Tendon Repair

Tendon repair is a surgical procedure that stitches together a torn or cut tendon — the tough, cord-like tissue that connects muscle to bone — so that normal movement can be restored.

When a tendon is damaged, the muscle can no longer pull the bone it controls, so the affected finger, hand, wrist, or other body part cannot move properly. During the operation, a surgeon locates the two ends of the damaged tendon, brings them together under the right tension, and secures them with specialised sutures (stitches). In complex or heavily damaged tendons, a graft (a piece of tendon taken from another part of the body) may be used to bridge a gap that cannot be closed directly.

Tendon repair is used whenever a tendon has been partially or completely disrupted and the loss of movement is significant enough to affect daily life. The most common setting is the hand and fingers, but the technique applies to tendons anywhere in the body.

• A deep cut (laceration) to the hand, wrist, or forearm that severs a flexor tendon (which bends the fingers) or an extensor tendon (which straightens them).
• A mallet finger — where the tendon at the fingertip is torn away, causing the fingertip to droop and unable to straighten.
• A jersey finger — where a fingertip tendon is pulled away from the bone, often during sports.
• A rupture (spontaneous tear) of a tendon due to a sudden forceful movement, such as a torn Achilles tendon at the back of the ankle.
• Tendon damage caused by rheumatoid arthritis (a condition where the immune system attacks the joints and surrounding tissue).
• Tendon injury following a crush injury or fracture (broken bone) where the tendon is also damaged.

Surgery is not always the first choice. Some partial tears, or injuries in patients with certain health conditions, may be managed without an operation.

• Very minor partial tears that respond well to splinting (immobilising the joint with a rigid support) and physiotherapy.
• Patients whose overall health makes anaesthesia (the medication that keeps you asleep or numb during surgery) too risky.
• Very old or contaminated wounds where immediate repair could lead to serious infection — in these cases, delayed or staged repair is considered instead.

Like any operation, tendon repair carries recognised risks, though most patients recover without serious complications. Your surgical team will discuss your personal risk level before the procedure.

• Stiffness and reduced range of movement — the most common outcome concern; the repaired tendon and surrounding tissue can form scar tissue (adhesions) that limit flexibility.
• Re-rupture — the repaired tendon tears again, especially if the hand is used too early or too forcefully during healing.
• Infection at the wound site, which may require antibiotics or further surgical cleaning.
• Nerve damage — nearby nerves may be injured during surgery, causing numbness, tingling, or weakness in the hand or fingers.
• Bowstringing — if the tendon's pulley system (small loops of tissue that keep the tendon in its correct path) is also damaged, the tendon may bow outward instead of gliding smoothly.
• Anaesthesia-related reactions, such as nausea, dizziness, or, very rarely, an allergic response.
• Prolonged swelling or complex regional pain syndrome (CRPS) — an uncommon condition where the limb becomes persistently painful, swollen, and sensitive after injury or surgery.

How you prepare depends on whether the surgery is planned in advance or done as an emergency after an acute injury. Your surgeon and anaesthetist will give you personalised instructions, but the following is what most patients can expect.

Before the procedure, your medical team will usually ask you to:

• Fast (stop eating and drinking) for a period before surgery if a general anaesthetic (fully asleep) or sedation is planned — your team will tell you exactly when to stop.
• Pause certain medications, such as blood thinners or anti-inflammatory drugs, as these can increase bleeding. Do not stop any medication without your doctor's guidance.
• Avoid smoking in the weeks leading up to surgery, as smoking reduces blood flow and slows tendon healing.
• Avoid alcohol for at least 24 hours before the procedure.
• Keep the injured area clean, elevated (raised above heart level), and immobilised, especially if surgery is delayed after an acute injury.

Tests that are commonly ordered before the operation include:

• Blood tests to check for anaemia (low red blood cell count), infection markers, and clotting function.
• X-ray (radiograph) of the affected area to check for associated bone fractures.
• Ultrasound (USG) to visualise the tendon ends and confirm the extent of the tear.
• MRI, in some cases, to map complex injuries involving multiple tendons or nearby structures.

On the day of surgery, the procedure typically follows these steps:

• 1. You are checked in and your vitals (blood pressure, heart rate, oxygen level) are recorded.
• 2. The surgical site is marked and the limb is cleaned with antiseptic solution.
• 3. Anaesthesia is administered — this may be a local nerve block (numbing only the arm or hand), regional anaesthesia, or general anaesthesia depending on the complexity and your medical history.
• 4. A tourniquet (a tight band that temporarily stops blood flow to the limb) is usually applied to keep the surgical field clear.
• 5. The surgeon makes a careful incision (cut) to expose the tendon ends.
• 6. The tendon ends are identified, cleaned of damaged tissue, and brought together.
• 7. The tendon is repaired using specialised suturing techniques designed to hold under the forces of movement.
• 8. If a graft is needed, it is harvested from the chosen donor site and sewn into place.
• 9. The skin is closed, a dressing is applied, and a protective splint is fitted to prevent accidental movement during early healing.

Recovery after tendon repair requires patience. The tendon needs time to heal to sufficient strength before it can bear normal loads, and how long this takes varies with the location of the injury, the type of repair, and the individual patient. Rushing recovery is one of the most common causes of re-rupture.

• Monitoring: Most patients are observed for a few hours in the recovery area after surgery. Overnight admission is sometimes needed for complex repairs or if general anaesthesia was used.
• Splinting: The operated hand or limb is kept in a protective splint for several weeks. The position and duration of splinting depend on which tendon was repaired — your team will explain the exact requirements.
• Physiotherapy (hand therapy): Controlled movement exercises usually begin early, often within days of surgery, under the guidance of a hand therapist. Early, carefully managed movement helps prevent scar adhesions and restores gliding function. The programme is gradual and tailored to your repair.
• Wound care: The dressing is usually changed at a scheduled clinic visit. The wound should be kept dry until your surgeon confirms it has healed sufficiently. Signs of infection — increasing redness, warmth, swelling, or discharge — should be reported promptly.
• Pain management: Some discomfort and swelling are expected after surgery. Pain is typically managed with prescribed medications; your doctor will advise on what is appropriate.
• Activity restrictions: Heavy gripping, lifting, or forceful use of the hand is restricted for several weeks to months, depending on the repair. Your surgeon and therapist will advise on a gradual return to daily activities and work.
• Elevation: Keeping the hand raised above heart level in the first days after surgery helps reduce swelling.
• Follow-up appointments: Regular clinic visits are needed to monitor tendon healing, adjust the rehabilitation programme, and check the wound. Do not miss these visits.
• Return to sport or manual work: This is usually only permitted once the tendon has regained adequate strength, which typically takes several months. Your surgical team will guide the timing.
• Lifestyle: Avoiding smoking throughout the recovery period supports better tendon healing. A balanced diet also supports tissue repair.