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Orthopaedics · UK

Tendon repair surgery - put back together properly.

Primary and delayed repair of flexor and extensor tendons of the hand, Achilles, distal biceps, quadriceps and patellar tendons. A consultant hand or orthopaedic surgeon, the correct technique for your tear, and hand therapy or physiotherapy booked before you leave.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private tendon repair surgery costs in the UK.

Indicative ranges across our partner hand and orthopaedic units.

In short

£6,000–£11,000, home day-case or one night.

Procedure Indicative range
Consultant consultation £250–£450
Hand flexor/extensor tendon repair £3,500–£7,500
Achilles tendon repair (open) £6,000–£11,000
Achilles minimally invasive/percutaneous £5,500–£9,500
Quadriceps tendon repair £6,500–£10,500
Patellar tendon repair £6,000–£10,000
Distal biceps tendon repair £6,500–£11,000

Prices vary by hospital, by the consultant, by approach (open, mini-open, percutaneous, single- or two-incision), and by whether a graft or synthetic augment is needed. Delayed and revision repairs sit at the top of the range. The NHS pathway for acute tendon injuries runs through A&E and hand trauma clinics - we can also help you decide when the private route is worth it.

The problem

The right window, the right technique, and the therapy plan you deserve.

Tendon repair is where general trauma quietly under-delivers - the window missed, the technique underpowered, the therapy plan an afterthought. We fix all three before the operation.

  • Repair on the correct clock

    Flexor and Achilles tendons have windows. Miss the window and you are into delayed repair with graft - longer, harder, less certain.

  • Use enough strands

    A two-strand Kessler cannot survive early motion. Modern practice is four- or six-strand cores with an epitendinous stitch so therapy can start on day three.

  • Book the therapist before the surgeon

    Hand therapy or physiotherapy from days 3–5 is what protects the repair. We line it up before you consent, not the week after.

When it helps

When tendon repair surgery is the right step.

The injuries we see most, plus the one red flag that means A&E and theatre urgently rather than a routine appointment.

  • Flexor tendon laceration (hand)

    A sharp cut to the palm or fingers that stops you bending - usually needs primary repair within 2 weeks to preserve gliding.

  • Extensor tendon injury (hand)

    A cut, crush or mallet mechanism over the back of the hand or finger that stops you straightening.

  • Achilles tendon rupture

    A sudden pop or kick to the calf during sport - inability to push off, positive Simmonds/Thompson test. Repair or protocolised bracing, decided together.

  • Distal biceps tendon tear

    A pop at the elbow lifting a heavy load - visible bulge, weakness in supination. Repair restores strength; delay past 3–4 weeks makes it harder.

  • Quadriceps tendon rupture

    A fall or heavy lift with the knee flexed - inability to straight-leg raise. Prompt transosseous repair is standard.

  • Patellar tendon rupture

    A jump or landing injury with a palpable defect below the kneecap - the patella rides high on X-ray. Early surgical repair is the rule.

  • Re-rupture after conservative care

    A tendon that failed non-operative treatment - often needs a delayed repair with augmentation or graft to bridge the gap.

  • Red flag: open wound with tendon exposure

    A visible tendon end in an open wound is an emergency - theatre, washout and repair, not a routine booking.

Procedure options

Technique and approach both depend on the tendon.

What each option involves - core suture (Kessler and cross-stitch), approach (percutaneous, mini-open, transosseous), and augmentation with graft where the tendon has retracted.

  • Primary repair with Kessler core suture

    The standard technique for acute flexor tendon lacerations within 2 weeks. Two- or four-strand core sutures give the tendon enough strength to tolerate early motion protocols.

  • Cross-stitch (epitendinous) suture

    A running peripheral stitch layered over the core repair. Adds strength, smooths the gliding surface, and reduces gap formation - used routinely alongside a Kessler.

  • Percutaneous Achilles repair

    A minimally invasive technique using small stab incisions and a jig-guided suture (Achillon or PARS). Less wound complication, quicker to weight-bear, similar re-rupture rates to open repair in selected cases.

  • Mini-open Achilles repair

    A 3–4 cm posterior incision with direct end-to-end suture. Preferred where the tear is proximal, ragged, or in tissue that will not hold a percutaneous jig.

  • Transosseous quadriceps/patellar repair

    The torn tendon is reattached to bone using drill tunnels or suture anchors through the patella. Protected in a brace, with graded weight-bearing over 6–8 weeks.

  • Distal biceps - single-incision anterior

    One anterior elbow incision, cortical button or interference screw fixation onto the radial tuberosity. Quick recovery, small risk of nerve irritation.

  • Distal biceps - two-incision Boyd-Anderson

    A second posterior incision to attach the tendon to the tuberosity through a bone trough. Lower nerve risk, small risk of heterotopic ossification.

  • Augmentation with allograft or synthetic

    Where the tendon has retracted and cannot reach - a hamstring or peroneus autograft, allograft, or synthetic ligament bridges the gap. Used in delayed and revision cases.

Safety and recovery

What to expect afterwards - honestly.

Tendon repair is a well-established operation. The things worth planning are the technique, the splint and the therapy protocol - because the rehab is where the outcome is won or lost.

  • GA or regional block in a proper theatre

    Most hand cases are done under regional (WALANT or brachial plexus) block; Achilles, biceps and knee cases are usually under GA. Day-case discharge is the norm.

  • Bleeding, infection, wound problems

    Wound infection is under 3 percent in elective repairs, higher in contaminated hand wounds - which is why washout timing matters. Bleeding needing return to theatre is rare.

  • Nerve and vessel injury

    Digital nerves sit millimetres from the flexor tendons; the sural nerve runs beside the Achilles; the lateral antebrachial cutaneous nerve is at risk in distal biceps repair. All are documented and consented.

  • Re-rupture is the big one

    Achilles re-rupture is around 2–5 percent after surgery versus up to 12 percent with bracing alone. Hand flexor re-rupture is 4–10 percent, usually in the first 6 weeks. Compliance with the splint matters.

  • Stiffness and adhesion

    The commonest long-term problem after hand flexor repair - adhesions between the tendon and its sheath. Early controlled motion protocols and hand therapy are the answer.

  • DVT, PE and equinus contracture (leg cases)

    DVT prophylaxis is standard for Achilles, patellar and quadriceps repairs. Contracture is prevented by staged brace angles and physiotherapy.

  • Heterotopic ossification (biceps)

    A small risk in distal biceps repair - bone forming in the soft tissues around the elbow. More often seen with two-incision techniques; usually asymptomatic.

  • Rehab is the operation, done slowly

    The surgery is the easy half. Hand therapy at 3–5 days, controlled motion for 6 weeks, strengthening from 8–12 weeks, and return to sport at 4–9 months by site.

  • Red flags after surgery

    Fever, spreading redness, a pop or sudden loss of function, calf pain or breathlessness need the same-day team or A&E, not a routine call.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever tendon was repaired - hand, Achilles, biceps or knee - the note the surgeon sends you keeps to the same shape.

A UK consultant orthopaedic surgeon reviewing a patient’s operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the operation note and the therapy protocol before your review, just ask.

  1. 01 Header

    Injury, site and timing

    Which tendon, which zone, when it was injured and how - the timing tells you whether this was primary, delayed or reconstruction.

  2. 02 Technique

    Suture, augmentation and anchors

    Core suture (Kessler, modified Kessler, Adelaide), epitendinous stitch, and any anchors, buttons, drill tunnels or graft used.

  3. 03 Findings

    Gap, quality and associated injuries

    How retracted the tendon was, the quality of the tissue, and whether nerves, vessels or the pulley system needed repair too.

  4. 04 Impression

    Splint, therapy protocol, follow-up

    Read this first: the splint angle, the therapy protocol (Duran, Kleinert, Manchester, early active motion), when to start weight-bearing and when to review.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Tendon repair surgery is usually covered when medically indicated for an acute rupture or laceration. Delayed and revision repairs are reviewed case by case.

Frequently asked

Everything we get asked about tendon repair surgery.

Quick answers on techniques, recovery, risk of re-rupture, cost and when surgery beats conservative care.

  • What is a tendon rupture and how do I know I have one?

    A tendon rupture is a full-thickness tear of the fibrous cord that connects muscle to bone. You usually feel a pop or a sudden give, followed by weakness or loss of a specific movement - pushing off the toes for an Achilles, straightening the knee for a quadriceps or patellar, bending a finger for a flexor. Bruising and a palpable gap follow within hours. Ultrasound or MRI confirms it.

  • Primary repair versus delayed repair - what is the difference?

    Primary repair is done within about 2 weeks of the injury, while the tendon ends are still healthy and reach each other. Delayed repair is anything later - the tendon retracts, scars form, and you may need to bridge a gap with a tendon graft or synthetic augment. Primary is simpler, stronger and heals faster, which is why we triage acute injuries urgently.

  • How long is recovery by site?

    Hand flexor repair: splint for 6 weeks, light use at 8–10 weeks, full return to sport at 4–6 months. Achilles: walking boot for 6–8 weeks, jog at 4 months, sport at 6–9 months. Distal biceps: sling 2 weeks, light use at 6 weeks, full load at 4–5 months. Quadriceps and patellar: brace 6–8 weeks, walking at 3 months, sport at 6–9 months.

  • When is surgery better than conservative treatment?

    For flexor lacerations, distal biceps ruptures, quadriceps and patellar tendon ruptures - surgery is usually the standard, because non-operative recovery is poor. For Achilles rupture, both operative and functional bracing pathways work in the right patient. We look at your age, activity, tear pattern and how quickly you present, then decide with you.

  • How much does private tendon repair cost in the UK?

    Roughly £3,500–£7,500 for a hand flexor or extensor repair, £6,000–£11,000 for an open Achilles, £5,500–£9,500 for a percutaneous Achilles, £6,500–£10,500 for a quadriceps, £6,000–£10,000 for a patellar, and £6,500–£11,000 for a distal biceps. Consultation is £250–£450 on top.

  • What are the risks - and how likely is re-rupture?

    The main risks are wound problems, infection (under 3 percent), nerve irritation, stiffness and re-rupture. Achilles re-rupture is 2–5 percent after surgical repair versus up to 12 percent with bracing alone. Hand flexor re-rupture is 4–10 percent, almost all in the first 6 weeks and almost always linked to splint non-compliance or a slip in therapy.

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