Significant changes in the concepts of tendon physiology and tendon healing have occurred in the last decade. Nevertheless, they reflect questions and controversies which date back many hundreds of years. Investigators and clinicians of today must recognise that, like their predecessors with an interest in flexor tendon surgery, they will contribute to the understanding of this very important structure, but they also will leave unanswered questions for future generations. The current interest in methods to prevent or modify adhesions is based on the presumption that the tendon can participate in the repair process. In this regard, it would be inappropriate to ignore the potential contribution by peripheral cellular elements as well. Surgeons may have moved on from the concept that pricking the tendon causes pain, twitching, and convulsions, but they have not yet clearly defined the repair process and how to consistently obtain healing of a lacerated tendon with a smooth gliding surface.

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