Tendons are strong, fibrous cords of connective tissue that attach muscle to bone, facilitating movement. They enable the force generated by muscle contraction to pull on a bone, causing a joint to move. A torn tendon occurs when these fibers are overloaded, either through an acute, high-force injury or chronic degeneration and repeated micro-trauma. The approach to repair is highly individualized, depending on the injury’s location and the extent of the damage.
Determining the Extent of the Tear
The first step in determining a repair strategy involves a physical assessment to evaluate the patient’s range of motion, strength, and the location of pain. Tendon tears are classified using a grading system that dictates the subsequent treatment pathway. A Grade 1 tear involves mild stretching of the fibers, while a Grade 2 tear is a partial tear where the tendon is damaged but not completely severed. A Grade 3 tear, or full-thickness tear, means the tendon has completely ruptured, separating into two distinct pieces.
Diagnostic imaging confirms the diagnosis and measures the tear’s severity and size. Ultrasound is often a first-line tool, providing high-resolution, real-time images that assess the tendon dynamically during movement. Magnetic Resonance Imaging (MRI) provides a broader view of the joint and surrounding soft tissues, helping assess partial-thickness or chronic injuries. Distinguishing between an acute tear, which may require immediate surgery, and a chronic overuse injury, which often responds to conservative treatment, is a determining factor in the plan of care.
Non-Surgical Treatment Pathways
For many partial tears or minor Grade 1 and 2 injuries, conservative management is the primary course of action. This treatment aims to reduce inflammation, protect the tendon, and allow natural healing processes to take effect. The initial approach often involves the RICE protocol: Rest, Ice, Compression, and Elevation, applied immediately after the injury.
Resting the affected area means avoiding strain for at least 24 to 48 hours, often with crutches or a splint. Ice is applied for 15 to 20 minutes every few hours during the first two days to minimize swelling and pain. Compression with an elastic bandage and elevation above the heart promote fluid drainage and limit swelling. Following this initial period, immobilization with a cast or brace protects the healing tissue while early, guided physical therapy begins. This therapy focuses on gentle, passive range of motion exercises to maintain joint mobility and prevent stiffness without actively stressing the tendon.
Surgical Repair Techniques
When a tendon tear is complete, or when conservative treatments fail, surgical repair re-establishes the connection between muscle and bone. The technique chosen depends on the gap size between the torn ends and the quality of the remaining tissue. The most common procedure is a direct repair, where the surgeon sutures the torn ends back together using strong, non-absorbable material to restore the tendon’s original tension and length. This repair may be performed through an open incision or with a less invasive arthroscopic technique.
Tendon Grafting
When a significant portion of the tendon is missing or retracted, making a direct connection impossible, a tendon graft is utilized. This bridges the gap with tissue harvested from another part of the patient’s body (autograft) or with donor tissue (allograft).
Tendon Transfer
For chronic tears where the tendon tissue is severely compromised, a tendon transfer may be the best option. This procedure redirects a nearby, working tendon to take over the function of the damaged one, common in complex hand or shoulder injuries. The surgeon detaches the functional tendon from its original insertion point and reattaches it to the bone where the torn tendon used to connect. All surgical repairs conclude with the fixation of the tendon to the bone, often using specialized anchors or tunnels drilled into the bone to ensure a secure attachment point.
The Rehabilitation Process
The success of a tendon repair relies heavily on a structured and lengthy rehabilitation program. The process begins with an initial immobilization phase, typically lasting several weeks, where the repaired tendon is protected in a splint or cast. This protection prevents the newly repaired fibers from experiencing excessive strain that could cause a rupture.
The intermediate phase introduces controlled movement, focusing on gentle, passive range of motion exercises. This protected motion prevents scar tissue from binding the tendon to surrounding structures, a process called adhesion formation, which limits movement. The program then progresses to the late phase, which emphasizes active range of motion and strengthening exercises. Full healing requires months, with patients often needing six months or more to regain strength and return to high-demand activities.