When a tendon is lacerated, a tendon repair is performed to reconnect the free ends. In some cases, a graft is required to lengthen the damaged tendon.

Tendon Repair Candidates

Tendon injuries are widespread in the general adult population. They are more common among people whose occupations or recreational athletic activities require repetitive motion of the shoulder, knee, elbow, or ankle joints. Injuries to the tendons in the shoulder often occur among baseball players, window washers, violinists, dancers, carpenters, and some assembly line workers. Rowers are at increased risk for injuries to the forearm tendons. The repetitive stresses of classical ballet, running, and jogging may damage the Achilles tendon at the back of the heel. So-called tennis elbow, which occurs in many construction workers, highway crews, maintenance workers, and baggage handlers as well as professional golfers and tennis players, is thought to affect 5% of American adults over the age of 30.

Women in all age brackets are at greater risk than men for injuries to the tendons in the elbow and knee joints. It is thought that injuries in these areas are related to the slightly greater looseness of women's joints compared to those in men.

Tendon Repair Outcome & Benifits

The goal of tendon repair is to bring back normal function of joints or surrounding tissues following a tendon laceration.

Prepare for Tendon Repair

You will report to a pre-operative nursing unit, where you will change into a hospital gown. A nurse will review your chart and confirm that all paperwork is in order. You will be taken to a pre-operative holding area, where an anesthesiologist will start an IV. You will then be taken to the operating room. After the appropriate form of anesthesia is administered, the surgery will be performed.

Tendon Repair Alternatives

There are no alternatives to surgery for tendon repair as of 2003; however, research is providing encouraging findings. Although there is no presently approved drug that targets this notoriously slow and often incomplete healing process, a cellular substance recently discovered at the Lawrence Berkeley National Laboratory may lead to a new drug that would improve the speed and durability of healing for injuries to tendons and ligaments. The substance, called Cell Density Signal-1, or CDS-1, by its discoverer, cell biologist Richard Schwarz, acts as part of a chemical switch that turns on procollagen production. Procollagen is a protein manufactured in large amounts by embryonic tendon cells. It is transformed outside the cell into collagen, the basic component of such connective tissues as tendons, ligaments or bones. Amgen Inc. is planning to use genetic engineering to bring CDS-1 into mass production.

Prolotherapy represents a less invasive alternative to surgery. It is a form of treatment that stimulates the repair of injured or damaged structures. It involves the injection of dextrose or natural glycerin at the exact site of an injury to stimulate the immune system to repair the area. Thus, prolotherapy causes an inflammatory reaction at the exact site of injuries to such structures as ligaments, tendons, menisci, muscles, growth plates, joint capsules, and cartilage to stimulate these structures to heal. Specifically, prolotherapy causes fibroblasts to multiply rapidly. Fibroblasts are the cells that actually make up ligaments and tendons. The rapid production of new fibroblasts means that strong, fresh collagen tissue is formed, which is what is needed to repair injuries to ligaments or tendons.

Tendon Repair Surgery Overview

Tendon repair refers to the surgical repair of damaged or torn tendons, which are cord-like structures made of strong fibrous connective tissue that connect muscles to bones. The shoulder, elbow, knee, and ankle joints are the most commonly affected by tendon injuries.

Anesthesia

You will have a pre-operative interview with an anesthesiologist who will ask you questions regarding your medical history. A tendon repair may be performed with local, regional or general anesthesia. With general anesthetic, you will be asleep during your surgery.  With regional anesthetic, a specific region of nerves will be anesthetized. With local anesthetic, you will be alert during the surgery, and only the incision location will be anesthetized.

Surgical Steps

After an incision is made, the ends of the tendon will be sutured together. Occasionally, a graft will be required to lengthen the tendon. Should a tendon graft be required, it will be taken from either the same forearm or from the leg. This should not cause any functional deficit in the forearm or leg.

Tendon Repair Recovery

Patients are asked to have someone drive them home after tendon repair surgery. Healing may take as long as 6 weeks, during which the injured part may be immobilized in a splint or cast. Patients are asked not to use the injured tendon until the physician gives permission. The physician will decide how long to rest the tendon. It should not be used for lifting heavy objects or walking. Patients are also asked to avoid driving until the physician gives the go-ahead. To reduce swelling and pain, they should keep the injured limb lifted above the level of the heart as much as possible for the first few days after surgery.

Splints or bandages should be left in place until the next checkup. Patients are advised to keep bandages clean and dry. If patients have a cast, they are asked not to get it wet, to cover it with plastic while bathing, and to avoid exposing the cast to water. Fiberglass casts that get wet may be dried with a hair dryer. Patients are also instructed not to push or lean on the cast to avoid breaking it. If patients have a splint that is held in place with an Ace bandage, they are instructed to ensure that the bandage is not too tight. They are also asked to ensure that splints remain in exactly the same place. Medications prescribed by the doctor should be taken exactly as directed. Patients who have been given antibiotics should take the complete course even if they feel well; this precaution is needed to minimize the risk of drug resistance developing in the disease organism. If patients are taking medicine that makes them feel drowsy, they are advised against driving or using heavy equipment.

Aftercare may also include physical therapy for the affected joint. There are a variety of exercises, wraps, splints, braces, bandages, ice packs, massages, and other treatments that physical therapists may recommend or use in helping a patient recover from tendon surgery.

Tendon Repair After Care

Once the surgery is completed, you will be taken to a post-operative or recovery unit where a nurse will monitor your progress. It is important that your bandages be kept clean and dry. Mild pain may occur at the incision site, so your physician may prescribe pain medication.

Usually, tendon repairs are performed on an outpatient basis. When hospitalization is required, the stays are typically no more than a day.

Depending on the nature of the tendon injury and type of repair performed, use of the involved hand will be limited for a number of weeks in order to allow for proper healing and rehabilitation. Your surgeon will discuss this in detail with you.

Light activity at home is encouraged after surgery. You can expect to return to normal activities such as showering, driving, walking up stairs, and work within a few days. If you are taking narcotic medications for pain, you should not drive.

Tendon Repair Possible Risks

As with any surgery, there are risks such as bleeding, infection, or an adverse reaction to anesthesia. Your surgeon will inform you of the risks prior to surgery.