur in healthy tendons that are acutely overloaded (e. 5 million people suffer from a serious Achilles tendon injury each year, and some 200,000 experience ACL (anterior cruciate ligament) damage in the knee. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. tendons M66. Tendon grafting involves the bridging of a gap in a tendon with an autogenous donor tendon from the same or a separate extremity. 00:00. "Call for appointment: 410-448-6400. It’s a type of surgery for treating arthritis of the thumb, a common type of arthritis in the hand. A tendon is a thick cord made up of tiny fibers that connect muscles to bones. 11138/mltj. Whatever your needs, our experts work with you to create personalized care plans and provide comprehensive support throughout your treatment. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. Knee Ligament Repair. -Tendon & Ligament Healing, Tendon & Ligament Injury, Damage, and Tear Recovery. Rotator cuff repair. Your surgeon drills holes into the bones of the upper arm and the forearm, around the elbow joint. currently undergoing prolotherapy for medial elbow pain (tendon injury) in both arms caused by repetive use as well as in right SI joint (ligament injury) caused by a heavy squat with bad form because of poor mobility / flexibility (which I am ardently. Tendons let us move our limbs. BioComposite, vented PEEK, or titanium Tenodesis screws provide superior and immediate fixation for foot and. Recovery can take up to 12 weeks. A significant proportion of patients requiring musculoskeletal management present with tendon and ligament pathology. It’s also known as the Brostrom procedure. An example is a twisting knee injury in basketball or skiing. Ankle Ligament. Sometimes, in order to repair the damage, physical therapy or surgery is also considered. ACL reconstruction. submaximal load held at a fixed length in toe region; tensile stress diminishes rapidly at first and then. The point at which the tendon forms attachment to the muscle is also known as the myotendinous junction. Normal and Healing Ligaments and Tendons. Your body contains thousands of tendons. The mature athlete faces challenges associated with age-dependent changes in the rotator cuff, Achilles tendon, lateral humeral epicondylar tendons, quadriceps tendon, and patellar tendon. (860) 449-1413. Tendon structure and composition. Tendons are fibrous cords, similar to a rope, and are made of collagen. Most surgeons treat these injuries surgically to lessen the risk of long-term disability and morbidity. The first-line treatment options are different facing acute and chronic tendon injuries. Shoulder tendons and muscles respond to Graston treatments, allowing for faster healing and. 1 Structure and Function. In 1 fl oz (approximately 30ml) of carrier oil or gel add: Lemongrass essential oil - 5 drops. Tendons connect muscles to bones, while ligaments connect bones to other bones. Tendons are anatomical structures connecting muscles to bones which generate transmission of forces, thereby ensuring joint movements. 12. Overview of Tendon Mending Pills. However, the complexity underpinning these interactive multifactorial elements is still not fully characterised. The symptoms of a peroneal tendon injury may vary somewhat, depending on the type and severity of the injury. The two peroneal tendons in the foot run side by side behind the outer ankle bone. 2 In addition to the economic cost, these injuries also have a significant impact on patients’ quality of life and. ACL reconstruction. Dr. 1 Each year, there are approximately 17 million ligamentous injuries that require medical treatment in the United States, with an estimated economic cost of over $40 billion. The ligament, located in the center of the knee, that controls rotation. This is independent of subcutaneous swelling. In tendon/ligament repair (see Fig. 23 Historically, transosseous tunnels were used in open rotator cuff repair, with sutures placed and tied through bone tunnels from the cuff footprint to the lateral aspect of the. Elbow Ligaments – you also have three primary ligaments that are located near your. They have the main function to produce Extracellular Matrix (ECM), such as collagen, fibronectin, and proteoglycans, to maintain tendon homeostasis and repair injured tendons. His office accepts new patients. Dr. Doctors perform tendon repair surgery to fix a tendon injury. J Orthop Res 2007; 25:1007-1017. Fusion repair is adopted when arthritis is present at the wrist. If your extensor tendons are damaged, you will be unable to straighten one or more of your fingers. 1. the tendon repair I would. He is affiliated with medical facilities Lawrence and Memorial Hospital and. Significant dysfunction and disability may result from suboptimal healing of tendon and ligament injuries. Torn or stretched ligaments are also called sprains. Tendinitis is inflammation of the thick fibrous cords that attach muscle to bone. Ligament/tendon and cartilage injuries are clinically common diseases that perplex most clinicians. Hip replacement and hip resurfacing. Although roughly 65%–70% of the total weight is water, 8 tendon is a highly organized. Sutter network surgeons offer a number of different tendon and ligament repair surgeries, such as: Achilles tendon repair. 1425 State St. 4 [95% CI, 0. Ruptures of the quadriceps and patellar tendons are common in elite and recreational athletes. ACL reconstruction. It is the balance of these multifactorial risk factors which will determine if the injury presents. Studies on the application of MSC-EVs for the enhancement of ligament and tendon-to-bone junction repair are limited. 3. Rest: try to avoid moving the tendon for 2 to 3 days. Redness. The content of this page is available to members of BC Family Doctors. In spite of surgical intervention, the natural healing process of tendons is still slow, due to their hypocellular and hypovascular nature (Liu et al. 60 (nontraumatic rupture of M66. View Profile. As with generic tissue repair, injured tendons and ligaments follow a prescribed tissue repair process 16,145 (Figure 4). They consist of collagens, cells, proteoglycans, elastin, glycolipids, and water. As tendon and ligament (T&L) tissue is mainly composed of collagen (Sharma and Maffulli, 2006), it is self-evident that many approaches aiming at tendon reconstructions are based on collagen. Ankle ligament injury is the most frequent cause of acute ankle pain. Musculoskeletal disease and injury, now and in the future. 2 This can mean the end of a career for many horses. Ligaments are fibrous connective tissues that span between bony surfaces acting to stabilize joints. In this. Therefore, surgeries are necessary and also widely used to treat ligament/tendon or cartilage injuries. 3. OBJECTIVE. It is attached to the bones of the shoulder and elbow by tendons — strong cords of fibrous tissue that attach muscles to bones. They have specialized zones (at the myotendinous junction for tendons and at the insertion to bone for both), which. In addition, tendons and ligaments have poor blood supplies. Each type of injury or degeneration can cause substantial pain and the loss of tendon function. New Albany, IN 47150. Tendinosis refers to hardening, thickening, and scarring of the tendons. They usually occur due to extreme force to a joint, such as with a fall or another high-impact event. Once injured,. The tendon graft may come from the person (autograft) or from an organ donor (allograft). Although ADSCs have been effective in tendon-bone healing in many studies, the exact mechanism remains unclear. The management of peroneus tendon tear is surgical repair using lateral approach. Tendon disorders are frequent, and are responsible for much morbidity both in sport and the workplace. g. Inferior check ligament – Connects the deep. The most severe ligament injury is a Grade 3 sprain, which is a complete tear of the ligament. Damage to the tendons and ligaments can effectively be considered sterile inflammation, a process characterized by DAMP-induced IL-1β release 144. To create Tough Gel Adhesives tailored to tendon regeneration, “we forward-engineered an alginate-polyacrylamide-based hydrogel into a two-sided biomaterial, essentially, by modifying one of its surfaces with a sugar known as chitosan, which we showed allows firm bonding to tendons. Inadequate cell numbers and donor site morbidity (i. In recent years, with the extensive development of sports, the incidence of Anterior cruciate ligament (ACL) injury increases year by year (Best et al. Introduction. Even after one year, the structure and function of the resulting tissue remain. Introduction. Many studies have shown that low-level laser therapy (LLLT) has a significant effect on tendon repair by firstly activating cytochrome C oxidase and thus. A wide range of injury mechanisms exist leading to tendinopathy or tendon rupture. Procedures vary depending on your diagnosis and the ligaments and tendons that need repair. Symptoms of a torn bicep tendon include: a “pop” or tearing sensation when the injury happens. External injuries include kicks, overreaching injuries, and lacerations. Open tendon repair. Rotator cuff repair. At the word tear, many envision massive damage and inevitable surgery to repair it or stitch it up. The ultrasound analyses focussed on changes in lesion echogenicity and its percentage. The ligaments supporting the bones of the arch are often torn, or at least stretched and weakened. 58 mi. If the tendon is degenerated severely and tendon repair does not seem feasible, especially when the muscle belly is scarred and heavily fibrotic, tendon transfer using flexor hallucis longus or flexor digitorum longus is preferable. Arthroscopic techniques for anterior talofibular ligament (ATFL) repair and reconstruction have been developed in recent years. Primary surgical repair is the gold standard modality of care; however, it is highly dependent on the extent of injuries. The tarsal bones are found near the. Tendons connect muscle to bone for the transmission of forces producing joint movement. The tendons are freed and mobilized, the ischial tuberosity is decorticated, and an anatomic repair is performed via 4 suture anchors, 2 at each tendon footprint. Common symptoms of tendinosis are: localized burning pain and. The most apparent difference between ligaments and tendons is that tendons join bone to a skeletal muscle and ligaments join bone to another bone. Advancements in arthroscopy have permitted adequate visualization and exposure of the hamstring footprint, thus allowing for an anatomic repair with increased protection of the. Tendons, ligaments and their entheses are commonly injured and, in adults, heal through the formation of a persistent fibrovascular. However, the outcome of biological graft healing is not satisfactory with graft failure. Orthopedic Surgery. The Anglo-Saxon word for tendon is “sinew” which means “strong” or “tough”. 230 N Wiget Ln Walnut Creek, CA 94598. The minimally invasive Percutaneous Achilles Repair System (PARS) technique can be used to treat quadriceps, patellar, and Achilles tendon ruptures. The almost acellular, collagen I-rich structure of tendons limits their regenerative potential and poses major clinical challenges. A potential disadvantage of tendon/ligament repair in clinical trials is that this method requires tearing down the intact tendon/ligament tissue, which may result in a length-tension mismatch in the repaired cuff and alter the normal orientation, and shape . (A) Tendons are connective tissues that connect muscle to bone. Ligament and tendon reconstruction is an open surgery involving at least one incision. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. The anterior talofibular ligament (ATFL) is the most frequently injured ligament in ankle sprains. PMC4041869. Tendons and ligaments are force-transferring tissues from muscle to bone and bone to bone, respectively. Tendons are strong and non-flexible while ligaments are flexible and. Tendon cell fate in repair. Flexor tendon injuries typically occur from a cut on the palm side of your fingers, hand, wrist, or forearm. Both of these issues have a particular type of cell called Fibroblast that forms the structural framework for connective tissues. The American Academy of Orthopaedic Surgeons estimates about 2. RenuTend™ is a targeted stem cell treatment with proven efficacy and repeatable results. Tendons are attached to muscles and bones to aid their movement, while ligaments help support and stabilize joints. But it's most common around shoulders, elbows, wrists, knees and heels. Using iMSCs to Repair Tendon and Ligaments. Differences in Treatment Sprain and Strain Prevention Tendons and ligaments are connective tissues that help support muscles and bones. There are relatively few of these cells compared to the amount of collagen in a tendon or ligament, and that’s one reason why these injuries heal slowly. They also help prevent muscle injury by absorbing some of the impact your muscles take when you run, jump or do other movements. Part 2: Tendon and ligament injuries. Tendon is a flexible but inelastic cord attaching a muscle to bone. This causes pain and a loss of flexibility in the joint. A torn ligament severely limits knee movement. The positive effect of NOS inhibition on tendon repair demonstrates that nitric oxide (NO) negatively regulates tissue recovery . Advancements in arthroscopy have permitted adequate visualization and exposure of the hamstring footprint, thus allowing for an anatomic repair with increased protection of the. Knee ligament repair or reconstruction is a treatment for a complete tear of a knee ligament that results in instability in the knee. When they're too tight, and when they can't fire optimally, they can't absorb force. If the tendon is degenerated, the surgeon may remove the damaged part of the tendon and repair the rest of the tendon with stitches. From the same test, the mechanical properties of the ligament or tendon substance, represented by the stress-strain curve, can also be obtained Woo et al. In other words, a tendon serves to move the bone to which it is attached. Avulsion of the flexor profundus tendon insertion. Curv ed Kel-. Sequence variants of the tenascin C (TNC) gene. 5 million people suffer from a serious Achilles tendon injury each year, and some 200,000 experience ACL (anterior cruciate ligament) damage in the knee. 5 mm in diameter tendon looped upon itself. 1%) of the fractures with tendon displacement had been treated with internal fixation, the tendon displacement was treated surgically in only seven (10. Tendon and ligament lesions don’t always heal properly, as scar tissue can be less elastic than healthy tissue, and reinjury rates can be up to 80 percent. Then, we review commonly encountered complications: those associated with decreased range of motion (impingement, arthrofibrosis, intraarticular bodies, ganglion cysts) and those associated. 99Ligaments connect two or more bones together and help stabilize joints. 2. Young graduated from the University of California San Diego School of Medicine in 1983. A previous total knee replacement extensor mechanism repair site had healed and been undamaged. Upon mechanical testing of the 8-week tendons using an Instron tension/compression system, we found that the failure force was much higher in ACF-rP-regenerated tendons (59. 5 million people suffer from a serious Achilles tendon injury each year, and some 200,000 experience ACL (anterior cruciate ligament) damage in the knee. A wide range of injury mechanisms exist leading to tendinopathy or tendon rupture. Care is taken to move muscles, tendons and nerves out of the way. Indirect Sharpey. 5 million people suffer from a serious Achilles tendon injury each year, and some 200,000 experience ACL (anterior cruciate ligament) damage in the knee. His office accepts new patients and telehealth appointments. Elbow Tendon and Ligament Repair. ACL reconstruction. Tendons are specialised, heterogeneous connective tissues, which represent a significant healthcare challenge after injury. The American Academy of Orthopaedic Surgeons estimates about 2. Our goal is to get you back in the. Your surgeon drills holes into the bones of the upper arm and the forearm, around.