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What Is Flexor Tendon Repair?

Flexor tendon repair is surgery used to reconnect a completely or significantly divided tendon that bends a finger or thumb. Flexor tendons travel from the forearm through the wrist and hand and glide within tight tendon sheaths in the fingers. A sharp laceration can separate the tendon ends and prevent normal active flexion. Surgical repair uses specialized sutures to restore tendon continuity while preserving enough strength for protected rehabilitation.

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What Is Flexor Tendon Repair?

Flexor tendon repair is surgery used to reconnect a completely or significantly divided tendon that bends a finger or thumb. Flexor tendons travel from the forearm through the wrist and hand and glide within tight tendon sheaths in the fingers. A sharp laceration can separate the tendon ends and prevent normal active flexion. Surgical repair uses specialized sutures to restore tendon continuity while preserving enough strength for protected rehabilitation.

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Why Is Flexor Tendon Repair Performed?

Surgery is commonly required when a flexor tendon is completely cut and the tendon ends cannot heal together in their normal position. Repair can also be needed for selected avulsion injuries, open fractures, or complex hand trauma involving nerves, vessels, pulleys, or joints. The exact plan depends on the injured tendon zone, time since injury, tissue condition, contamination, and associated damage. Delayed or severely scarred injuries can require tendon grafting, tendon transfer, or staged reconstruction rather than primary repair.

How Is Flexor Tendon Repair Performed?

The surgeon explores the wound, identifies the tendon ends, and repairs associated nerve, vessel, bone, or pulley injuries when present. The tendon ends are joined with a strong core suture construct and additional peripheral sutures to improve alignment and repair strength. Pulley tissue is preserved when possible, although limited venting can be used when needed to permit smooth tendon gliding. The hand is then placed in a protective splint that limits forces capable of pulling the repair apart.

What Is Recovery Like After Flexor Tendon Repair?

Hand therapy begins early with a carefully controlled motion program designed for the injury zone and strength of the repair. The tendon must glide enough to reduce adhesions while remaining protected from forceful gripping or excessive extension. A custom splint is commonly worn for several weeks, with active motion and strengthening advanced in stages. Functional recovery takes several months, and final motion depends on tendon healing, scar formation, joint stiffness, nerve injury, and adherence to therapy.

What Are the Risks and Complications?

Possible complications include infection, stiffness, tendon adhesions, reduced finger motion, weakness, and repair rupture. Excessive scar formation can tether the tendon and prevent normal gliding even when the repair remains intact. A repaired tendon can gap or rupture if it is overloaded before healing is mature. Persistent loss of motion can require additional therapy, tenolysis, tendon grafting, or another reconstructive procedure.

Frequently Asked Questions About Flexor Tendon Repair

Do flexor tendon cuts heal without surgery?

Complete flexor tendon lacerations generally do not heal in the correct position without repair because the divided tendon ends retract away from each other.

Why is early hand therapy used after flexor tendon repair?

Controlled early motion helps the tendon glide and reduces adhesion formation while the splint protects the repair from excessive force.

Can a repaired flexor tendon rupture?

Yes. The repair is vulnerable during early healing, especially with forceful gripping or movements outside the prescribed rehabilitation program.

What is tenolysis after flexor tendon repair?

Tenolysis is surgery that frees a healed tendon from restrictive scar adhesions when therapy cannot restore adequate tendon gliding and finger motion.

References

Flexor Tendon Injury: Signs & Treatment. American Society for Surgery of the Hand. https://www.assh.org/handcare/condition/flexor-tendon-injury. Date Accessed August 13, 2026.

Flexor Tendon Lacerations. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK493223/. Date Accessed August 13, 2026.

Flexor tendon injuries. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC6739511/. Date Accessed August 13, 2026.

Rehabilitation following surgery for flexor tendon injuries of the hand. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC8094509/. Date Accessed August 13, 2026.

Complications after flexor tendon repair: a systematic review and meta-analysis. PubMed. https://pubmed.ncbi.nlm.nih.gov/22317947/. Date Accessed August 13, 2026.