Significant advances in the understanding of intrasynovial flexor tendon repair and rehabilitation have been made since the early 1970s. The concept of adhesion-free, or primary tendon healing - that tendons could heal intrinsically without the ingrowth of fibrous adhesions from the surrounding sheath has been validated both experimentally and clinically in studies over the past 25 years. Recent attempts to understand and improve the results of intrasynovial flexor tendon repair have focused upon restoration of the gliding surface, augmentation of early post-operative repair site biomechanical strength and on the elucidation of the molecular biology of early post-operative tendon healing. The goals of the surgical treatment of patients with intrasynovial flexor tendon lacerations remain unchanged: to achieve a primary tendon repair of sufficient tensile strength to allow application of a post-operative mobilization rehabilitation protocol. This program should inhibit the formation of intrasynovial adhesions and restore the gliding surface, while facilitating the healing of the repair site.