What does a tendon graft replace?
It replaces a missing or unusable section of tendon.
Tendons connect muscles to bones. A graft creates a bridge when the remaining tendon ends cannot be repaired directly.
Hand, Wrist & Upper Extremity
Tendon Grafting – Upper Extremity
Upper-extremity tendon grafting uses replacement tendon tissue to bridge a damaged tendon gap and help restore movement in the hand, wrist, or arm.
Is this the same as tendon transfer?
No. A graft bridges a gap; a transfer redirects a working tendon.
A graft usually relies on the original muscle still being able to pull. A transfer uses a different functioning muscle-tendon unit to provide movement.
Is therapy part of treatment?
Usually, protected hand therapy is central to recovery.
Your surgeon and hand therapist balance tendon healing with movement to limit stiffness and scar tethering.
01 · Overview
Rebuilding a connection for movement
Tendons transmit a muscle's pull to a bone. In the hand and wrist, flexor tendons help bend the fingers and extensor tendons help straighten them. A significant tendon defect can interrupt that connection even when the joints can still be moved by someone else. [2]
Direct tendon repair joins the original tendon ends. Tendon grafting is different: it adds replacement tissue when there is a gap or the original tendon is too damaged to reconnect reliably. It may be considered after a major injury, a delayed presentation, or an unsuccessful earlier repair. [1]
A graft needs a functioning muscle, a usable attachment, and a pathway where it can glide. Your surgeon also checks joint stiffness, skin coverage, blood supply, nerve function, and scarring. These findings help determine whether grafting, another reconstruction, or nonsurgical care best fits your needs.
- Purpose
- Bridge a tendon defect to support movement
- Graft tissue
- Often your own tendon; donor tissue in selected cases
- Treatment pathway
- One operation or staged reconstruction
- Recovery commitment
- Protection and guided rehabilitation over months
Why does passive movement matter?
Passive movement is how far a joint moves when another hand moves it without relying on the injured tendon. A graft cannot by itself correct a very stiff joint. Therapy or additional treatment may be needed before reconstruction.
Does a graft restore sensation?
Not directly. Tendons provide movement, while nerves provide sensation and signals to muscles. A nerve injury may need separate evaluation or treatment and can limit what tendon reconstruction achieves.
02 · Concerns & Goals
What may bring you to a consultation
A tendon injury can affect everyday tasks, from holding a cup to opening your hand. Your surgeon will assess what limits your movement and whether grafting could help.
Lost bending or straightening
You may be unable to actively move a finger, thumb, or wrist through part of its usual range.
Reduced grip or control
Holding objects, turning keys, or performing precise tasks may feel difficult or unreliable.
An older or complex injury
A tendon gap, tissue loss, or previous surgery may make a simple end-to-end repair unsuitable.
Stiffness and scar tethering
Scar tissue can limit tendon glide. The condition of the joints and surrounding tissue matters as much as the tendon gap.
03 · Options
How the approaches differ
These approaches are not interchangeable. The injured tendon, available tissue, muscle function, and amount of scarring guide the surgical plan.
Single-stage tendon grafting
The graft is placed during one reconstructive operation.
How it worksThe surgeon bridges the defect and secures the graft to the remaining tendon or its attachment.
May suitSelected injuries with a suitable gliding pathway, adequate coverage, and sufficiently mobile joints.
Main tradeoffScar tethering, stretching, or rupture can still occur, and rehabilitation remains essential.
Two-stage flexor tendon reconstruction
The tendon pathway is prepared before the final graft is placed.
How it worksA temporary silicone rod may be placed first, sometimes with pulley reconstruction. A later operation replaces the rod with a tendon graft.
May suitSelected finger flexor injuries with substantial scarring or a damaged tendon sheath.
Main tradeoffIt requires separate operations and a longer treatment course; readiness for the second stage depends on healing and joint motion.
Grafting with your own tendon
An available tendon from elsewhere in your body supplies the graft.
How it worksThe surgeon selects a donor tendon whose removal is expected to have an acceptable effect on function.
May suitPatients with suitable donor tissue and a defect that can be reconstructed with it.
Main tradeoffHarvesting creates another surgical site with its own scar, discomfort, and possible functional effects.
Grafting with donor tendon
Processed donor tissue may be considered in selected reconstructions.
How it worksA tissue-bank tendon is sized and secured to bridge the defect.
May suitCertain defects or situations where using the patient's own tendon is less suitable.
Main tradeoffIt avoids tendon harvesting but introduces tissue-specific considerations, including incorporation and a small risk of disease transmission.
The number of operations and the source of graft tissue are separate decisions. Not every tendon injury needs a graft; some can be repaired directly. [1].
What are tendon pulleys?
Pulleys are bands of tissue that keep finger flexor tendons close to the bones as the fingers bend. Damaged pulleys may need reconstruction so a tendon graft can work effectively.
Why might surgery be delayed?
An open wound, infection, inadequate skin coverage, or marked joint stiffness may need treatment first. Your team may recommend therapy or another procedure to create better conditions for reconstruction.
04 · Results
What may improve and what may remain
Movement may improve
The goal is useful function, not a promise of normal motion.
- Improvement depends on muscle strength, joint mobility, tendon glide, and the condition of nearby nerves and tissue.
- Some loss of motion, grip strength, or fine control may remain.
Progress takes time
Early movement does not mean the graft is ready for force.
- Protected motion may begin while the graft attachments are still vulnerable.
- Function is assessed over months as healing and rehabilitation progress.
Further treatment may be needed
Reconstruction can involve more than the initial graft operation.
- A staged reconstruction includes a planned later procedure.
- Persistent stiffness, scar tethering, or graft failure may lead to discussion of additional treatment.
Tendon surgery may not restore full function. The type of injury and participation in the prescribed rehabilitation program influence recovery. [1]
05 · Recovery
Planning your recovery
Recovery at a glance
- Stay after surgery
- Determined by Your Surgeon
- Initial recovery at home
- Varies by Individual
- Return to desk work
- Varies by Procedure and Work Activity
- Light daily activities
- Based on Individual Recovery
- Strenuous exercise
- Based on Surgeon Clearance
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Recovery differs for flexor and extensor grafts, attachment methods, and any accompanying repairs. Your surgeon and hand therapist should provide a coordinated plan; returning to work is not the same as complete healing.
Step 1 · Day of surgery
Treatment day
The graft is secured and the limb is usually protected in a dressing and splint. Before leaving, review pain control, hand positioning, restrictions, and whom to call.
Step 2 · First days to weeks
Protection and early review
The team checks the wound, circulation, and splint fit. Depending on the reconstruction, a therapist may begin carefully controlled movement or continue immobilization.
Step 3 · Following weeks
Guided movement
Exercises and splint use change according to healing and the repair's strength. Unapproved stretching, gripping, or resistance can damage the reconstruction.
Step 4 · Later weeks to months
Strength and practical use
Strengthening and task practice begin only when cleared. Heavy work and sports may take longer, and staged surgery extends the overall timeline.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Desk workPlanning context: May be possible before full healing if duties can be adapted.What affects it: The operated hand, splint, swelling, pain medicine, and typing demands affect timing.
DrivingPlanning context: Resume only when your team clears you and you can safely control the vehicle.What affects it: A restrictive splint, impaired grip, or sedating medicine can make driving unsafe.
Lifting and manual workPlanning context: Usually restricted until the graft can tolerate loading.What affects it: Your job's force requirements and the graft fixation determine progression.
Sports and exercisePlanning context: Activities that load the hand or risk a fall need specific clearance.What affects it: Gripping equipment, contact, and weight-bearing through the arm can stress the graft.
Ask for written restrictions tailored to your reconstruction, including what you may do with the uninjured hand and when duties can change.
Before your procedure
- Describe the injury timeline, previous operations, and the tasks you most want to regain.
- Bring relevant imaging, operation reports, and therapy records if available.
- Review medicines, supplements, allergies, and any blood-thinning treatment; do not stop prescribed medicines without guidance.
- Discuss nicotine use, diabetes, circulation problems, and any current wound or infection.
- Arrange transportation and help with tasks that will be difficult while the limb is protected.
- Confirm access to hand therapy, follow-up appointments, and the team's fasting and medication instructions.
Why can too much and too little movement both cause problems?
Too much force can stretch or rupture the graft attachments. Too little movement can contribute to stiffness and adhesions. The safe balance depends on the reconstruction, so do not substitute general hand exercises for your prescribed program.
What if my splint becomes uncomfortable?
Contact your team about rubbing, increasing pressure, or a poor fit rather than altering it yourself. New numbness, coldness, or color change needs urgent assessment.
06 · Safety
Risks and what your clinician assesses
Pain, swelling, bruising, temporary stiffness, and scars at the reconstruction and any graft-harvest site are expected to varying degrees. Symptoms should be monitored with your team, especially if they worsen rather than gradually settle.
Graft rupture or stretching
The graft or its attachments may fail or lengthen, reducing movement and sometimes requiring another operation.
Adhesions and stiffness
Scar tissue may tether the graft, and joints may become stiff despite therapy. Additional treatment is sometimes considered.
Infection or wound problems
Infection, delayed healing, or skin breakdown can interrupt rehabilitation and threaten the reconstruction.
Nerve or blood-vessel injury
Nearby structures can be injured, causing altered sensation, weakness, or circulation problems.
Persistent pain or donor-site effects
Pain, sensitivity, weakness, or an uncomfortable scar can persist. Complex regional pain syndrome is an uncommon possible complication.
Bleeding and anesthesia complications
Bleeding or a blood collection may occur. Anesthesia has separate risks that depend on your health and the planned technique.
Discuss these risks and your individual health history with your surgeon. [1]
What your clinician assesses
- Which tendon is affected, the size of the defect, and whether the original muscle still functions
- Passive joint motion, tendon scarring, pulley condition, and skin coverage
- Sensation, circulation, infection status, and health factors that influence healing
- Available graft tissue, functional priorities, and ability to follow a rehabilitation plan
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope, including the tendon being reconstructed, graft source, any additional repairs, and whether treatment involves one or two stages.
Surgeon
Surgical care
Surgeon's services for grafting, tissue harvesting, and any planned additional reconstruction.
Ask your surgeonAsk whether separate stages, assistant fees, or later procedures are included.
Facility
Anesthesia and facility
Anesthesia services and use of the operating facility.
Ask your surgeonConfirm separate bills, network status, and charges for each planned operation.
Supplies
Supplies and follow-up
Splints, dressings, postoperative visits, and hand therapy when included.
Ask your surgeonAsk about custom orthoses, donor tissue charges, therapy visit limits, and replacement supplies.
TRC
Patient Services
Any separately listed coordination or administrative services.
Ask TRCAsk what is provided, whether participation is optional, and whether a separate fee applies.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Will a tendon be taken from my other arm or leg?
Possibly. The donor site depends on the size and length of graft needed and which tendons are available. Ask why that donor tendon is being chosen and what effects harvesting may have.
Can an old tendon injury still be treated?
Sometimes. Time since injury matters, but muscle function, joint flexibility, scarring, and nerve status also guide the decision. An older injury may need staged treatment or a different reconstruction.
Will I need to stay overnight?
Some tendon reconstructions are outpatient procedures. More complex surgery, other injuries, or medical needs may require a stay. Your team will explain the plan.
Will insurance cover tendon grafting?
Reconstruction for injury or loss of function may be covered, but authorization, network rules, deductibles, and therapy benefits vary. Confirm coverage for each stage and for rehabilitation directly with your insurer.
0 consultation questions in your plan
View in My TRC workspaceMy Aesthetic Plan
Prepare for your consultation
Bring these to help your consultation:
- Understand the proposed graft, donor source, and number of treatment stages.
- Arrange therapy, practical help, and written work and activity restrictions.
- Keep the follow-up schedule, urgent contact instructions, and itemized estimate accessible.
View My Aesthetic Plan
Choices stay in this visit until saving to your account completes. Nothing is sent to a clinician.
Sources
- [1]MedlinePlus — Tendon repairDirect tendon repair and grafting when tendon ends cannot be joined; anesthesia, surgical risks, splinting, rehabilitation, and the possibility of incomplete functional recovery.
- [2]Cleveland Clinic — TendonTendons connect muscles to bones and transmit force for movement; tendon injury can impair function.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.