Learn About the 3 Phases of Healing From Our Orthopaedic Surgeon in Sydney

Jun 28, 2014

After shoulder surgery, the repaired tendon heals in three distinct, overlapping phases. Understanding these can help you make sense of your recovery timeline and why your surgeon and physiotherapist set the restrictions they do.

Phase 1: Inflammatory Phase

This phase occurs during roughly the first week after surgery. A small amount of bleeding at the repair site leads to clot formation, and platelets and inflammatory cells are drawn to the area through chemical signalling. This is the body’s natural first response to injury and repair, and some swelling and discomfort during this period is expected.

Phase 2: Proliferative Phase

Beginning around two to three weeks after surgery, inflammatory cells begin producing scar tissue, which gradually replaces the original clot with new blood vessels and connective tissue. This scar tissue forms the scaffold on which stronger, more permanent repair tissue is later built. The tendon is still relatively fragile at this stage.

Phase 3: Maturation and Remodeling Phase

From around three weeks onward, new tissue production tapers off and the scar tissue already laid down begins to mature and remodel into stronger repair tissue. This phase generally lasts at least 12 weeks, and in some cases up to 26 weeks, which is why full recovery from tendon repair surgery takes considerably longer than the initial wound-healing period.

Throughout each of these phases, your rehabilitation program is adjusted to protect the repair while gradually reintroducing movement – enough to prevent stiffness, but not so much that it places undue stress on healing tissue. If you’d like more detail on what to expect in the early weeks after arthroscopic shoulder surgery, see our related article on post-operative recovery.

Dr Mark Haber is an orthopaedic surgeon with a special interest in shoulder surgery, based in Sydney.