Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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Once the diagnosis is confirmed, the conversation shifts to treatment. Tendon surgery is a balance of biology and engineering. The surgeon must create a repair that is strong enough to hold, but the patient must respect the biology of healing. You cannot force a tendon to heal faster than nature allows.
This section covers the surgical journey, from the moment you are wheeled into the operating room to the day you take your first steps in recovery. We will discuss the different anesthesia options, the techniques used to stitch tendons, and the critical first few weeks post-op, when the repair is most vulnerable. Understanding this timeline helps patients plan their lives, arrange for help at home, and mentally prepare for the road ahead.
Preparation begins weeks before the surgery. You will likely need medical clearance to ensure your heart and lungs are safe for anesthesia. If you smoke, you will be strongly advised to stop. Smoking creates a high risk of wound infection and failure of the tendon to heal.
You may need to stop blood-thinning medications to reduce bleeding risk. You should also prepare your home. You will likely be immobilized in a cast, splint, or brace for weeks. Setting up a sleeping area on the ground floor, preparing easy meals, and removing tripping hazards like rugs can make your recovery much smoother.
Tendon surgery can be performed under various types of anesthesia depending on the location and duration of the procedure. For hand tendon repairs, surgeons often use regional anesthesia (numbing the arm) or even WALANT (Wide Awake Local Anesthesia No Tourniquet). This allows the patient to be awake and actually move their finger during surgery so the surgeon can verify the repair is strong and glides smoothly.
For larger tendons like the Achilles or rotator cuff, general anesthesia (being asleep) or a spinal block (numbing from the waist down) is more common. The anesthesiologist will discuss the best option for you based on your health and anxiety levels.
Open surgery involves making an incision over the injury to visualize the tendon directly. This is standard for Achilles ruptures, hand tendons, and complex fractures. It gives the surgeon the best view and allows for robust stitching.
Arthroscopic surgery is minimally invasive. It uses small cameras and instruments inserted through buttonhole incisions. The method is the gold standard for rotator cuff repairs in the shoulder. It causes less damage to the surrounding muscle (deltoid), leading to less pain and a lower risk of infection. However, not all tendons can be fixed this way; the technique depends on the anatomy.
The stitch is at the core of the surgery. Surgeons use specialized, high-strength sutures. They use specific weaving patterns (like the Krackow or Bunnell stitch) that grip the tendon fibers tightly so the thread doesn’t pull out under tension.
The goal is to bring the two torn ends together until they touch (“kissing”). They must not be too tight, or the blood supply will be cut off. They must not be too loose, or the tendon will heal long and weak.
If the tendon tore off the bone, the surgeon uses suture anchors. These are small screws (made of metal or absorbable plastic) that are drilled into the bone. The sutures are attached to the anchor eyelet and are used to tie the tendon down.
If the tendon is too short or damaged to be repaired directly, the surgeon may use a graft. This can be an autograft (taken from the body, like a hamstring tendon) or an allograft (taken from a donor). The graft acts as a bridge or a patch to reinforce the repair.
You will wake up with the surgical area immobilized. For a shoulder, this means a sling. For a leg, a cast or boot. A specialized splint is used for a hand injury. This immobilization is non-negotiable. The repair is held together only by thread; any forceful movement can rip it apart.
Pain management is a priority. You will likely be prescribed narcotic pain medication for the first few days. Ice and elevation are critical to control swelling. Keeping the limb above the heart (“toes above nose”) reduces pain significantly by draining fluid away from the surgical site.
Healing happens in phases.
Infection is a risk with any surgery. Signs include fever, increasing redness, or drainage. Nerve damage can occur, causing numbness around the incision.
The most significant specific risk is re-rupture. If a patient puts weight on the limb or moves it too aggressively before the tendon has healed, the repair can snap. Adhesions (scar tissue sticking the tendon to the skin) are also common, especially in the hand, which is why early controlled motion therapy is often started.
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You usually need to keep the incision dry until the stitches are removed, which takes about 10–14 days. You can shower if you cover the cast/splint with a waterproof bag.
It varies, but typically immobilization lasts 2 to 6 weeks depending on the tendon. You will then transition to a removable brace that allows some motion but prevents extreme stretching.
You cannot drive while taking narcotic pain medication. You also cannot drive if your right leg (braking leg) is in a cast or boot. For arm surgery, you must be out of the sling and have enough strength to steer safely.
Usually, no. Small suture anchors are often made of non-metallic materials or are too small to trigger detectors. If they do, simply tell the agent you have had surgery.
Eventually, yes, but not initially. The repair is actually weaker than a normal tendon for several months. It never quite regains the perfect elasticity of the original, but it becomes strong enough for function and sports.
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