Basic Science of Tendon Healing

Tendon-healing biology is one of the most studied areas in hand surgery basic research; yet its influence on clinical practice is limited, as tendon repair and rehabilitation has seen only modest improvements over the decades (e.g., from early active mobilization and multistrand core repairs). It appears largely due to limits in marginal gains in flexor tendon surgery, given the heterogeneity of patients, injuries, repair techniques, and postoperative rehabilitation regimens. We believe that advancement in tendon healing requires a greater appreciation of cell and matrix biological processes and how customized protocols may enhance rehabilitation. It is critical to understand how tissues respond to injury, how tendon repairs interact with surrounding tissues, and the mechanobiological effects on tissue remodeling. Directing current surgery and therapy regimens more toward biological processes will facilitate optimal healing. This chapter explores the history, key considerations, and current paradigm for flexor tendon healing, and provides some insight into the latest research. The review will also aim to signpost readers toward areas that may show promise for translation toward improving patient care.