When a tendon has been injured or ruptured due to diseases such as rheumatoid arthritis, it is not always possible to stitch the two ends together. This may be because the ends are too frayed or because some time has passed since the injury and now the two tendon ends no longer meet or would be too tight if repaired to be useful.
In these situations, tendon reconstruction is performed. It can involve borrowing a tendon segment to use as a tendon graft and bridge the gap between the two ends of the damaged tendon. This may have to be done in two stages if the tunnel that the tendon normally runs in has closed down. Then a silicone rod is temporarily placed to reopen the tunnel. Once this has occurred, the rod is removed and the tendon graft is used to repair the original tendon.
It may be possible to transfer the damaged tendon end to a neighbouring working tendon. The neighbouring tendon then takes on the work of both. This is done in some cases of rheumatoid arthritis and also in some nerve injuries where not all muscles can work anymore.
Both of these techniques require hand therapy afterwards. Splints are used to protect the tendon surgery and exercise regimes are used to gradually get the new tendons working properly again. As when a direct tendon repair is done, it is very important to follow the rehabiliation programme carefully. Overuse of the hand too soon can lead to rupture of the tendon surgery, while no movement at all will lead to stiffness of the tendon and hand which can be very hard to overcome.