A tendon graft surgery is a reconstructive procedure performed when a tendon is severely damaged, has a significant gap, or is missing entirely, making a simple repair impossible. Tendons are the strong, fibrous connective tissues that link muscles to bones, transmitting the force needed for movement. When a tendon is ruptured or degenerated, a surgeon uses a section of healthy tissue, known as a graft, to bridge the defect. This transplanted tissue acts as a scaffold, allowing new cells to grow and form a strong, functional tendon. The goal of this surgery is to restore movement to the affected joint and return the limb to working function.
Understanding Graft Sources
The choice of tissue for a tendon graft is a primary consideration, and the material can come from three main sources. The most common source is an autograft, which uses tissue harvested from the patient’s own body, such as a section of the hamstring, patellar, or foot tendon.
An advantage of using an autograft is that the body recognizes the tissue as its own, promoting faster biological integration. However, this method requires a secondary surgical site for harvesting, which can lead to additional pain, a longer recovery, and slight weakening of the donor area. Autografts are often preferred for highly active individuals due to their strength and long-term performance.
The second primary source is an allograft, which is tissue taken from a deceased human donor. Allografts are processed and sterilized to remove cellular material, minimizing the risk of disease transmission and immunological rejection. Using allograft material eliminates the need for a second surgical site, often resulting in a less painful initial recovery and a shorter operative time.
A potential disadvantage of allografts is that the integration of the tissue into the host body can be slower compared to an autograft. While rigorous testing for diseases is standard, there remains a remote concern for transmission and a slightly higher reported failure rate in some highly active, younger patient populations. Synthetic materials and xenografts—tissue derived from animals—are also used, typically as a scaffold to reinforce existing tendons rather than replacing an entire section. These materials offer consistency and unlimited supply but may face challenges with biocompatibility and long-term integration.
The Surgical Procedure Steps
Tendon graft surgery begins with the patient receiving anesthesia (general, regional, or local). The surgical team prepares the affected limb and makes an incision over the damaged tendon. If an autograft is used, a second incision is made to harvest the necessary tissue, which is then shaped and prepared for implantation.
The surgeon addresses the damaged area by removing damaged tissue to create a clean bed for the new graft. Specialized instruments expose the bone and remaining tendon fragments to ensure a solid connection for the reconstruction. In joint cases, tunnels may be drilled through the bone to allow the graft to be passed through and positioned correctly.
The prepared graft is threaded into the defect site between the healthy ends of the remaining tendon or muscle. Securing the new tendon is a precise step, often involving strong sutures, specialized staples, or bio-absorbable screws to fix the graft firmly to the surrounding bone or tissue. This fixation provides immediate structural stability, allowing the graft to withstand light stress while biological healing begins. Once secured, the incisions are closed, and the area is covered with a sterile dressing and placed in an immobilizing splint or brace.
Post-Surgical Rehabilitation
Rehabilitation is a structured process following a tendon graft that determines the success of the surgery. Immediately following the operation, the limb is immobilized with a cast or brace to protect the repair and allow initial healing. Managing pain and swelling is essential during the first few days, involving prescribed medication and keeping the affected area elevated.
Within the first few weeks, the patient begins working with a physical therapist on a recovery protocol. The initial phase focuses on protected passive or partial-range active motion. The goal is to gently prevent stiffness and encourage blood flow without placing excessive strain on the new graft. The new tendon tissue is at its weakest during this early stage, requiring strict adherence to the therapy schedule.
Around four to six weeks post-surgery, the graft begins a remodeling phase, where the body converts the transplanted tissue into functional tendon. During this time, rehabilitation progresses to include greater range-of-motion exercises and light strengthening activities. The splint or brace may be adjusted or removed as the therapist guides the patient toward full active flexion and extension.
The later phases, typically spanning three to twelve months, focus on intensive strengthening, building endurance, and restoring full functionality. Patients work on activity-specific drills, such as balancing, squatting, and eventually cutting or jumping, to prepare the joint for the demands of daily life and sports. While a return to daily activities might occur within three to six months, the biological process of graft maturation and full strength return can take nine to twelve months or longer.