Tendons are strong, fibrous bands of connective tissue that connect muscles to bones throughout the body. They transmit the force generated by muscle contractions, enabling a wide range of movements, from walking and running to grasping objects. Tendons also absorb impact, protecting muscles from injury during activity. When a tendon detaches from a bone, it creates a significant injury that can severely limit movement and cause pain, often requiring intervention to restore function.
Understanding Tendon Injuries
Tendons can detach from bone through acute injuries or chronic degeneration. Acute injuries often result from sudden trauma, such as a fall, a direct blow, or a sports-related incident where a sudden, forceful contraction or stretch can overload the tendon. For example, a powerful push-off in sports can lead to an Achilles tendon rupture, or a heavy lift might cause a rotator cuff tendon to tear away from the shoulder bone.
Chronic degeneration involves a gradual weakening of the tendon over time. This can be due to repetitive strain from activities that involve the same movements repeatedly, or it can be a natural consequence of aging, as tendons can become thinner and experience reduced blood flow. Conditions like gout or certain medical injections, such as steroids into a tendon, can also increase the risk of detachment by weakening the tendon tissue. When a tendon detaches, it can lead to significant pain, weakness, and a loss of movement, often requiring reattachment.
The Surgical Reattachment Procedure
Surgical reattachment of a detached tendon to bone restores the connection between these tissue types. The procedure begins with the surgeon making incisions near the injured joint to access the detached tendon. This can be done through open surgery with a larger incision or arthroscopically, using smaller incisions, specialized instruments, and a tiny camera to visualize the area.
Once the tendon is located, damaged tissue is removed from the tendon ends and bone surface. The bone where the tendon originally attached is also prepared, sometimes by drilling small holes. This preparation helps the tendon reattach and encourages bone healing.
The detached tendon is then secured to its original attachment site on the bone. This is often achieved using strong stitches or sutures anchored into the bone. For complete detachment, suture anchors—small devices inserted into the bone—may provide a stable point of fixation. The goal is to create a stable connection for secure healing, restoring the mechanical link for movement. If the tendon is too short or damaged for direct repair, a tendon graft from the patient’s body or a donor may bridge the gap.
Post-Surgery Recovery and Rehabilitation
Following tendon reattachment surgery, recovery focuses on protecting the repaired tendon and managing discomfort. The affected area will be immobilized with a brace, splint, or cast for several weeks to prevent excessive stress. Pain medication will be prescribed for pain and swelling, and elevating the limb can help reduce swelling.
Physical therapy is important for recovery, usually beginning with gentle, controlled movements once approved by the surgeon. This rehabilitation gradually restores strength, flexibility, and range of motion to the affected joint. Full recovery typically ranges from 12 weeks to several months, sometimes longer, for complete healing and return to full activity. Adherence to the prescribed program is important for optimal outcomes, preventing stiffness, muscle wasting, and re-injury, and guiding the patient back to normal activities.