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  • 1. CLASSIFICATION AND MECHANISMS OF INJURIES
  • 2. OBJECTIVES
    • MECHANISMS OF INJURY
    • TISSUE-BASED CLASSIFICATION
    • GENERAL PATHOLOGY OF THE REPAIR PROCESS
    • BASIC BIOMECHANICS OF TISSUE INJURY
  • 3. OBJECTIVES
    • LIGAMENTS AND TENDONS
    • BONE
    • FIBROCARTILAGE MENISCI OF THE KNEE
    • MUSCLE
  • 4. MECHANISMS OF INJURY
    • PRIMARY INJURY:
    • 1) DIRECT OR EXTRINSIC INJURY
    • 2) INDIRECT OR INTRINSIC INJURY
    • 3) OVERUSE INJURY:
    • A) ACUTE REPETITIVE FRICTION
    • B) CHRONIC REPETITIVE MICROFATIGUE
  • 5. MECHANISMS OF INJURY
    • SECONDARY INJURY:
    • 1) SHORT TERM – PRIMARY INJURY MISMANAGED
    • 2) LONG TERM – DEGENERATIVE PROBLEMS ( ACL )
  • 6. TISSUE-BASED CLASSIFICATION
    • SOFT TISSUE INJURIES:
    • 1) SKIN AND DEEP FASCIA
    • 2) MUSCLE-TENDON UNIT AND TENDOPERIOSTEAL ATTACHMENTS
    • 3) MUSCLE COMPARTMENTS
    • 4) JOINTS AND THEIR ASSOCIATED STRUCTURES
    • 5) INTEVERTEBRAL DISC
  • 7. TISSUE BASED CLASSIFICATION
    • HARD TISSUE INJURIES:
    • 1) BONE FRACTURES, OSTEOCHONDRAL FRACTURES AND AVULSIONS
    • 2) PERIOSTITIS
    • 3) STRESS FRACTURES
    • 4) HYALINE ARTICULAR AND EPIPHYSEAL CARTILAGE INJURIES
  • 8. TISSUE BASED CLASSIFICATIONS
    • SPECIAL TISSUE OR ORGAN INJURIES:
    • 1) BRAIN AND PERIPHERAL NERVES
    • 2) EYE, NOSE, SINUSES, LARYNX, TEETH
    • 3) THORACIC, ABDOMINAL AND PELVIC ORGANS
  • 9. GENERAL PATHOLOGY OF THE REPAIR PROCESS
    • THREE PHASES: ( ALVAREZ ET AL 1987 )
    • 1) THE ACUTE INFLAMMATORY RESPONSE ( APPROX.0-72H AFTER INJURY )
    • 2) THE MATRIX AND CELLULAR PROLIFERATION PHASE (72H-6/52 )
    • 3) REMODELING AND MATURATION OF HEALING ( 6/52 – 7/12 )
  • 10. BASIC BIOMECHANICS OF TISSUE INJURY
    • MUSCLE-TENDON-BONE INJURY:
    • 1) “ TWO-JOINT MUSCLES” – RECTUS FEMORIS AND HAMSTRINGS
    • 2) ECCENTRIC AND LESS CONCENTRIC LOADING – JUMPERS KNEE
  • 11. BASIC BIOMECHANICS OF TISSUE INJURY
    • MUSCLE-TENDON JUNCTION:
    • - THE TERMINAL MUSCLE SARCOMERE INFOLDING
    • TENDON INJURY:
    • SPONTANEOUS TENDON RUPTURE:
  • 12. LIGAMENTS AND TENDONS
    • 1) STRUCTURE AND BIOMECHANICS OF LIGAMENTS AND TENDONS
    • 2) CORRELATION OF COLLAGEN FIBRIL SIZE WITH MECHANICAL PROPERTIES OF TISSUE
    • 3) THE EFFECTS OF IMMOBILIZATION OF LIGAMENTS
  • 13. BONE
    • 1) ACUTE FRACTURES
    • 2) AVULSION FRACTURES
    • 3) STRESS FRACTURES: THRESHOLD LEVEL VS CYCLIC LOADING
    • MEASURE OF PLASMA HYDROXYPROLINE (BONE RESORPTION )
  • 14. FIBROCARTILAGE MENISCI
    • LOCATION OF THE TEAR DICTATES THE RESPONSE TO THE INJURY
  • 15. MUSCLE
    • TWO COMPETING PROCESSES DURING MUSCLE HEALING:
    • 1) REGENERATION OF THE DISRUPTED MUSCLE FIBRES
    • 2) THE PRODUCTION OF CONNECTIVE TISSUE COLLAGEN
  • 16. MUSCLE
    • - IMMOBILIZATION ( LESS POSSIBLE ) WILL REDUCE CONNECTIVE TISSUE AND ASSIST PENETRATION OF REGENERATED FIBRES
    • - STRETCHED MUSCLES WILL INCREASE NUMBER OF TERMINAL SARCOMERES, REDUCE INTRAMUSCULAR CONNECTIVE TISSUE