Comprehensive Tendon Repair Protocol

Pre-operative Assessment

Patient Evaluation

• Complete history and physical examination
• Detailed injury mechanism assessment
• Neurovascular status evaluation
• Documentation of associated injuries

Imaging Studies

• Plain radiographs to rule out associated fractures
• MRI when diagnosis is unclear
• Ultrasound for dynamic assessment

Surgical Technique

Preparation

1. Position patient appropriately based on affected tendon
2. Apply tourniquet if indicated
3. Prep and drape using sterile technique

Core Repair Steps

1. Exposure

   • Make appropriate incision
   • Protect neurovascular structures
   • Identify tendon ends

2. Debridement

   • Remove devitalized tissue
   • Freshen tendon ends
   • Maintain adequate length

3. Primary Repair

   • Modified Kessler suture technique preferred
   • Use 3-0 or 4-0 nonabsorbable suture
   • Maintain appropriate tension

4. Epitendinous Repair

   • Running 6-0 suture
   • Smooth repair site

Post-operative Protocol

Immediate Post-op (0-3 days)

• Splint immobilization
• Elevation
• Pain management
• Early motion if indicated

Early Phase (3-14 days)

• Wound care
• Controlled passive motion
• Edema management

Intermediate Phase (2-6 weeks)

• Progressive passive/active motion
• Strengthening exercises
• Scar management

Late Phase (6-12 weeks)

• Advanced strengthening
• Sport-specific training
• Return to activity protocol

Complications Management

Prevention

• Proper surgical technique
• Appropriate post-op protocol adherence
• Regular follow-up

Common Complications

• Adhesion formation
• Re-rupture
• Infection
• Stiffness

Documentation Requirements

• Detailed operative notes
• Post-op protocol compliance
• Rehabilitation progress
• Functional outcome measures