Reconstruction
Tendon Reconstruction
A tendon that has just been cut can usually be sewn back together. A tendon that was cut months ago is a different problem: the muscle has shortened, the ends have retracted and scarred, and the smooth tunnel the tendon used to glide through may have collapsed.
Reconstruction in that setting is about restoring a working system - a tendon that glides, a pulley system to hold it down, and joints supple enough to move - rather than simply joining two ends.
What the problem looks like
- A finger that will not bend or straighten, months after an injury
- A tendon repair that has ruptured
- A finger that healed but does not move - where the tendon is stuck rather than divided
- Loss of a specific movement following nerve injury
- Tendon rupture where a tendon has worn against bone or hardware
Loading anatomy
Principles
How this kind of reconstruction is approached
- 01
Supple joints first
A reconstructed tendon cannot move a stiff joint. Restoring passive movement through therapy comes before, not after, tendon reconstruction.
- 02
Rebuild the tunnel
Where the smooth sheath a tendon runs in has been destroyed, reconstruction may be staged - first creating a new gliding tunnel, then passing a tendon graft through it.
- 03
Graft the gap
Where a length of tendon is missing, a graft taken from a tendon that can be spared is used to bridge it.
- 04
Transfer a spare
A tendon transfer redirects a working muscle-tendon unit to do the job of one that cannot be restored. It trades a function that can be spared for one that matters more.
- 05
Release what is stuck
Where a healed tendon is bound down in scar, tenolysis frees it. Success depends heavily on the therapy programme that follows immediately afterwards.
Clinical detail
Staged flexor reconstruction with a silicone implant followed by grafting remains an established approach where the sheath and pulley system are inadequate for single-stage grafting.
Pulley reconstruction is considered where loss of the A2 or A4 pulley would produce bowstringing and loss of efficiency.
Tendon transfer planning applies the standard principles - adequate excursion and power, expendable donor, straight line of pull, synergy and a supple joint - with the donor selected according to the deficit.
Related conditions
Tendon Injuries
Cuts, ruptures or damage to the cords that connect muscle to bone and make the fingers and thumb move.
Complex Hand Trauma
Severe injuries that damage more than one tissue system at once - bone, tendon, nerve, blood vessel and skin together.
Peripheral Nerve Injuries
Damage to the nerves that carry signals between the brain and the hand, causing numbness, weakness or pain in the territory that nerve supplies.
All reconstruction categories · Revision & secondary surgery
Discuss tendon reconstruction
Consultations begin with understanding your symptoms, what you can no longer do comfortably, and what has already been tried.