Tendons are dense, fibrous connective tissues that link muscle and bone. Composed primarily of collagen fibers, these strong, rope-like structures transmit the force generated by muscle contraction to the skeletal system, making movement possible. When a tendon is damaged, this mechanical function is compromised, leading to pain and limited mobility. Damaged tendons can often be successfully repaired, but the specific treatment approach depends heavily on the nature and severity of the injury.
Understanding Tendon Damage and Repair Feasibility
Doctors must first assess the specific type of injury. Tendon problems fall into two categories: tendinopathy, a chronic condition involving tissue degeneration, and acute tears, a sudden, traumatic rupture. Tendinopathy involves a breakdown of the collagen matrix rather than inflammation. Acute tears are classified as either partial, where the tendon is frayed, or complete, where the tendon is severed into two pieces.
Diagnostic imaging is used to visualize the damage. Ultrasound is highly accurate for identifying full-thickness tears and evaluating the gap between the tendon ends. Magnetic Resonance Imaging (MRI) is often preferred for more subtle injuries, such as detecting partial-thickness tears and assessing the extent of chronic degeneration.
The decision to treat conservatively or surgically hinges on several factors. A complete tendon rupture, especially one where the ends have retracted significantly, usually requires surgery. Conversely, most cases of tendinopathy and minor partial tears are managed non-surgically. Factors such as the patient’s age, health, activity level, and the injury’s location also influence the final treatment plan.
Conservative Management Strategies
For less severe injuries like tendinopathy or small partial tears, conservative management is the initial and often successful treatment. The cornerstone of this approach is a structured physical therapy program focused on therapeutic loading of the affected tendon. This frequently includes eccentric training, where the muscle is actively lengthened while under a load.
Eccentric exercises stimulate the production of Type I collagen, the primary building block of tendon tissue. This loading effectively remodels the disorganized collagen found in chronic tendinopathy and gradually increases the tendon’s tolerance for mechanical stress. NSAIDs may be used temporarily to manage pain, but they do not address the underlying degenerative changes.
Advanced conservative options, such as injection therapies, are utilized when initial physical therapy is insufficient. Platelet-Rich Plasma (PRP) injections involve drawing the patient’s blood, concentrating the platelets and growth factors, and injecting the solution. PRP is regenerative, aiming to initiate a healing response, and shows superior long-term results in chronic tendinopathy compared to other injections. Corticosteroid injections provide rapid, short-term pain relief by reducing local inflammation but do not promote tissue healing. Repeated corticosteroid injections can potentially weaken the collagen structure, increasing the risk of a future rupture.
Surgical Interventions for Tendon Repair
When a tendon is completely ruptured or chronic damage makes conservative treatment ineffective, surgical repair becomes necessary. The goal of surgery is to restore the tendon’s length and tension, allowing it to transmit muscle force effectively. The most common procedure is direct repair, where the surgeon sutures the torn ends back together using specialized techniques like the modified Kessler or Krackow stitch.
Direct repair is typically performed for acute tears where the injury is recent and the tendon ends have not retracted too far. For large defects, a tendon graft procedure is required to bridge the gap. A graft can be an autograft (tissue harvested from the patient) or an allograft (tissue from a donor). While an autograft avoids rejection, it may cause pain and weakness at the harvest site.
For chronic, severe, or irreparable damage, a tendon transfer or tenodesis may be performed. Tendon transfer involves detaching a nearby, functional tendon and rerouting it to take over the damaged tendon’s function. Tenodesis involves cutting the damaged tendon and reattaching the remaining portion to the adjacent bone. These procedures can be performed using open incision techniques or minimally invasive, arthroscopic methods. Minimally invasive methods result in a lower risk of wound infection.
The Rehabilitation Process and Long-Term Outlook
Following intervention, the success of tendon repair requires structured rehabilitation. This recovery is typically divided into distinct phases that gradually increase the load applied to the healing tissue. The initial phase focuses on protection and immobilization, often lasting four to six weeks, where the repaired tendon is held in a brace or splint to prevent excessive strain.
During the early mobility phase, starting a few weeks after surgery, the focus shifts to restoring gentle, controlled range of motion. A physical therapist guides the patient through specific exercises, often passive movements, to prevent the formation of restrictive scar tissue. Around the ten-week mark, the strengthening phase begins, introducing light, resistive exercises to rebuild muscle and tendon strength.
Full functional recovery, especially for high-demand activities, often takes six to twelve months before a return to sport. The long-term outlook is generally positive, but complications must be managed. The most frequently encountered post-surgical complication is the development of adhesions, which can severely limit range of motion and may require a second procedure. Re-rupture is another risk, especially in the first few months when the repaired tissue is weakest, and joint stiffness can persist if the patient does not adhere strictly to the rehabilitation protocol.