Tendon repair surgery: when and how it is done

Tendons transmit the force of muscle to bone. When one is completely divided, the two ends separate and the muscle it served no longer moves the joint it served. That does not resolve without repair.

When surgery is indicated

A complete tear generally requires operative repair. In the hand this most often means the flexor or extensor tendons of the fingers and thumb; elsewhere, the Achilles and the rotator cuff are the common sites.

Partial tears and tendinopathy are usually managed conservatively first, with surgery considered where pain and loss of function persist despite that. Chronic problems — long-standing extensor injury of the thumb, for instance — warrant surgical assessment rather than continued observation.

The reason for assessing early is that a divided tendon retracts, and the muscle attached to it begins to shorten and waste. A delayed repair is a more difficult operation with a worse result than a timely one.

How the repair is done

Depending on the site and the injury, it is performed open or, where the anatomy allows, arthroscopically.

The torn ends are identified, brought together and held with sutures placed in a configuration designed to resist the pull of the muscle while healing occurs. Where a tendon has retracted badly, or where tissue has been lost, a graft may be needed to bridge the gap. Repairs at the shoulder frequently use anchors placed into bone. Repairs in the hand use fine instruments and fine suture, because the tendon has to run within a narrow sheath afterwards and bulk at the repair site catches.

Anaesthesia and pain

Regional anaesthesia — a nerve block — is often used, alone or with general anaesthesia. Afterwards, pain is managed with analgesia, cold and elevation, and is usually at its most intense in the first forty-eight hours before easing.

Recovery

This is the part patients underestimate. A repaired tendon has to heal without being pulled apart, and it also has to avoid becoming stuck to the tissues around it. Those two requirements pull in opposite directions, which is why rehabilitation is protocol-driven rather than intuitive.

A splint, cast or brace is used in the early weeks. Controlled early movement is usually introduced deliberately to prevent adhesion, within a range your surgeon specifies precisely. Therapy generally begins within the first weeks and follows an individual plan.

Return to full pre-injury activity commonly takes three to six months, and longer for complex repairs. Age, general health and — above all — adherence to the therapy programme determine where in that range you land.

Aftercare

Keep the wound clean and dry initially. Elevate the limb to control swelling. Use the splint, sling or crutches as instructed and do not load the repair until cleared. Attend every follow-up. Do not smoke: nicotine impairs the healing this repair depends on. Eat and sleep properly.

Before the operation

Discuss what has been injured, whether surgery is genuinely the best option, what technique is planned and what recovery will involve. Ask about less invasive alternatives if any exist for your injury. Declare your medical history, medications and any previous injury or surgery to the same area. Imaging — ultrasound or MRI — is used to confirm the diagnosis and plan the repair.