Fig. 4.

Scheme of tenocyte mechanoresponse. Stretching at a physiological level leads to activation of mechanoreceptor and primary cilias. Crimping of the collagen fibre bundles disappears (in biomechanical measurement: toe region of a stress-stain curve). Connexin expression is elevated and hence, cell–cell signalling via gap junctions is also elevated. Protective cytokines and anabolic growth factors are released followed by de novo extracellular matrix (ECM) synthesis and ECM-degrading enzyme release, which mediate reorganization of ECM by a remodelling process to adapt the ECM biomechanics according to the stretch direction. The image was created by G. G. Schulze-Tanzil using Krita 4.1.7 (Krita Foundation, The Netherlands).