Extensor tendon injuries are common and require a complex treatment strategy to appropriately manage them, including initial repair, revision/reconstruction options, and postoperative protocols. Intrinsic and extrinsic components of the extensor mechanism contribute to a complex anatomic apparatus but also allow for numerous reconstructive options. Tenolysis, tendon grafting, and local tissue reconstruction are all options that can be used to treat complex extensor tendon injuries, but the type of repair is dependent on which of the eight extensor zones and accompanying structures are injured. To adequately assess and treat these injuries, a working knowledge of the anatomy, reconstructive techniques, and rehabilitation is imperative.