Structure and metabolism of tendons and ligaments

Tendons and ligaments are mainly composed of type I collagen fibers surrounded by a mesh of loose connective tissue. The whole tendon transmits forces from muscle to bone. However, it also shows viscoelastic behavior such as creep or stress relaxation. Tendons respond dynamically to physical activity. Release of neurotransmitters and growth factors, as well as cell communication between tenocytes by gap junctions, initiate a cascade of transcriptions and metabolic alterations leading to enhanced activity of synthetic and degrading enzymes to ensure optimal functional adaptation of extracellular tissue. Tendons and ligaments vary greatly in shape, length, and composition. Especially where they are subject to compression, they are fibrocartilaginous. Loss of vasculature may explain the high incidence of pathological alterations in these areas. The aging tendon is characterized by a reduced ability to adapt to force transmission. Inactivity markedly decreases collagen turnover soon leading to reduced stress resistance. Counteracting these phenomena requires a full understanding of the physiological processes during mechanical loading.