Tendon Repair

Tendon repair surgically reconnects a lacerated or ruptured tendon to restore finger or wrist movement.

A divided tendon does not heal by itself — the cut ends retract and the muscle can no longer move the joint. Tendon repair reapproximates those ends with suture techniques strong enough to allow early controlled motion, because a tendon that is immobilised heals stuck to everything around it. This is one of the few areas of hand surgery where the rehabilitation is as important as the operation, and where the result depends on both being right.

Anyone with a divided flexor or extensor tendon, which is usually the result of a laceration and is diagnosed by the loss of a specific movement rather than by the size of the wound. A small, tidy-looking cut over the finger or palm can divide a tendon completely. Repair is best performed within days of injury; delayed presentation is still repairable for a period, but after several weeks the tendon ends retract and the muscle shortens, at which point reconstruction with a graft or a staged procedure is needed instead of a direct repair. Associated nerve, vessel and bone injury is common and is addressed at the same operation.

The operation is done under regional or general anaesthesia, usually as a day case. The wound is extended along lines that will not cause a contracture, the tendon ends are retrieved — which is the technically demanding part, as flexor tendons retract into the palm — and repaired using a multi-strand core suture with a circumferential epitendinous suture. The number of strands matters: a repair strong enough for early movement is a deliberate technical choice. The pulley system is preserved or vented as required. Any divided digital nerve is repaired under magnification at the same time. A protective splint is applied in a position that keeps tension off the repair.

This is a three to six month recovery and the rehabilitation programme is specific to the tendon, the level of injury and the repair used. A hand therapy regime starts within days, not weeks, using controlled passive or early active movement within a splint. The splint is worn for around six weeks. Light use without the splint begins at six to eight weeks, strengthening from eight to twelve weeks, and unrestricted heavy loading and sport at around three to six months. Attendance at hand therapy is not optional — a technically perfect repair that is not moved correctly gives a stiff finger, and a repair loaded too early ruptures.

Rupture of the repair is the most serious early complication and usually follows using the hand against instruction; it requires further surgery. Adhesions — scar binding the tendon to its sheath — are the commonest cause of a disappointing result and produce a finger that cannot be actively bent as far as it can be passively bent; persistent adhesions may need tenolysis later. Stiffness, particularly of the proximal interphalangeal joint, is common and is minimised by early movement. Infection, incomplete recovery of grip, cold intolerance and altered sensation where nerves were involved all occur. Full pre-injury function is not always achievable, and where that is likely it is said before the operation.