Jennifer belongs to a women's rugby team. At 23 years old, she has been playing for 5 years and trains daily to keep up her strength and stamina. During one game, she was injured
Unable to walk, she was carried off the field supported by her coach and an athletic therapist. At the hospital, after an examination and MRI of her right knee, she was given her diagnosis. Jennifer suffered what is often termed the "O'Donoghue triad": a ruptured medial collateral ligament, a ruptured anterior cruciate ligament, and tear of the medial meniscus.
Jennifer's injury involved the complete tearing of two ligaments. What are the similarities and differences between the anatomy and function of ligaments and tendons?
The knee joint exemplifies a diarthrodial joint. What are the anatomy of the synovial membrane and the importance of synovial fluid in such a joint?
Ligaments and tendons are both composed of dense connective tissue rich in organized bundles of collagen. Both tissues have neural innervation and a blood supply, although blood circulation to these tissues is limited.
Tendons are found at the ends of muscle bundles and act to attach muscle to bone. They are surrounded by a connective tissue sheath containing a small amount of fluid that serves to reduce friction as the muscle works over the bone to which it is attached.
Ligaments are closely associated with the articular capsules of joints and are responsible for binding the articular ends of bone to one another. They are also rich in inelastic collagen, but afford a certain degree of pliability for joint movement to occur.
Jennifer's rehabilitation will include techniques that will increase her joint proprioception. What is proprioception, and what will occur if this neural function is not restored?
Proprioception is provided by nerve endings in the tendons and ligaments of surrounding joints. Proprioception senses joint position, and reflexively adjusts the tension of surrounding muscle to ensure the joint is stabilized. When proprioception is lost, joint instability and destructive change eventually result.
A protective fibrous outer layer surrounds the synovial membrane. The membrane itself contains a series of folds to ensure a full range of movement in the joint. Cells of the membrane produce and secrete synovial fluid. The fluid plays a critical role in maintaining a low-friction environment within the joint and facilitates joint movement through its lubricating ability. Synovial fluid also provides articular cartilage with necessary nutrients as it circulates within the joint space.
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