Background Information:

What are the other Names for the Procedure?

• Repair of Tendon

What is Tendon Repair surgical procedure?

A Tendon Repair procedure involves a surgery to reattach the injured tendon, or the torn segments of the tendons are sewn together.

What part of the Body does the Procedure involve?

Injured tendons could be present in the hand, foot, ankle, wrist, knee, shoulder, hip, or elbow.

Why is the Tendon Repair surgical procedure Performed?

• Tendons are cord-like structures that connect the muscles to the bones, enabling joint movement
• A Tendon Repair procedure is performed when a person injures their tendon, also called tendinopathy
• The injury could be of the following two types:
  • Tendinitis: where there is inflammation of the tendons
  • Tendinosis: where there are micro tears on the tendons, but no apparent inflammation
• These injuries could be caused due to a number of reasons. Overuse, in case of athletes is one of the major reasons
• Women are more prone to these injuries than men

What are some Alternative Choices for the Procedure?

• In case the injury is minor, rest and physiotherapy can help heal the injury. However, in case of severe injuries, a surgery may be required.

What are the Recent Advances in the Procedure?

• Various developments are being carried out to enable the surgery with minimal invasion and quick recovery
• Prolo-therapy: In this form of treatment, the body’s immune system is stimulated to repair the area, by placing a dextrose/natural glycerin injection, at the exact injury site
• Various other animal tissue techniques are being developed to enable a quicker recovery

What is the Cost of performing the Tendon Repair surgical procedure?

The cost of Tendon Repair procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.surgeryencyclopedia.com/St-Wr/Tendon-Repair.html#b (accessed on 09/01/2012)

http://www.nlm.nih.gov/medlineplus/ency/article/002970.htm (accessed on 09/01/2012)

Prior to Tendon Repair surgical procedure:

How is the Tendon Repair surgical procedure Performed?

• Once anesthesia has been administered, the site of injury is cleansed with an antiseptic
• An incision is made to reveal the tendons and muscles
• The injured tendon is identified and the two edges of the tendon are sewn together with the help of sutures
• In case the tear is severe, a graft maybe used to patch the tendons. The graft may be obtained from another healthy area
• Once the tendons are put together, the surrounding nerves, muscles, and bones are checked for further damage
• The skin is then sutured together. A cast is placed over the injured area

Where is the Procedure Performed?

The Tendon Repair procedure can be performed in the surgical facility of a hospital, in an emergency room, or even in an out-patient surgical facility.

Who Performs the Procedure?

The surgery is performed by an orthopedic surgeon, a hand surgeon, or a general surgeon.

How long will the Procedure take?

The procedure usually takes about 1-2 hours or longer, depending on the severity of the injury.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the patient’s medical history to gain a comprehensive knowledge of the medications that are being taken currently
• Some of the medications may increase the patient’s chances of bleeding and hence the physician may recommend them to stop such medications for a period of time before performing the procedure
• Sometimes blood test might be performed to determine if the patient has a bleeding tendency or any other medical conditions that prevent them from undergoing the procedure
• A physician will request your consent for Tendon Repair procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Tendon Repair procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Tendon Repair surgical procedure?

The following tests maybe recommended by the physician prior to the surgery:

• X-ray of the injured region
• Routine blood tests
• Routine urine examination

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Tendon Repair procedure?
• Why is this procedure necessary? How will this procedure help?
• What does the procedure involve?
• Will I need adjunct treatments after the surgery?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the complications associated with the surgery?
• What are the risks involved?
• How long will it take to recover? When can I resume normal work?
• Are there any life style restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• How many procedures have you (the physician) performed?
• What are the costs involved?

During the Tendon Repair surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Anesthesia administered during the surgery could be local anesthesia, regional or spinal anesthesia, or a general anesthesia given by injection and inhalation.

How much Blood will you lose, during the Procedure?

The blood loss during the surgery is minimal. No transfusion is required unless complications arise.

What are the possible Risks and Complications during Tendon Repair surgical procedure?

The following risks and complications may be possible during the surgery:

• Excessive bleeding
• Injury to bones or muscles in the joint
• Reactions to anesthesia or medicines

What Post-Operative Care is needed at the Healthcare Facility after Tendon Repair surgical procedure?

A cast may be placed to support the joint. In such a case, the removal of the cast would be required at the health care facility. Apart from that no post-operative care is required at the facility. The patient is usually discharged on the same day, unless any complications arise.

After the Tendon Repair surgical procedure:

What are the possible Risks and Complications after Tendon Repair surgical procedure?

The following complications and risks are possible after the surgery:

• Surgical wound infection
• Loss of partial movement of the joint
• Stiffness of the joint
• Repeat rupture of the tendon

What is the Prognosis after the Surgery?

A complete recovery without any complications can be expected in about 3 to 4 weeks with proper rest and physiotherapy. However, in case of chronic tendonitis, it would take longer to recover.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Skin below the cast becomes numb or cold
• Fever, weakness, or dizziness
• Headache or muscle aches
• Nausea or vomiting
• Redness, swelling or pain
• Any signs of infection

What Post-Operative Care is needed at Home after Tendon Repair surgical procedure?

At home, the following post-operative care is recommended, after a Tendon Repair procedure:

• Proper rest with no strain on the injured part, per physician’s advice
• Regular physiotherapy
• Regular medications as prescribed by the physician

How long does it normally take to fully recover, from the Procedure?

It can take anywhere between 2 weeks to 6 months to recover from the procedure, depending on the severity of the injury.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Tendon Repair surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility
• The surgeon who performed the procedure
• An anesthesiologist (if anesthesia was administered)
• A radiologist (if radiological tests were performed during the procedure)

The patient is advised to inquire and confirm the type of billing, before a Tendon Repair surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA