Tendon Repair is a surgical treatment performed to restore the previous function of fibrous tissues (tendons) that connect muscles to bones and enable movement, in cases where these structures are torn or ruptured.
✓What is Tendon Injury?
Tendon injury is treated surgically if it causes loss of function. Tendons are connective tissues in our body that attach muscles to bones.
✓While ligaments attach bone to bone, tendons extend from muscle to bone and provide force transmission. These tendons lose function due to blunt trauma or cutting injuries, or due to tearing on a degenerative basis.
✓How Does Tendon Damage Occur?
Overuse
✓Degeneration in tissues that occurs with aging
✓Work accidents (especially in heavy industry workers)
✓Sports injuries
✓Traffic accidents (along with bone fractures)
✓Unintended events such as punching a wall (flexor tendons in the forearm, wrist, palm and fingers may be injured), knife cuts, gunshot wounds
✓What Are the Symptoms of Tendon Injuries?
Depending on which part of the body's tendon is injured, various complaints occur at the relevant point. What are these?
✓Pain and increased pain in the related area depending on use
✓Stiffness (more intense at night and/or upon waking from sleep)
✓Loss of strength
✓A faint crackling sensation coming from the tendon
✓Inability to bend the related joint
✓How is Tendon Injury Diagnosed?
Physical examination and patient history are quite important in diagnosing tendon injuries. X-rays, ultrasound or MRI scans are needed to confirm the diagnosis and see the severity of the injury.
✓How Are Tendon Injuries Treated?
Rest and Simple Measures: If tendon injury is mild, rest and avoiding activity are recommended. Additionally, cold application should be applied at regular intervals. For pain, pain relievers are used. The problem is attempted to be resolved through exercise and stretching movements.
✓Physical Therapy: If tendon injury is more severe or the above recommendations have not benefited the patient, physical therapy application is considered. A splint or cast may be applied to the patient.
✓Surgery: Some tendon injuries require surgical treatment.
✓For example, surgical methods are used in deep injuries to tendons such as flexor tendons and Achilles tendon. Tendon injury surgeries generally need to be performed within the first week after the injury. During surgery, the injured tendon is repaired and restored to its original condition. After surgery, the patient needs to rest for approximately 6 weeks. Only in this way can complete healing be achieved. After the surgery and rest period, the patient's recovery is completed with physical therapy.
✓How is Tendon Surgery Performed?
The surgical methods used in tendon surgery may vary depending on the patient's condition. However, generally the surgery is performed with the following steps:
✓Assessment and Diagnosis: Comprehensive assessment and diagnosis before surgery is important. This usually includes medical history, physical examination and imaging studies (for example, MRI) to assess the extent of damage.
✓Anesthesia: Tendon surgery can be performed under local, regional or general anesthesia depending on the nature of the procedure and the patient's health.
✓Incision: A surgical incision is made to reach the damaged tendon. The size and location of the incision depend on the specific tendon used and surgical techniques.
✓Access to the Tendon: After the incision is made, the surgeon carefully opens the damaged tendon and surrounding tissues. In some cases, the surgeon may need to move other structures or muscles to properly access the tendon.
✓Tendon Repair or Reconstruction: The surgeon then addresses the damaged tendon. Different approaches exist depending on the severity of the injury:
✓Tendon Repair: If the tendon is partially torn, the surgeon can bring the torn ends together and perform suturing.
✓Tendon Graft: In cases of complete tear or severe damage, a graft may be used to replace the damaged tendon. The graft can be taken from the patient's own tissue or from a donor source.
✓Suturing or Graft Fixation: The repaired or reconstructed tendon is fixed using sutures, screws, anchors or other fixation devices.
✓Closure: After the tendon is repaired and fixed, the incision is closed using sutures or staples. The goal is to ensure proper healing and minimize scarring.
✓Post-operative Care: After surgery, patients generally enter a rehabilitation period, which may include methods such as physical therapy.
✓How Many Days Does Tendon Surgery Recovery Take?
The recovery time after tendon surgery can vary depending on several factors. These factors include the type and location of tendon injury, the surgical procedure performed, the individual's general health and post-operative care compliance. Generally, the initial recovery process can take a few weeks and complete recovery can take a few months.
✓What Are the Side Effects of Tendon Surgery?
Side effects after tendon surgery can vary depending on the patient's general health status and the type of tendon surgery. The general side effects of tendon surgery are:
✓Pain and Discomfort
✓Swelling and Bruising
✓Restricted Movement
✓Stiffness
✓Infection
✓Nerve Damage
✓Scarring
✓Blood Clot Formation
✓Allergic Reactions
✓Joint Instability
✓What Are the Diseases That Increase the Risk of Tendon Rupture?
Some systemic diseases in our body prevent healthy nourishment of tendon tissue and disrupt collagen production, which is the building block. This condition makes the tissue fragile over time and prone to tearing with even the slightest strain. These diseases are:
✓Systemic lupus erythematosus
✓Rheumatoid arthritis
✓Psoriatic arthritis
✓Gout disease
✓Chronic kidney failure
✓Hyperparathyroidism
✓How is Tendon Rupture in the Shoulder and Knee Areas Noticed?
Tearing of the rotator cuff tendons located in the shoulder joint is usually manifested by severe pain that wakes the person from sleep at night and radiates from the side of the shoulder toward the arm. The person has great difficulty lifting their arm up on their own or moving it toward their back. In the knee area, when the tendons just above or below the kneecap tear, it becomes impossible to extend the leg straight forward. The patient cannot lift their leg from a sitting position straight up into the air. Additionally, the kneecap sliding from its normal position much higher or much lower can be noticeably observed.
How to Recognize Tendon Rupture in the Shoulder and Knee Regions?
Rupture of the rotator cuff tendons located in the shoulder joint typically manifests with severe pain that wakes the person from sleep at night and radiates from the side of the shoulder toward the arm. The person experiences great difficulty lifting their arm on their own or moving it toward their back. In the knee region, if the tendons above or below the kneecap rupture, it becomes impossible to extend the leg straight forward. The patient cannot lift their leg straight into the air while sitting. Additionally, it can be visibly noticed that the kneecap shifts much higher or much lower than its normal position.
What Methods Are Used to Diagnose Tendon Rupture?
Although clinical examination and the patient's history are often sufficient to make a diagnosis, imaging methods are used for support to understand the full extent of the damage and create a treatment plan. The most frequently used methods for this purpose are as follows:
Ultrasonography
Magnetic resonance imaging
X-ray imaging
Can Tendon Rupture Be Treated Without Surgery?
Not every tendon rupture necessarily ends up on the operating table. In cases where the rupture is partial, meaning part of the tendon remains intact, non-surgical methods yield quite successful results. Additionally, in cases where the patient is elderly, anesthesia carries vital risks, or daily activity expectations are very low, conservative treatments, also called non-surgical treatments, are preferred. This process generally involves keeping the area immobilized with special splints, casts, or medical walking boots for a certain period. The goal is to allow the ruptured ends to naturally fuse together over time. However, in this method, the healing process is longer, and especially in complete ruptures, the likelihood of experiencing another rupture in the future is slightly higher compared to surgical methods. Additionally, muscle atrophy and wasting in muscles that remain immobilized for long periods is an inevitable outcome.
Does tendon rupture heal on its own or does it require surgery?
The treatment decision varies based on the location and size of the rupture and the patient's lifestyle. While some partial tears can heal with conservative methods, complete ruptures may be a more effective surgical option.
How long does the healing process take after tendon rupture surgery?
The healing time depends on the location of the tendon and the treatment applied. In mild cases, a few weeks may be sufficient, but complete functional recovery after surgery may require rehabilitation lasting several months.
Why is physical therapy so important after tendon rupture?
Physical therapy helps preserve muscle strength, increase joint range of motion, and aid in safe healing of the tendon. Regular rehabilitation programs can support the process of returning to daily activities and sports.
How can the risk of re-injury after tendon rupture be reduced?
It is important to exercise regularly, strengthen muscles, perform appropriate warm-up movements, and avoid overloading. Completing the rehabilitation process thoroughly can also reduce the risk of re-injury.
What Is the Price of Tendon Surgery?
The price of tendon surgery varies based on which area the tendon is located (hand, foot, Achilles, etc.), the size of the tear, the hospital where the surgery will be performed, and the surgeon's experience.
How long does tendon surgery take?
Tendon surgery typically takes between 30 minutes and 2 hours on average. However, this duration varies depending on the location of the injury, the size of the rupture, and whether there is concurrent blood vessel or nerve damage.
Achilles Tendon: In simple and single tears, it typically takes an average of 30-60 minutes.
Hand and Finger Tendons: In single finger or wrist cuts, it can take 1-2 hours. If multiple tendons or nerve/vessel injuries are involved, the duration can extend to 2-4 hours.
Tendon Loosening / Tenolysis: Operations to release adhesions typically take 30-60 minutes.
How many days does tendon suture healing take?
Tendon suture fusion and healing typically takes an average of 6 to 12 weeks (approximately 1.5-3 months). However, the tendon reaching its former strength and full power can take 3 to 6 months (sometimes 1 year). The healing speed varies depending on the location of the tendon and the size of the rupture.
