Wound healing of tendon--II. A mathematical model

Computerized ultrasonographic tissue characterization of equine superficial digital flexor tendons by means of stability quantification of echo patterns in contiguous transverse ultrasonographic images

OBJECTIVE

To describe a method of computerized ultrasonographic tissue characterization that includes structures below the size limits of resolution in equine superficial digital flexor tendons.

SAMPLE POPULATION

2 damaged and 2 structurally normal superficial digital flexor tendons.

PROCEDURE

Transverse ultrasonographic images were collected along the tendon long axis. Stability of echo pattern was quantified by means of variation in gray levels of each pixel in contiguous images and expressed as correlation, entropy, and waviness ratios.

RESULTS

Normal young and normal old tissues were characterized by high correlation and low entropy and waviness ratios. In necrotic tissue, collapsed intratendinous septa resulted in high correlation, moderate entropy, and high waviness ratios. In early granulation tissue, complete lack of bundle formation resulted in values of zero for correlation and waviness ratios; loose connective tissue matrix resulted in a high entropy ratio. In late granulation tissue, formation of new bundles resulted in a high correlation ratio; swollen intratendinous septa and incomplete organization of connective tissue matrix were reflected in high entropy and waviness ratios. In early fibrotic tissue, rearrangement of tendon bundles resulted in a correlation ratio within reference range and a slight increase in the waviness ratio; an increase in cellularity and lack of fibrillar arrangement led to an increase in the entropy ratio. In late fibrotic and scar tissues, inferior quality of repair with almost complete lack of organization was reflected in low to moderate correlation, low waviness, and high entropy ratios.

CONCLUSIONS AND CLINICAL RELEVANCE

Stability of echo patterns accurately reflects homogeneity of tendons in horses.

Efficacy of computerized discrimination between structure-related and non-structure-related echoes in ultrasonographic images for the quantitative evaluation of the structural integrity of superficial digital flexor tendons in horses

OBJECTIVE

To evaluate effectiveness of computerized discrimination between structure-related and non-structure-related echoes in ultrasonographic images for quantitative evaluation of tendon structural integrity in horses.

SAMPLE POPULATION

4 superficial digital flexor tendons (2 damaged tendons, 2 normal tendons).

PROCEDURE

Transverse ultrasonographic images that precisely matched histologic sections were obtained in fixed steps along the long axis of each tendon. Distribution, intensity, and delineation of structure-related echoes, quantitatively expressed as the correlation ratio and steadiness ratio , were compared with histologic findings in tissue that was normal or had necrosis, early granulation, late granulation, early fibrosis, or inferior repair.

RESULTS

In normal tendon, the even distribution of structure-related echoes with high intensity and sharp delineation yielded high correlation ratio and steadiness ratio. In areas of necrosis, collapsed endotendon septa yielded solid but blurred structure-related echoes (high correlation ration and low steadiness ratio). In early granulation tissue, complete lack of organization caused zero values for both ratios. In late granulation tissue, reorganization and swollen endotendon septa yielded poorly delineated structure-related echoes (high correlation ratio, low steadiness ratio). In early fibrosis, rearrangement of bundles resulted in normal correlation ration and slightly low steadiness ratio. In inferior repair, the almost complete lack of structural reorganization resulted in heterogeneous poorly delineated low-intensity echoes (low correlation ratio and steadiness ratio).

CONCLUSIONS AND CLINICAL RELEVANCE

The combination of correlation ratio and steadiness ratio accurately reflects histopathologic findings, making computerized correlation of ultrasonographic images an efficient tool for quantitative evaluation of tendon structural integrity.

The development of mechanical strength of surgically anastomosed arteries sutured with Dexon

The strength of surgically anastomosed arteries of the rat sutured with Dexon thread is studied. The abdominal aortas and the carotid arteries were severed, sutured and then the wounds were closed and the animal healed. After a specific period of time up to 13 months, the vessels were taken out and tested in uniaxial loading condition. The stress-strain relationship of the vessels was measured, and then the vessels were pulled to failure. It was found that the strength of the anastomosis was the lowest in about 4 months. In the first day, the force at failure was about the same as that of the control. Then the strength decreased with time, until a minimum was reached in 4-6 months. The tensile force to failure was about 25% of the control for the carotid artery and 49% of the control for the abdominal aorta. The corresponding values of the tensile stress at failure were 17 and 11%, respectively. The different percentages of forces and stresses were caused by the thickening of the vessel wall in the neighborhood of the suture line in the healing process. After 4-6 months, the strength gained again. At 13 months, the strength of the anastomosis was about the same as that of the control. The stretch ratio at failure was approximately constant through all periods.