For instance, six arteries supply blood to the rotator cuff tendons [], branches of the peroneal and posterior tibial. Damaged tendon and ligament can severely affect the normal body movement and might lead to many. Hip tendonitis is painful inflammation or irritation of a tendon in the hip. It typically takes place as an outpatient procedure. , 2011). The enthesis displays gradients in tissue organization, composition and mechanical. Pharma / TRT. 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. 1]; P ≥ . It can take as long as 2 years to completely recover full pain-free motion and strength after an ankle fracture. Carpal tunnel procedures. He works in San Mateo, CA and 5 other locations and specializes in Family Medicine. Swelling. Tendons are specialised, heterogeneous connective tissues, which represent a significant healthcare challenge after injury. The natural healing process of tendon injury is complex. After you have studied this chapter, you will have an understanding of: (1) the structure and function of tendons and ligaments, (2) the classification, morphology, histology, microanatomy and cell biology, (3) vascularization and innervation, (4) functions, proprioception, (5) clinical injuries and healing periods, and (6). 7. To better understand the role of the coracoclavicular ligament, it is necessary to understand the anatomy of the. Together, these 2 ligaments stabilize the acromioclavicular joint, which is one of the major shoulder joints. Postoperative. Ligament Repair. Suspensory ligament – Runs from the back of the knee (hock in the hind leg) to the fetlock, located between the flexor tendons and the cannon bone. We're taking extra precautions every day to help keep. Introduction. See full list on upmc. 6. 3035 Demers Ave, Grand Forks ND 58201. Then, we review commonly encountered complications: those associated with decreased range of motion (impingement, arthrofibrosis, intraarticular bodies, ganglion cysts) and those associated. Graston breaks up scar tissue, eliminate pain, and the treatments are safe, effective, and non surgical. the tendon crimp, decreases the number of fascicles, and increases the thickness of the endotenon. Whatever your needs, our experts work with you to create personalized care plans and provide comprehensive support throughout your treatment. , 2008; Connizzo et al. Your foot and ankle ligament and tendon reconstruction will be performed in a hospital or outpatient surgery setting. Rotator cuff repair. 3. 58 mi. Listened & answered questions. His office accepts new patients and telehealth appointments. Commonly used donor tendons include the palmaris longus, the plantaris, and, on occasion, a toe extensor. 2013 Sep;99 (3):203-222. Tears can occur in healthy tendons that are acutely overloaded (e. 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. 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. Many different types of surgeries are available for rotator cuff injuries, including: Arthroscopic tendon repair. Muscles are shock absorbers. The interfacial musculoskeletal diseases as a global burden. Ligament and tendon reconstruction is an open surgery involving at least one incision. 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. 1990. Ligament/tendon and cartilage injuries are clinically common diseases that perplex most clinicians. The extracapsular ligaments or external ligaments are the patellar ligament, medial collateral ligament (MCL), lateral collateral ligament (LCLs), oblique popliteal ligament, and. They have specialized zones (at the myotendinous junction for tendons and at the insertion to bone for both), which. Both of these issues have a particular type of cell called Fibroblast that forms the structural framework for connective tissues. He is affiliated with medical facilities Lawrence and Memorial Hospital and Westerly Hospital. Injuries show a disrupted fiber pattern and a black or gray appearance. 5 mm in diameter tendon looped upon itself. Among different tendon and ligament, Achilles tendon (Raikin et al. ”. Autologous conditioned plasma as therapy of tendon and ligament lesions in seven horses. 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. Tendon and ligament injuries are leading causes of poor performance in horses. Knee ligament injuries can be caused by trauma, such as a car accident. If the tendon is degenerated, the surgeon may remove the damaged part of the tendon and repair the rest of the tendon with stitches. A previous total knee replacement extensor mechanism repair site had healed and been undamaged. While an open cut may cause a tendon laceration. Degenerative tears (tendonosis) —Sporadic pain (occurring from time to time) on the outside of. Whatever your needs, our experts work with you to create personalized care plans and provide comprehensive support throughout your treatment. 3. If you tear the biceps tendon at the shoulder, you may lose some strength in your arm and have pain when you forcefully turn your arm from palm down to palm up. Introduction: Tendon and ligament injuries are a frequent and debilitating issue that affects many patients worldwide. Ligaments attach one bone to another. We simultaneously performed anatomical arthroscopic ATFL repair and reconstruction using a free tendon graft. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. 365 Montauk Ave, New London, CT. Enhanced histologic repair in a central wound in the anterior cruciate ligament with a collagen-platelet-rich plasma scaffold. Richard Alan Young, MD. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. This injury is nearly certain to result in a complete tear of the quadriceps tendons. 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. Initially, 1 to 5 days post-injury, an inflammatory response occurs in which. swelling. Symptoms. 21 (spontaneous rupture of extensor tendons, shoulder) 727. The American Academy of Orthopaedic Surgeons estimates about 2. One is a white ligament,. Even after one year, the structure and function of the resulting tissue remain. Orthopedic Surgery. If the ligament is still mostly healthy, the surgeon can do the repair using only the. Meanwhile, tissue. Tendon is a flexible but inelastic cord attaching a muscle to bone. Overview of Tendon Mending Pills. Tendons are attached to muscles and bones to aid their movement, while ligaments help support and stabilize joints. The ultrasound analyses focussed on changes in lesion echogenicity and its percentage. These inadequacies combined with the significant economic and health impact have prompted the. Request an Appointment Find a Doctor. 8 to $409. The attachment of tendons and ligaments to bone is termed the enthesis, whilst the attachment of tendon to muscle is termed the myotendinous junction. 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]. Recovering from Tendon Repair SurgeryFormalPara Learning Outcomes . Enhanced tendon and ligament repair would have a major impact on orthopedic surgery outcomes, resulting in reduced repair failures and repeat surgeries, more rapid return to function, and reduced health care costs. 3. Anatomy. Therefore, surgeries are necessary and also widely used to treat ligament/tendon or cartilage injuries. Ligaments are fairly similar to tendons in both structure and physiology; however, ligaments and tendons differ in function. Tendon and ligament fibers can become damaged from trauma or overuse injuries and are slower to heal than muscle fibers due. The aim of this study was to evaluate the effects of HILT on injured tendon and ligament repair in horses. The American Academy of Orthopaedic Surgeons estimates about 2. focusing on biologically‐based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Tendons are fibrous cords, similar to a rope, and are made of collagen. The pain is usually worse when the hand and thumb are in use. Ligaments and tendons are fibrous tissues with poor vascularity and limited regeneration capacity. The quadriceps tendon is the most important tendon involved in straightening the knee from a bent position. 6 (rupture of tendon, nontraumatic) - 727. Glucosamine functions in the formation and repairment of cartilage, improves joint function, and reduces pain. Symptoms of a torn bicep tendon include: a “pop” or tearing sensation when the injury happens. 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. SUGGESTED FORMULA. 1 million annually, with a total direct cost of $13,725 per injury and indirect costs ranging from $60,786 to $112,888 per. It can rapidly restore knee function and reduce the incidence of osteoarthritis. The system of ligaments in the vertebral column, combined with the tendons and muscles, provides a natural brace to help protect the spine from. Johanna Buschmann, Gabriella Meier Bürgisser, in Biomechanics of Tendons and Ligaments, 2017. Knee Ligament Repair. Starting with procollagen that weaves together to form collagen molecules, which are then packaged into fibrils, and subsequently fibers, fascicles, and. . The positive effect of NOS inhibition on tendon repair demonstrates that nitric oxide (NO) negatively regulates tissue recovery . Sutter network surgeons offer a number of different tendon and ligament repair surgeries, such as: Achilles tendon repair. joint stability and protection, force attenuators, protective reflexes, position sense (pacinian corpuscles) Load relaxation. Sometimes a tendon graft is needed to hold the injured joint together. Members, please log in. transmission of forces from muscle to bone (reducing work of muscle) Function of ligament. Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved. 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. The bicipital aponeurosis, or lac-ertus fibrosis, is the continuation of the fascia of the distal biceps muscle; it courses from the distal biceps tendon to blend with the deep fascia of the forearm. It’s also known as the Brostrom procedure. Common symptoms of tendon and ligament tears are pain and swelling. -Essential for all tendon and sinew injuries, tear, or damage to be take for 3+ weeks to heal, strengthen & full recovery. Although roughly 65%–70% of the total weight is water, 8 tendon is a highly organized. Tendons attach muscles to bones. When one or more of the rotator cuff tendons is torn, the tendon becomes partially or completely detached from the head of the humerus. Staff friendliness. Tendons primarily function by transmitting the contraction force produced by muscle to bone, thereby enabling movement. 12,17–21 Tenocytes are found in linear alignment along tendon fibers, which are grouped into visible tendon subunits called fascicles. Damage to the glenohumeral ligaments and the rotator cuff tendons of the shoulder. Implantable medical devices have gained more attention as an alternative approach. The main function of the peroneal tendons is to. 54. Learn the 6 effective ways to treat elbow tendonitis and the pain elbow located in the tendons. Apply the ice pack for up to 20 minutes every hour on the first day, then 3 to 4 times a day on the second day. In the. 18-11. com. Tendons are attached to muscles and bones to aid their movement, while ligaments help support and stabilize joints. Tendon/ligament. Extensive research continues to further understand the complex healing pathways that are involved when these structures are damaged. Tissue engineering represents an alternative solution for good tissue integration and. g. ACL reconstruction. This causes pain and a loss of flexibility in the joint. 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]. During a tendon or ligament repair, your orthopedic surgeon makes an incision on your skin over the injured tendon or ligament and carefully sews the damaged or torn ends together. 12. In this paper we review the development and function of entheses as well as the enthesis organ concept. The biceps muscle is located in the front of your upper arm. Vet J. Sequence variants of the tenascin C (TNC) gene. Rotator cuff repair. More than one ligament or the fibrous cartilage in your knee also is injured; The injury is causing your knee to buckle during everyday activities; During ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a segment of tendon — tissue similar to a ligament that connects muscle to bone. Whatever your needs, our experts work with you to create personalized care plans and provide comprehensive support throughout your treatment. Tendon injury can be divided into two types, chronic and acute. Elbow Tendon and Ligament Repair. Their job is to allow the body to move and to transfer weight. Sutter’s network of 400 orthopedic and sports medicine experts perform more than 10,000 orthopedic procedures a year, placing us among the most experienced providers in Northern California. This chapter provides an overview of different mouse models useful in tendon and ligament research. Current biological strategies to augment tendon repair. Damage to the tendons and ligaments can effectively be considered sterile inflammation, a process characterized by DAMP-induced IL-1β release 144. The American Academy of Orthopaedic Surgeons estimates about 2. Timmerman, M. Currently, a ligament/tendon injury often require a surgical procedure using auto- or allografts that present some limitations. 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. Rotator cuff repair. Ice, rest, tendonitis elbow braces, anti-inflammatory medications, massage and stretching are all helpful way to treat tennis elbow. Tarsals. The enthesis displays gradients in tissue organization, composition and mechanical. In the Sutter Health network, orthopedic surgeons provide a range of treatments to repair damage to the knee, ankle, shoulder, elbow, hand and wrist. Abstract. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. The wound healing. Then, we review commonly encountered complications: those associated with decreased range of motion (impingement, arthrofibrosis, intraarticular bodies, ganglion cysts) and those associated with laxity (graft tearing, graft stretching). The structure of the four zones, (1) tendon, (2) fibrocartilage, (3. Popping or crunching noises. Inability to fully straighten the knee. 1, 2 Incomplete healing of tendon injuries can lead to marked dysfunction and disability, with compromised joint biomechanics and debilitating pain. A tear in either can come from trauma or repetitive stress. Doctors perform tendon repair surgery to fix a tendon injury. Tendons and ligaments (T/L) have transition areas at the boundaries that are highly specialized. Achilles tendon rupture is a frequent injury with an increasing incidence. Ice: Put an ice pack or cold compress on your foot for up to 20 minutes at a time. Because of the lack of blood vessels and nerves, their self-repairing abilities are rather poor. The structure of the four zones, (1) tendon, (2). doi: 10. The protein, Secreted Protein Acidic and Rich in. Synthetic material could help heal injured tendons and ligaments. His office accepts new patients and telehealth appointments. 1 The Broström technique is the most popular procedure for repairing the ruptured ATFL. A bicep tear occurs when one of these tendons becomes either partially or completely severed. The orthopedic surgery service at the Foster Hospital for Small Animals is overseen by our board-certified faculty, who specialize in treating all types of orthopedic trauma (fractures, luxations) and neurologic trauma (fractures and prolapsed intervertebral discs). Not surprisingly, playing tennis or other racquet sports can cause this condition. Reconstruction repair is often recommended for ligament injuries that occurred a long time before treatment – usually over six months. Their phone number is (778) 404-1394 and you can find them at #304, 2250 Oak Bay Ave V8R 1G5. Tendons contain bundles of fiber, which a type of. They stabilize the ankle joint and prevent the ankle from twisting, folding or collapsing. Whatever your needs, our experts work with you to create personalized care plans and provide comprehensive support throughout your treatment. These are the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the lateral collateral ligament (LCL), and the medial collateral ligament (MCL). The American Academy of Orthopaedic Surgeons estimates about 2. The tarsal bones are found near the. Dr. Function of tendon. Lateral ankle ligament reconstruction is a surgery to tighten and firm up one or more ankle ligaments on the outside of your ankle. Improvement of graft healing to bone is crucial for facilitating an early and aggressive rehabilitation and ensuring rapid return to pre-injury levels activity. Repair surgery of tendon full rupture injury is the primary therapeutic intervention with >300,000 rotator cuff repair surgeries performed per. This level of injury typically takes 6 to 12 weeks to heal and may require more extensive physical therapy. Practice Essentials. The American Academy of Orthopaedic Surgeons estimates about 2. Ankle ligaments are like cords that connect the foot bones with the lower leg bones. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. For a long time, chronic painful tendons have. Acute Tears —Pain, swelling, weakness or instability of the foot and ankle. Our goal is to get you back in the. 1 Structure and Function. In recent years, it. ),. In fact, nearly one-quarter of the bones in the body are found in the feet. The enthesis, where the tissue attaches to the bone, is categorized into four zones. Once injured,. bruising. A severe tear will take longer to heal than a mild one, and a 20-year-old horse may heal more slowly than a 5-year-old. 1 Introduction. Facilitation of healing of tendons and ligaments. 19. The time it takes to fully recover from an MCL tear depends on how severe the tear is. 5. The American Academy of Orthopaedic Surgeons estimates about 2. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. Our goal is to get you back in the. As it occurs in the case of bone, three options have been tried for the repair or replacement of damaged ligaments/tendons by using: (1) biological substitutes, namely, autografts (such as patellar tendon with bony attachments or two of four hamstring tendons harvested from the patient at the time of surgery) ( Fu et al. A partial tear of a tendon or ligament is exactly what it sounds like: a tendon or ligament that is partially torn. At present, arthroscopic ACL reconstruction is the main treatment (Majumdar et al. The ligament, located in the center of the knee, that controls rotation. Rest: try to avoid moving the tendon for 2 to 3 days. read more. The symptoms of a peroneal tendon injury may vary somewhat, depending on the type and severity of the injury. Learn more about our services in Soquel and how we partner with you to create personalized care. We will finally focus on T/L repair after injury and on genetic diseases responsible for T/L defects. Click here for driving directions and location map. Each muscle has two tendons, one proximally and one distally. If your flexor tendons are damaged, you will be unable to bend one or more of your fingers. Altogether, the presented evidence suggests that VC can favor tendon recovery by acting against oxidative stress that occurs in tendon degeneration. 40 Years Experience. ACL reconstruction. A tendon graft might be needed if your tendon or ligament is severely injured. Overuse injuries (including tendon and ligaments) account for 7% of all doctor visits in the USA. Tendinitis can occur in any tendon. Therefore, surgeries are necessary and also widely used to treat ligament/tendon or cartilage injuries. A ligament is made of fibrous connective tissue that attaches bones to bones and bone to cartilage, and. These well-known dietary supplements are responsible for joint, tendon, and ligament health. Description. Although ADSCs have been effective in tendon-bone healing in many studies, the exact mechanism remains unclear. They account for 45% of the 32 million musculoskeletal injuries each year in the United States (Butler, Juncosa, & Dressler, 2004), with rates rising due to contact sports participation and the aging population. Sutter network surgeons offer a number of different tendon and ligament repair surgeries, such as: Achilles tendon repair. At the beginning of the rupture, inflammatory cells. The rotator cuff tends to fail at or near the tendon-bone junction, and the goal of repair is to restore the tendon to its anatomic footprint to encourage healing. 19 At a humoral level, higher levels of interleukin-1 beta (IL-1-β) and advanced glycated endproducts (AGEs) have been showed in tendons of diabetic patients; 20 AGEs and oxidative stress mediators such as H. Both the cases and controls may harbour genetic and non-genetic elements, which may confer an increased or decreased risk to sustaining a potential tendon or ligament injury. Sometimes, in order to repair the damage, physical therapy or surgery is also considered. 5 Its importance is for nutrition of the central part of the tendon. While an open cut may cause a tendon laceration. (860) 449-1413. There are also many unnamed fibrous connections linking tendons and ligaments directly together near their. Tendon injuries are all too common and some have difficulty healing, which can lead to chronic pain. Hypothesis-Free Approach. Conventional MRI and MR arthrography are the imaging modalities. The road to recovery is often long and complicated, leading to reduced quality of life and financial strain. Tendon and ligament damage caused by injury or overuse or associated with aging and arthritis is a common clinical problem because damaged tissues heal very slowly and rarely recover completely (). ACL reconstruction. Activity limitations. For example, collagen content of Achilles tendons from postnatal day (P)4 mice is less than 3% of the dry weight [], and in 1 week old sheep, cells account for nearly 33% of the tendon. Tendon and ligament structure and function. An inversion injury to the ankle may thus not only produce ligament damage to the anterior talofibular and calcaneofibular ligaments but also injury. Scaffolds have been the most common strategy. 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. This includes models addressing the roles of (1) fibril-forming collagens as well as interacting molecules regulating tendon fibrillogenesis; (2) growth factors and their receptors; (3) transcription factors and (4) cell surface receptors. Aftercare Outlook What is tendon repair surgery? Tendon repair is surgery done to treat a torn or otherwise damaged tendon. Or perhaps you got a sprain when you took a spill. 2 (spontaneous rupture of extensor tendons) 727. Tendons. RenuTend™ is a targeted stem cell treatment with proven efficacy and repeatable results. (701) 746-7521. Next we examine the process of tendon to bone healing. Swelling. For centuries, the Chinese Gua sha technique has been used to promote healing by scraping muscle tissue to stimulate blood flow. The American Academy of Orthopaedic Surgeons estimates about 2. Your ankle is a hinge joint that allows motion up and down, and from side to side. St Vincent’s Hip and Knee Surgeons. Recovery can take up to 12 weeks. A tear can also be complete or partial. A doctor or nurse will dress and cover the wound. In general, surgical intervention is necessary to restore stability to the injured knee, and to prevent meniscal damage. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. 25 Factors affecting ligament healing include blood supply and function. Google ScholarLigament surgery may consist of repairing or replacing the ligament. Tendon/ligament structure and function. The minimally invasive Percutaneous Achilles Repair System (PARS) technique can be used to treat quadriceps, patellar, and Achilles tendon ruptures. In this procedure, surgeons insert a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone. Appointment wasn't rushed. 22 The main reason for this is that a large area of tendon repair usually results in scarring and adhesion of the tendon to the sheath and. Rotator cuff repair. Daniel Gaccione, MD is an orthopedic surgery specialist in Groton, CT and has over 37 years of experience in the medical field. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. (A) Tendons are connective tissues that connect muscle to bone. Tendon-to-bone healing taking place between inhomogenous tissues is. 6. They have a very high collagen content, mostly Type I collagen [], arranged in a cross-linked triple-helix structure [2,3]. However, the healing of injured flexor tendons is stretched over a long period of up to 12 weeks, therefore, remaining a significant clinical problem. , 2016; Macaulay et al. 4 million tendon and ligament injuries occur in the United States every year2 and the incident rate of TLIs is expected to rise drastically as the population ages and remains active. Small tendon tears can make it difficult to walk and participate in other daily activities. 55 ± 8. The predominant solution is the suture thread, which is not without potential side effects and limitations. 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. Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. Ruptures of the quadriceps and patellar tendons are common in elite and recreational athletes. Learn about different conventional and therapeutic treatment modalities. Dr. He is affiliated with medical facilities Lawrence and Memorial Hospital and. 1002/bdrc. Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL) reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis") which connects tendon to bone. The flexor tendon cross-sectional area increases with age, exercise, and injury. 10. Advancements in arthroscopy have permitted adequate visualization and exposure of the hamstring footprint, thus allowing for an anatomic repair with increased protection of the. In this. Muscles Ligaments Tendons J. Along with surgery, intense postoperative. Email: Info@OldTownStrings. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The content of this page is available to members of BC Family Doctors. When hand tendon repair is needed. , a knife injury). In this pictorial essay, the ligaments around the ankle are grouped,. the tendon repair I would. The remaining 5–10% consists of chondrocytes, synovial cells (outer sheath), capillary endothelial cells, and arteriolar smooth muscle cells . Symptoms. Flexor tendon injuries typically occur from a cut on the palm side of your fingers, hand, wrist, or forearm. Tendon and ligament injuries — sprains, strains, ruptures and tears — occur frequently. Ligament reconstruction is considered in patients with ligament rupture. Our goal is to get you back in the. The number of incisions and the use of. 99Ligaments connect two or more bones together and help stabilize joints. When the degenerated zone of the tendon exceeds or even approaches 50% of the tendon cross-sectional area, and/or is complex or very long, debridement and repair is more likely to produce a poor result.