Tenodesis is an orthopedic surgical procedure involving the fixation of a tendon directly to a bone. This operation is performed when a tendon is damaged, unstable, or needs to be relocated to a different attachment site. The goal is to stabilize a joint or restore a functional movement pattern that has been lost due to injury or disease.
The Purpose of Tenodesis
Tenodesis is often necessary when a tendon has suffered chronic inflammation or a partial tear, creating a persistent source of pain and mechanical friction within a joint. By surgically relocating and fixing the tendon end to the nearby bone, the painful, damaged portion is effectively removed from the joint space.
The procedure also serves to restore biomechanical function by eliminating instability or weakness. In some cases, a tendon may be rerouted and attached to a new point on the bone to provide an anchor, stabilizing the joint and preventing abnormal movement.
Common Joints Requiring Tenodesis
The shoulder is the most frequent site for this procedure, specifically involving the long head of the biceps tendon. Chronic irritation, partial tears, or instability of this tendon, often associated with other shoulder issues like rotator cuff tears, necessitates fixation. Biceps tenodesis involves detaching the tendon from its original anchor point within the shoulder socket and reattaching it lower down on the humerus.
In the ankle, tenodesis procedures are frequently used to treat chronic lateral ankle instability or complex tears of the peroneal tendons. If the peroneal tendon suffers significant tears, it may be fixed to an adjacent, healthy tendon. This fixation provides necessary lateral stabilization to the ankle.
Tenodesis is used in the wrist and hand for functional restoration following nerve injury or to stabilize joints. For instance, a dynamic tenodesis can be performed in the hand to restore the ability to extend the fingers after a brachial plexus injury, utilizing the wrist’s movement. By fixing the finger extensor tendons to a point on the wrist, extending the wrist passively causes the fingers to open, a functional pattern often referred to as the “tenodesis effect.”
Another application in the wrist involves stabilizing the distal ulna, which can become unstable following certain surgical procedures or due to conditions like rheumatoid arthritis. Tendons are sometimes used to create a fixation, anchoring the remaining bone structure to prevent abnormal motion. These stabilizing procedures are designed to improve joint alignment and reduce pain during movement.
Surgical Methods for Tendon Fixation
The method used to secure the tendon to the bone varies depending on the joint and the surgeon’s preference, often falling into open or arthroscopic categories. An open approach uses a single, larger incision for direct visualization of the anatomy. The arthroscopic method is minimally invasive, using small keyhole incisions for a camera and specialized instruments.
Once the tendon is prepared, the surgeon must create a strong, durable fixation to allow biological healing to occur. In many cases, a tunnel or socket is drilled into the bone, and the prepared end of the tendon is then inserted into this bony channel.
Specialized hardware is used to hold the tendon securely against the bone until it biologically integrates. These devices include bioabsorbable interference screws, which press the tendon into the bony tunnel, or suture anchors, which are small implants secured into the bone with strong sutures woven through the tendon. The mechanical strength provided by this fixation allows the tendon to heal into its new bony position over several months, a process known as fibro-osseous integration.
Rehabilitation and Expected Recovery
Immediately after surgery, the joint is typically immobilized using a sling or brace to protect the surgical repair from excessive strain.
Physical therapy usually begins shortly after the operation, initially focusing on passive range of motion exercises to prevent stiffness without stressing the repair site. The primary goal of the first few weeks is to protect the tendon-to-bone interface while gradually restoring motion. The timeline for progression is carefully managed, as the biological healing of the tendon to the bone is a slow process.
Over the following months, the rehabilitation program advances to active range of motion and progressive strengthening exercises, gradually increasing the load on the repaired tendon. While non-strenuous activities may resume within a few weeks, the total recovery time to return to full strength and demanding physical activities typically ranges from four to six months. Successful long-term outcomes depend entirely on allowing the tendon to fully integrate with the bone before subjecting it to maximal force.