Tendon repair reconstruction and transfers

Restoring a missing movement

Tendon repair and grafting

A recent injury may allow direct repair. A gap, scarring or a delayed presentation can require a tendon graft or a staged reconstruction. Graft choice, tension and the route through the tissues affect how the reconstructed tendon glides. Restoring continuity is only part of the task: stiffness and adhesions can still limit movement.

Tendon transfers

A tendon transfer redirects a functioning muscle and tendon to perform a movement that has been lost, for example after nerve injury or tendon rupture. It does not restore the original nerve. The donor must have adequate strength and its original action must be dispensable or replaceable. Joint flexibility, soft-tissue condition and the ability to undertake therapy are important in planning.

Rehabilitation and risks

Tendon procedures require a specific balance between protected movement and avoiding overload. Splints and hand therapy are often essential. Heavy use too early can disrupt a repair; excessive stiffness can also compromise the result. Recovery is measured in stages and commonly extends over months.

Risks include infection, rupture, adhesions, stiffness, loss of strength, donor-site problems, incomplete movement and further surgery. A transfer also requires learning to use the redirected muscle. We discuss what functional gain is realistic before committing to reconstruction.

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