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Reconstructive surgery · UK

Tendon transfer surgery - restoring function the nerve cannot.

Redeploying a working muscle to do a lost job - for radial, ulnar and median nerve palsy, foot drop, chronic Achilles gap, irreparable rotator cuff and tetraplegia. A consultant reconstructive surgeon, a named hand therapist, and a 12-month plan agreed before you consent.

See indicative pricing
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 transfer surgery costs in the UK.

Indicative ranges across our partner reconstructive units.

In short

£10,000–£16,000, home day-case or one night.

Procedure Indicative range
Reconstructive consultation £250–£500
Single tendon transfer (foot or wrist) £8,000–£12,000
Multiple tendon transfer (hand, radial palsy set) £10,000–£16,000
Tetraplegia upper-limb reconstruction £12,000–£18,000
Foot drop transfer (tibialis posterior) £8,500–£13,000
Chronic Achilles reconstruction with FHL transfer £9,000–£14,000
Rehabilitation / hand therapy course £700–£1,800

Prices vary by the surgeon, the number of transfers, whether allograft or contracture release is bundled in, and the length of the hand therapy course. NHS access exists via hand or limb reconstruction MDTs, but waits are often long - many patients come to us for planning and to protect the rehab pathway.

The problem

The right donor, the right timing, and a rehab plan you can actually finish.

Tendon transfers fail more often through poor selection and rehab drop-off than through poor surgery. We fix all three before you consent.

  • Pick the right donor

    Excursion, moment arm, expendability and phase - a synergistic donor makes motor re-education far easier than a heroic out-of-phase transfer.

  • Wait for the nerve - or do not

    A partial nerve palsy that may still recover is not the same case as a fixed palsy. We time transfer against nerve conduction, not the calendar alone.

  • Build the rehab into the operation

    Splint, therapist and 12-month plan agreed before consent. Without that, the best transfer in the world becomes a tendon the patient cannot switch on.

When it helps

When a tendon transfer is the right step.

The indications we see most, plus the one red flag that means release or serial casting first - not a transfer.

  • Radial nerve palsy - wrist and finger drop

    A high radial nerve injury that has not recovered - no wrist, finger or thumb extension. Pronator teres, FCR and PL redeploy to restore extension.

  • Ulnar claw hand

    Low ulnar nerve palsy with intrinsic loss and MCP hyperextension. A Zancolli lasso or FDS transfer restores balanced grasp.

  • Median nerve palsy - lost thumb opposition

    Loss of thenar function after high median injury. FDS opponensplasty (Camitz or Burkhalter) brings the thumb back across the palm.

  • Foot drop from peroneal nerve or CVA

    A dropped foot that will not clear the floor. Tibialis posterior transferred through the interosseous membrane replaces active dorsiflexion.

  • Chronic Achilles gap

    A neglected or re-ruptured Achilles with more than 5cm of missing tendon. Flexor hallucis longus (FHL) is transferred to bridge and re-power push-off.

  • Irreparable rotator cuff tear

    A massive, retracted cuff tear in a younger patient without arthritis. Lower trapezius or latissimus dorsi transfer restores external rotation and elevation.

  • Tetraplegia - C5/C6 upper limb

    A staged reconstruction - brachioradialis, ECRL or deltoid - to give an elbow-flexed, key-pinching, self-catheterising hand in a spinal cord injury patient.

  • Red flag: fixed contracture blocking transfer

    A joint that will not passively move through the target arc will not move actively after transfer either. Contracture release or serial casting comes first - not straight to theatre.

Procedure options

The classic transfers, and when each one is right.

Each option marries a specific donor to a specific lost function - chosen on biomechanics, not preference.

  • PT-to-ECRB - radial nerve palsy set

    The classic three-transfer set: pronator teres to ECRB for wrist extension, FCR to EDC for finger extension, and PL to EPL for thumb extension. Restores a functional working hand.

  • FDS opponensplasty

    Flexor digitorum superficialis (usually of the ring finger) rerouted around the FCU pulley and inserted into the thumb to reproduce opposition after median nerve loss.

  • Zancolli lasso for claw hand

    FDS looped through the A1 or A2 pulley to flex the MCP joint and correct claw posturing, restoring balanced power grasp in low ulnar nerve palsy.

  • Tibialis posterior for foot drop

    The tibialis posterior tendon rerouted through the interosseous membrane to the dorsum of the foot - the workhorse for permanent foot drop.

  • FHL to Achilles

    Flexor hallucis longus harvested and secured to the calcaneus to reconstruct chronic Achilles gaps, insertional tendinopathy after debridement, or failed primary repair.

  • Lower trapezius transfer for irreparable cuff

    Lower trapezius with an Achilles allograft extension routed to the greater tuberosity - reliably restores external rotation in massive posterosuperior cuff tears.

  • Latissimus dorsi transfer

    Latissimus dorsi rotated to the posterosuperior humeral head for irreparable rotator cuff - improves active elevation and pain in the right patient.

  • Staged tetraplegia reconstruction

    A two- or three-stage plan across each upper limb - elbow extension by deltoid-to-triceps, then key pinch by brachioradialis to FPL - tailored to the International Classification level.

Safety and recovery

What to expect afterwards - honestly.

Tendon transfer is well-established. The things worth planning are donor selection, the immobilisation window and the twelve months of motor re-education that follow.

  • Donor site weakness

    Every transfer robs one function to restore another. A well-chosen expendable donor - PT, PL, FDS ring, FHL - leaves negligible loss, but some measurable weakness is honest to expect.

  • Transfer rupture

    The tendon-to-tendon or tendon-to-bone junction can fail in the first six weeks. Early aggressive use, non-compliance with splinting or an under-tensioned repair are the usual culprits.

  • Adhesions and stiffness

    Transferred tendons scar to their new bed. Early protected motion and hand therapy are the mainstay; tenolysis is occasionally needed later to free a stuck transfer.

  • Motor re-education failure

    The brain has to learn to fire the donor for its new job. Older patients, cognitive impairment and out-of-phase transfers (flexor doing extensor work) all raise the risk of a working tendon the patient cannot switch on.

  • Incomplete recovery

    A transfer restores useful, not perfect, function - typically one MRC grade below the donor’s pre-op strength. We say this before you consent, not after.

  • Long splinting, staged rehab

    Four weeks in cast or splint, then weeks of protected motion, then months of strengthening. This is not a two-week recovery - plan work, driving and childcare around it.

  • Revision surgery risk

    A proportion of transfers need adjustment - re-tensioning, tenolysis or, occasionally, a fresh transfer. We build revision access into the network.

  • DVT and PE

    Any lower-limb transfer with immobilisation carries thromboembolic risk. Chemical prophylaxis, stockings and early weight-bearing where safe are standard.

  • Rehab non-compliance is the biggest predictor of failure

    The best surgeon and the best donor cannot rescue a patient who does not attend therapy or cuts their splint off early. We say this bluntly, and often.

Reading your operation note

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

Whichever transfer was chosen, the note the reconstructive surgeon sends you keeps to the same shape.

A UK consultant reconstructive 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 surgeon’s rehab plan before your review, just ask.

  1. 01 Header

    Indication and donor chosen

    Why the transfer was done - nerve palsy, irreparable rupture, tetraplegia, foot drop - and which donor tendon was harvested and for what recipient function.

  2. 02 Technique

    Routing and tensioning

    The path taken (subcutaneous, through the interosseous membrane), the repair technique (Pulvertaft weave, tendon-to-bone), and how tension was set intra-operatively.

  3. 03 Findings

    Intra-operative findings and any augmentation

    Muscle quality of the donor, condition of the recipient bed, and whether allograft, tendon augmentation or contracture release was needed at the same sitting.

  4. 04 Impression

    Rehab plan and expected timeline

    Read this first: the splinting regime, when place-and-hold starts, when active use begins, and the honest expected outcome at 6 and 12 months.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Tendon transfer surgery is usually covered when medically indicated after documented nerve or tendon injury. Hand therapy is often bundled under post-operative rehabilitation cover.

Frequently asked

Everything we get asked about tendon transfer surgery.

Quick answers on how a transfer differs from a repair, donor selection, timelines, success rates and cost.

  • What is a tendon transfer, and how is it different from a tendon repair?

    A tendon repair stitches a torn tendon back to its original position - the muscle still owns the same job. A tendon transfer takes a working muscle-tendon unit and redeploys it to do a different job that has been lost through nerve injury, irreparable rupture or paralysis. Repair restores anatomy; transfer restores function that anatomy alone cannot give back.

  • Who needs a tendon transfer?

    The main groups are peripheral nerve palsies that will not recover (radial, ulnar, median), chronic tendon ruptures with too much gap to repair (neglected Achilles, massive rotator cuff), foot drop from peroneal nerve or stroke, cerebral palsy upper limb, and staged upper-limb reconstruction after cervical spinal cord injury. It is not a first-line operation - it comes after nerve repair, splinting and time have been given a fair chance.

  • How is the donor tendon chosen?

    The surgeon looks at three things: expendability (can the hand or foot spare this muscle without meaningful loss), excursion (how far the donor tendon travels - enough to power the new movement) and moment arm (the mechanical advantage at the target joint). Synergy - a flexor doing another flexor’s job - makes motor re-education far easier than an out-of-phase transfer.

  • How long is recovery, honestly?

    Four weeks in a protective cast or splint, then eight to twelve weeks of therapist-guided place-and-hold and active use, then months of strengthening. The final judgement on outcome is at 12 months, not sooner. This is a rehab-heavy pathway - the surgery is the first quarter of the journey.

  • What success rates should I expect?

    For well-selected patients with the classic transfers - radial palsy set, tibialis posterior for foot drop, FHL for Achilles - 80 to 90 percent achieve useful, satisfaction-improving function. Perfect strength is not the goal: a transferred muscle usually ends one MRC grade below its pre-op strength, and that is enough to restore independence.

  • How much does tendon transfer surgery cost privately in the UK?

    Roughly £8,000–£12,000 for a single transfer such as tibialis posterior for foot drop, £10,000–£16,000 for a multi-tendon hand set for radial palsy, £12,000–£18,000 for staged tetraplegia upper-limb reconstruction, and £9,000–£14,000 for a chronic Achilles reconstruction with FHL. Hand therapy sits on top at £700–£1,800 for a full course.

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