How is the procedure performed?
The procedure is performed under a combination of general and regional anaesthesia. An incision is made on the front of the elbow and forearm. The bone where the tendon normally attaches is exposed and a socket is drilled to match the size of the tendon. Sutures are placed in the tendon and the tendon is then advanced in to the socket and fixed with the aid of a button, which may be supplemented with a non-metallic bone screw. In chronic cases a tendon graft may be required to bridge the gap. The graft may be prepared from the patient’s own tendon or from donor tissue.
The main benefit of the procedure is to reattach the tendon and improve the function of the joint and ability to use the arm. More than 90% of patients achieve benefit from surgery.
The overall risk of complications is less than 10%. The development of a complication may rarely require further surgery.
Nerve injury - The risk of this is approximately 3%. The nerve most commonly affected is the posterior interosseous nerve and if injured this results in weakness of the wrist and fingers. The injury is usually temporary and recovers over some weeks. Occasionally the nerves to the skin of the forearm may be injured resulting in numbness on the outer aspect of the forearm. This may persist permanently but does not affect function.
Damage to the bone – A hairline fracture of the bone may occur during preparation of the socket or insertion of the screw. This may require protection of the elbow for 4-6 weeks to allow healing.
Rerupture - This is rare.
Hardware failure – The device used to fix the tendon may rarely work loose from the bone.
Infection – The risk of infection is about 1-2%. You will be given antibiotics as a precaution.
Heterotopic ossification – Occasionally new bone may form at the site of injury and repair and may result in stiffness of the elbow or forearm.
Following the procedure the skin incision will be closed with sutures and tape and covered with a shower-proof dressing, which should be left undisturbed until the sutures are removed at 12-14 days. Prior to discharge from hospital a physiotherapist will provide instructions about looking after the elbow. You will be advised to protect the elbow by wearing a sling and intermittently performing limited active-assisted movements of the elbow only for 2 weeks. After 2 weeks you will be allowed to move the elbow actively. Heavy lifting should be avoided for at least 12 weeks. Outpatient physiotherapy will be arranged if necessary.
You may resume driving at approximately 2-3 weeks after surgery or when you have regained sufficient movements and control of the arm to drive safely. Return to work will depend on your occupation. Manual activities should be avoided for at least 3 months. Non-contact sports may be resumed at 4 months.
An appointment will be arranged for you to be seen 2 weeks after the procedure. Follow-up is required for at least 6-12 months after surgery or until a satisfactory recovery is achieved.