Houston Methodist. Leading Medicine

Ankle FAQ

Question:

I tore my Achilles tendon playing ice hockey with a bunch of kids 30-years younger than me. I knew I was the old geezer trying to keep up but what the heck! Now I'm paying the price. At age 52, I expect more injuries that might take a little longer to heal than when I was a young buck. But it's been three months and I'm still hobbling around. Why is this taking so long?

Answer:

Tendons and ligaments don't heal quickly even in younger adults. The healing response is complex and involves several stages or phases of repair. The body can't just conjure up new tendon tissue and send it to replace the damaged tendon. First, the innate healing wisdom of the body calls for more tendon cells called tenocytes. While that is taking place, a special scaffold is prepared at the injured site. The scaffold is like a trellis that flowers or vines cling to and spread to fill in all the spaces. Only in this case, its the new tissue that is being deposited on the scaffold. And once healed, the tissue just doesn't have the elasticity and spring of muscles. Once they are torn, the injured area tends to fill in with scar tissue. And as you might suspect, scar tissue is firm to hold but doesn't have much give to it. That means the area is at increased risk for reinjury -- especially if it is stressed with too much load before it is ready. Many athletes of all ages experience tendon injuries. That's why efforts are being made to find ways to speed up and enhance the healing process. Scientists have discovered that human blood contains key ingredients for healing. The plasma portion of human blood (the clear liquid) has parts called components that may come to our aid. In particular, tiny platelets circulate every minute of every day in the blood -- they are always there in case of an injury. Platelets help form blood clots to stop bleeding. When the body signals that there is a need for platelets, they become activated and rush to the area of injury. Once there, they clump together to form a clot and then release tiny chemicals called growth factors. It's those growth factors that turn stem cells into tendons. Stem cells are basic cells that haven't formed a specific type of cell (e.g., heart, muscle, joint, organ). The body can turn a stem cell into any kind of cell needed including tenocytes (tendon cells). The use of platelet-rich plasma injections into torn or damaged tendons isn't in routine use yet. In any case, Achilles tendon ruptures do take time to heal. We're not even sure yet whether it's best to surgically repair the torn tendon or follow the old-fashioned method of letting it heal on its own by following a nonoperative approach (rest, heel lift, nonweight bearing standing and walking). If you are under a physician's care for your injury, the rehab process can be between six and 12 months for this type of injury. It's best to let an orthopedic surgeon guide you through the process. In this way, you'll know how to protect the healing tissue and avoid reinjury. Jianying Zhang, PhD, and James H.-C. Wang, PhD. Platelet-Rich Plasma Releasate Promotes Differentiation of Tendon Stem Cells into Active Tenocytes. In The American Journal of Sports Medicine. December 2010. Vol. 38. No.12.Pp.2477-2486.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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