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Gruber MS, Bischofreiter M, Rittenschober F, Schachermayr M, Ortmaier R, Ritsch M. Distal Triceps Tendon Repair in Strength Athletes Leads to Satisfactory Return to Sports: A Retrospective Analysis of 22 Cases. J Clin Med 2024; 13:4913. [PMID: 39201054 PMCID: PMC11355401 DOI: 10.3390/jcm13164913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Distal triceps brachii tendon rupture (DTTR) is a relatively rare injury that is common in bodybuilding and high-intensity contact sports and can lead to significant functional impairment of the elbow joint. This study was conducted to evaluate clinical outcomes and the rate of return to sports among competitive bodybuilders and high-demand strength athletes after surgical repair of DTTR. Methods: This retrospective case series was performed in an institutional setting in tertiary health care. Return to sports of 22 competing or high-demand strength athletes (meaning three or more exercises per week) were analyzed pre- and postoperatively after surgical repair of DTTR using a hybrid technique of transosseous sutures and anchor fixation. Descriptive statistics were used to analyze demographic variables, and independent and paired t-tests were used to assess clinical outcomes. Results: The follow-up showed that from pre- to postoperatively, there was no deterioration in the number of sports disciplines (2.4 and 2.5 sporting activities per person, respectively; p = 0.540) or in the frequency of weekly training (4.1 and 4.1 times per person, respectively; p = 0.329). The postoperative visual analog scale for pain (from 6.0 to 1.6, p < 0.001), level of fitness (from 5.1 to 2.6, p = 0.002), and ability to train (from 5.2 to 1.3, p < 0.001) improved significantly. The time of return to sports was 1.5-3 months and 4-6 months after the surgery for ten patients each. The overall rate of return to sports was 95%, whereas 86% returned to the preinjury level of sporting activity. Conclusions: Repair of DTTR leads to high rates of return to sports in competitive athletes.
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Affiliation(s)
- Michael Stephan Gruber
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstraße 69, 4040 Linz, Austria
| | - Martin Bischofreiter
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstraße 69, 4040 Linz, Austria
| | - Felix Rittenschober
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Michael Schachermayr
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
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Haft M, MacKenzie JS, Shi BY, Ali I, Jenkins S, Nguyen D, van Riet R, Srikumaran U. Biomechanical strength of triceps tendon repairs: systematic review and meta-regression analysis of human cadaveric studies. Musculoskelet Surg 2024; 108:153-162. [PMID: 38713360 DOI: 10.1007/s12306-024-00817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/23/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE It is unclear which triceps tendon repair constructs and techniques produce the strongest biomechanical performance while minimizing the risk of gap formation and repair failure. We aimed to determine associations of construct and technique variables with the biomechanical strength of triceps tendon repairs. PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov were systematically searched for peer-reviewed studies on biomechanical strength of triceps tendon repairs in human cadavers. 6 articles met the search criteria. Meta-regression was performed on the pooled dataset (123 specimens). Outcomes of interest included gap formation, failure mode, and ultimate failure load. Covariates were fixation type; number of implants; and number of sutures. Stratification by covariates was performed. We found no association between fixation type and ultimate failure load; however, suture anchor fixation was associated with less gap formation compared with transosseous direct repair (β = - 1.1; 95% confidence interval [CI]:- 2.2, - 0.04). A greater number of implants was associated with smaller gap formation (β = - 0.77; 95% CI: - 1.3, - 0.28) while a greater number of sutures was associated with higher ultimate failure load ( β= 3; 95% CI: 21, 125). In human cadaveric models, the number of sutures used in triceps tendon repairs may be more important than the fixation type or number of implants for overall strength. If using a transosseous direct repair approach to repair triceps tendon tears, surgeons may choose to use more sutures in their repair in order to balance the risk of larger gap formation when compared to indirect repair techniques. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- M Haft
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - J S MacKenzie
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - B Y Shi
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Ali
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - S Jenkins
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - D Nguyen
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - R van Riet
- Department of Orthopedic Surgery, University Hospital Antwerp, Edegem, Belgium
| | - U Srikumaran
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
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Pohl NB, Brush PL, Russo J, Fras SI, Beredjiklian PK, Fletcher DJ. Triceps Tendon Reattachment Using Mini Plates and Screws After Failure of Olecranon Avulsion Fracture Fixation in Osteoporotic Bone: A Case Report. Hand (N Y) 2024:15589447241238373. [PMID: 38491923 DOI: 10.1177/15589447241238373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
This is a case report of an 85-year-old woman with osteopenia who underwent olecranon avulsion fracture repair with supplemental triceps tendon repair following a fall on an outstretched arm. The initial procedure failed due to osteoporotic bone quality and an atraumatic disruption of the olecranon fracture fixation. The patient subsequently underwent further surgical intervention with an olecranon avulsion fracture excision and a novel triceps tendon repair technique using plate augmentation and fiber tape. Surgeons may consider this novel approach as an initial treatment for elderly patients with osteopenia or osteoporosis undergoing olecranon avulsion fracture fixation, to prevent the failure and consequent revision surgery.
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Affiliation(s)
- Nicholas B Pohl
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Parker L Brush
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - James Russo
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Sebastian I Fras
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Pedro K Beredjiklian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Daniel J Fletcher
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Lee E, Stillson QA, Seidel HD, Bhattacharjee S, Koh JL, Strelzow JA, Shi LL. Surgical Outcomes, Trends, and Risk Factors of Distal Triceps Repairs. Hand (N Y) 2023; 18:1300-1306. [PMID: 35658641 PMCID: PMC10617476 DOI: 10.1177/15589447221095114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Distal triceps ruptures are rare, and complete ruptures are commonly treated with surgery. Studies of patients in small cohorts with distal triceps tear have reported outcomes and risk factors; however, large-scale data are scant. This study seeks to determine current trends, outcomes, and risk factors of distal triceps tears. METHODS Within a large insurance claims database, distal triceps repair patients were identified through Current Procedural Terminology coding with concomitant distal triceps International Classification of Diseases, 9th Revision/10th Revision diagnosis codes and 1-year active status before and after surgery. Demographics, total costs, 90-day complications, and revision rates within 1 year of index surgery were analyzed. Logistic regression was performed for revision and complication rates using sex, age, and comorbidities (anabolic steroid use, diabetes, ischemic heart disease, tobacco use, rheumatoid arthritis, and chronic kidney disease). RESULTS A total of 8143 patients were included in the cohort. Male patients and patients aged 40 to 59 years comprised most of the study population. The postoperative complication rate was 5.8%, and the 1-year revision rate was 2.6%. Male sex, age >60 years, ischemic heart disease, rheumatoid arthritis, and chronic kidney disease were statistically significant risk factors for higher 90-day complication rates. Anabolic steroid use significantly increased the risk of surgical revision. CONCLUSIONS Distal triceps repairs in this large cohort study occur most frequently in men aged 40 to 59 years. Complications are generally low, with age >60 years, male sex, ischemic heart disease, rheumatoid arthritis, and chronic kidney disease as risk factors for 90-day complications and prior anabolic steroid use as a risk factor for 1-year revision surgery. This information can help to improve education and expectations of this procedure.
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Affiliation(s)
| | - Quinn A. Stillson
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Henry D. Seidel
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Jason L. Koh
- NorthShore University HealthSystem, Evanston, IL, USA
| | - Jason A. Strelzow
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA
| | - Lewis L. Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA
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Alkhalfan YH, Jha G, Verma B, Coatwala A, Mishra A, Rasheed Ali Khan TM, Sinha A, Bollineni RL, Subbiah P. The Elbow's Achilles Heel: A Systematic Review and Meta-Analysis of Triceps Tendon Rupture and Repair Techniques. Cureus 2023; 15:e41584. [PMID: 37559858 PMCID: PMC10407265 DOI: 10.7759/cureus.41584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
Triceps tendon avulsion is a rare but debilitating condition and the least frequent of all tendon injuries, but it is receiving increasing attention in the literature. The most common mechanism of injury is resisted extension, which is typically seen in a fall onto an extended hand. Such injuries are easily overlooked and should be considered a differential diagnosis in all patients who describe pain and swelling at the posterior aspect of the elbow following a traumatic event. Non-operative management is the general principle for partial rupture as opposed to a variety of surgical treatments for a complete avulsion. The goal of this meta-analysis is to analyse the current literature on triceps avulsion and provide a detailed overview of the occurrence, diagnosis, treatment options and outcomes, comparison of various repair techniques, and consequences of this injury.
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Affiliation(s)
- Yousif H Alkhalfan
- Trauma and Orthopaedics, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, GBR
| | - Gaurav Jha
- Trauma and Orthopaedics, Leicester Royal Infirmary, Leicester, GBR
| | - Bhawika Verma
- Medicine, Maharashtra University of Health Sciences, Mumbai, IND
| | - Aadila Coatwala
- Surgery, Mahatma Gandhi Mission Institute of Health Sciences, Mumbai, IND
| | - Aarushi Mishra
- Medicine, Danylo Halytsky Lviv National Medical University, Lviv, UKR
| | | | - Akatya Sinha
- Medicine, Mahatma Gandhi Mission Medical College, Mumbai, IND
| | | | - Praveen Subbiah
- Intensive Care Unit, Broomfield Hospital, Mid and South Essex National Health Service (NHS) Foundation Trust, Chelmsford, GBR
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6
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Ritsch M, Regauer M, Schoch C. [Surgical treatment of distal triceps tendon ruptures]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2022; 34:438-446. [PMID: 36094541 DOI: 10.1007/s00064-022-00781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/21/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Restoration of the anatomy and the original length of the muscle-tendon unit in triceps tendon ruptures. INDICATIONS Acute and chronic triceps tendon ruptures with persisting symptoms and significant strength deficits. CONTRAINDICATIONS Infections and tumors in the surgical area. SURGICAL TECHNIQUE Prone position. Skin incision over the distal triceps in a lateral direction around the olecranon. Mobilization of the tendon and débridement of the olecranon. Drilling of 2 × 2.9 mm suture anchor holes medial and lateral into the footprint of the olecranon. In addition, drilling through the olecranon 12 mm distal to the tip of the olecranon and transosseous introduction of 4 sutures. Then the suture anchors (all-suture or titanium anchors) are inserted into the drill holes. Refix the deep and superficial tendons with the anchor threads. Refix the upper tendon portions with the transosseous sutures. In the case of chronic lesions, a graft interposition is necessary. POSTOPERATIVE MANAGEMENT Dorsal 10 ° splint, then change to an orthosis fixed in 20 ° extension and passive mobility 0-30 ° flexion for 6 weeks. From the 7th week onwards, load-free, physiotherapeutically controlled increasing mobilization. Starting weight-loading from the 13th week on. Full load after 6 months. RESULTS In all, 34 male strength athletes with acute triceps tendon rupture underwent surgery using the hybrid technique described and were prospectively recorded. The MEPS‑G score averaged 94.7 points, there were no permanent limitations in mobility, and the postoperative strength ability averaged 94% of the original strength performance ability. The return to sport achieved 100%. The complication rate was 20.6%. Reconstruction of the distal triceps tendon using hybrid technology leads to very good functional results. Half of all patients complained of symptoms even before the rupture, which suggests previous damage to the distal triceps tendon caused by degeneration.
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Affiliation(s)
- Mathias Ritsch
- sportortho-ro, Schön-Klinik Vogtareuth, Luitpoldstr. 4, 83022, Rosenheim, Deutschland.
| | - Markus Regauer
- sportortho-ro, Schön-Klinik Vogtareuth, Luitpoldstr. 4, 83022, Rosenheim, Deutschland
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Macknet DM, Ford SE, Mak RA, Loeffler BJ, Connor PM, Gaston RG. Complications after traumatic distal triceps tears: an analysis of 107 cases. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:520-525. [PMID: 37588465 PMCID: PMC10426459 DOI: 10.1016/j.xrrt.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background The major complication and reoperation rates after distal triceps repair are poorly defined. The purpose of this large retrospective cohort study of distal triceps repairs performed by multiple surgeons within a large orthopedic group was to more clearly define the rates and risk factors of clinically impactful major complications and reoperations. Methods All distal triceps tendon repairs for traumatic injuries performed from January 2006 to April 2017 with a minimum 2-month follow-up were identified using the Current Procedural Terminology code 24342. A total of 107 patients were included in this study. The primary outcome measure was total major complication rate. Reoperations, minor complications, and risk factors were also tracked. Results Repairs were performed via bone tunnels (63.5%), suture anchors (13%), or a combination of the two (17.8%). A 14% complication rate and 13.1% reoperation rate were observed. Indication for reoperation included 9 reruptures, 3 infections, and 2 others. The time between injury and surgery was not found to be a risk factor for tendon rerupture. Smoking status, gender, utilization of a splint or controlled motion brace, and time to first active mobilization were not shown to influence rates or rerupture. Conclusion Distal triceps repair for traumatic injuries is associated with 14% complication and 13.1% reoperation rates. Patient, rehabilitation, and surgeon-specific factors did not influence the complication rate.
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Affiliation(s)
- David M. Macknet
- Department of Orthopaedic Surgery, Carolina Medical Center, Charlotte, NC, USA
| | - Samuel E. Ford
- Department of Orthopaedic Surgery, Carolina Medical Center, Charlotte, NC, USA
| | - Ryan A. Mak
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA
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A biomechanical comparison between transosseous cruciate sutures and suture anchors for triceps tendon repair: a systematic review and meta-analysis. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tran DV, Yetter TR, Somerson JS. Surgical repair of distal triceps rupture: a systematic review of outcomes and complications. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:332-339. [PMID: 37588859 PMCID: PMC10426566 DOI: 10.1016/j.xrrt.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Triceps tendon injury is rare and accounts for only 2% of all tendinous injuries. It typically occurs after trauma or physical strain with eccentric loading. Treatment involves surgical repair, commonly with either transosseous bone tunnels or suture anchors. Nonsurgical management is typically reserved for low-demand or high-risk patients, as this is associated with deficits in strength and functional disability. Despite several recent high-quality observational studies that have added to our understanding of outcomes after surgical repair, we are not aware of a systematic review that includes literature published after 2015. In addition, prior reviews did not compare outcomes between different surgical repair methods, particularly transosseous bone tunnel and suture anchor techniques. Methods This systematic review examines published literature between January 1970 and May 2021 in PubMed, Scopus, and Cochrane databases to further examine reported functional outcomes and compare those outcomes between the two surgical repair methods. Results Our literature search yielded 309 results, of which only 16 met inclusion criteria. At the latest follow-up, the mean Disabilities of Arm, Shoulder, and Hand score was 4, the mean Quick Disabilities of Arm, Shoulder, and Hand score was 8, the mean Mayo Elbow Performance Score was 92, the mean American Shoulder and Elbow Surgeons-Elbow score was 99, the mean modified American Shoulder and Elbow Surgeons score was 94, the mean Oxford Elbow Score was 43, and the mean isokinetic muscle strength testing was 87%. A very high percentage (95%) of patients reported being satisfied with the repair. Preinjury levels of function were achieved in 92% of patients, and 100% regained at least a score of 4 of 5 for gross muscle strength. Complications occurred in 15% of cases, of which retears accounted for 5%. Subanalysis of cases with reported repair types revealed a significantly higher overall complication rate with transosseous repairs than with suture anchor repairs (18% vs. 8%, P = .008) as well as a higher retear rate in the transosseous repair group (7% vs. 2%, P = .03). Conclusion Patient-reported outcome measures were favorable for both suture anchor and transosseous tunnel repair methods. Suture anchor repair showed significantly better results with regard to isokinetic strength testing, complication rates, and retear rates. Further study is needed to establish superiority of either technique and cost-efficacy. In light of the evidence supporting greater biomechanical strength and lower clinical rates of failure, surgeons may consider use of a suture anchor technique for repair of distal triceps ruptures.
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Affiliation(s)
- Danny V. Tran
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Thomas R. Yetter
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jeremy S. Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Agarwalla A, Gowd AK, Liu JN, Garcia GH, Jan K, Naami E, Wysocki RW, Fernandez JJ, Cohen MS, Verma NN. Return to Sport Following Distal Triceps Repair. J Hand Surg Am 2022; 48:507.e1-507.e8. [PMID: 35074247 DOI: 10.1016/j.jhsa.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/18/2021] [Accepted: 11/10/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this investigation was to examine the timeline of return-to-sport following distal triceps repair; evaluate the degree of participation and function upon returning to sport; and identify risk factors for failure to return to sport. METHODS Patients who underwent distal triceps repair with a minimum of 1 year of follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire and were scored on a visual analog scale for pain; the Mayo Elbow Performance Index; the Quick Disabilities of the Arm, Shoulder, and Hand; and the Single Assessment Numerical Evaluation. RESULTS Out of 113 eligible patients who had a distal triceps repair, 81 patients (71.7%) were contacted. Sixty-eight patients (84.0%) who participated in sports prior to surgery were included at 6.0 ± 4.0 years after surgery, and the average age was 46.6 ± 11.5 years. Sixty-one patients (89.7%) resumed playing at least 1 sport by 5.9 ± 4.4 months following distal triceps repair. However, 18 patients (29.5%) returned to a lower level of activity intensity. The average postoperative Quick Disabilities of the Arm, Shoulder, and Hand; Mayo Elbow Performance; visual analog scale for pain; and Single Assessment Numerical Evaluation scores were 8.2 ± 14.0, 89.5 ± 13.4, 2.0 ± 1.7, and 82.2 ± 24.3, respectively. No patients underwent revision surgery at the time of final follow-up. CONCLUSIONS Distal triceps repair enables 89.7% of patients to return to sport by 5.9 ± 4.4 months following surgery. However, 29.5% of patients were unable to return to their preinjury level of activity. It is imperative that patients are appropriately educated to manage postoperative expectations regarding sport participation following distal triceps repair. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, CA
| | | | - Kyleen Jan
- School of Medicine, University of Illinois, Chicago, IL
| | - Edmund Naami
- School of Medicine, University of Illinois, Chicago, IL
| | - Robert W Wysocki
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - John J Fernandez
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Mark S Cohen
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Nikhil N Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL.
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Alnaji O, Erdogan S, Shanmugaraj A, AlQahtani S, Prada C, Leroux T, Khan M. The surgical management of distal triceps tendon ruptures: a systematic review. J Shoulder Elbow Surg 2022; 31:217-224. [PMID: 34343662 DOI: 10.1016/j.jse.2021.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal triceps tendon ruptures (DTTRs) are highly uncommon injuries and can be treated with surgical repair. The purpose of this review was to compare the outcomes and complications of various surgical techniques used for primary repair of DTTRs. METHODS The electronic databases MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed were searched from data inception to October 15, 2020. The Methodological Index for Non-randomized Studies tool was used to assess study quality. Data are presented descriptively. RESULTS A total of 19 studies were identified, comprising 560 patients (565 triceps tendons), of whom 78.6% were male patients. The mean age was 46.1 ± 8.4 years, and the mean follow-up period was 31.8 ± 21.0 months. The overall complication rate across all DTTR repair procedures was 14.9%. The distribution of complications for each technique was 29.2% for the direct repair technique, 15.2% for the transosseous technique (transosseous suture), and 7.7% for the suture anchor technique. Common complications include ulnar neuropathies, infections, and pain. The overall rerupture rate for transosseous suture, suture anchor, and direct repair was 4.3% (n = 12), 2.1% (n = 3), and 0% (n = 0), respectively. Patients undergoing DTTR repair experience significant improvements postoperatively regarding pain, strength, and range of motion. CONCLUSIONS Patients undergoing DTTR experience improvements in postoperative outcomes; however, there is a moderate reported risk of rerupture or complication. Owing to the heterogeneity in rupture patterns, surgical procedures, and outcome measures, it is difficult to ascertain the superiority of one surgical technique over another. Future studies should use large prospective cohorts and long-term follow-up to determine more accurate complication rates and outcome scores.
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Affiliation(s)
- Omar Alnaji
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Safiya Erdogan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Saad AlQahtani
- Orthopedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Timothy Leroux
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
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12
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Triceps Rupture and Repair in a Healthy, Young Woman following Rock Climbing. Case Rep Orthop 2021; 2021:3340479. [PMID: 34840839 PMCID: PMC8616681 DOI: 10.1155/2021/3340479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 12/03/2022] Open
Abstract
Triceps tendon rupture in females is rare. In this case report, we present a young adult female patient with a distal triceps tendon rupture from bouldering treated with open surgical repair technique using a modified bone tunnel and suture anchor fixation technique. The diagnosis and technique for repair and postoperative rehabilitation are described. A review of the current literature of biomechanical and clinical outcomes of various repair techniques is also presented.
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13
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Constantino DC, Varela E, Quintas I, Campos V, Carpinteiro E, Barros A. Acute and chronic triceps tendon rupture treated with knotless double-row anchor repair: two case reports. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:457-463. [PMID: 37588701 PMCID: PMC10426664 DOI: 10.1016/j.xrrt.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
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Ritsch M. Bizeps- und Trizepssehnenrupturen im Kraftsport. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Acute Distal Triceps Tendon Rupture Repair: Case Presentation and Surgical Technique. J Orthop Trauma 2021; 35:S18-S19. [PMID: 34227595 DOI: 10.1097/bot.0000000000002164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
This case presentation and surgical technique demonstrates a complete distal triceps tendon rupture repair with single-row suture anchor fixation through a posterior midline approach to the elbow in a 17-year-old male rugby player. Key procedure points include complete triceps mobilization for adequate excursion to facilitate repair, identification of the ulnar nerve, isolation and sharp debridement of torn tissue to healthy tendon, thorough debridement of the olecranon reattachment site, suture construct, and order of fixation to optimize tendon-bone apposition.
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16
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Lozekoot PWJ, Tegels JJW, van Vugt R, de Loos ER. Bone suture anchor repair and functional outcome of a triceps tendon rupture, a rare clinical entity. BMJ Case Rep 2021; 14:14/7/e241773. [PMID: 34315735 PMCID: PMC8317102 DOI: 10.1136/bcr-2021-241773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Triceps tendon rupture is rare and easily missed on presentation. A 58-year-old man was seen in our accident and emergency department with an inability to extend his right elbow against gravity after he fell. Ultrasound and MRI confirmed the suspected diagnosis of a traumatic triceps tendon rupture and excluded additional injuries. Surgical repair was carried out by a bone anchor suture reinsertion of the tendon to the olecranon. After 2 weeks of cast immobilisation, an early active range of motion (ROM) rehabilitation schedule was followed, resulting in excellent elbow function at 12 weeks postoperatively.In conclusion, it is important to suspect this rare injury and use additional studies to confirm the diagnosis of triceps tendon rupture. Also, good clinical outcome with regards to function can be achieved using bone anchor suture repair and an early active ROM rehabilitation schedule.
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Affiliation(s)
| | | | - Raoul van Vugt
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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17
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Tramer JS, Patel R, Kuhlmann NA, Muh SJ. Simultaneous, Ipsilateral Distal Biceps and Distal Triceps Rupture in Healthy Weight Lifter: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00021. [PMID: 34252056 DOI: 10.2106/jbjs.cc.20.00693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 38-year-old weight lifter presented with a complete distal biceps rupture with retraction and a near complete ipsilateral distal triceps tear sustained during the bench press exercise. The tendons were fixed operatively using a simultaneous posterior and anterolateral approach to the elbow. CONCLUSION Simultaneous, ipsilateral distal biceps and distal triceps tendon injury is a rare occurrence that leads to significant functional loss. Repair of distal biceps rupture using a single-incision technique with a cortical button and distal triceps using a double-row suture anchor repair was successful in restoring functional anatomy to our patient.
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18
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Najefi AA, Domos P. A unique case of bilateral triceps avulsion fracture in a patient with pseudohypoparathyroidism. Shoulder Elbow 2021; 13:334-338. [PMID: 34659475 PMCID: PMC8512989 DOI: 10.1177/1758573219876553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022]
Abstract
Triceps tendon ruptures and avulsions are rare injuries and are often associated with systemic diseases. This paper illustrates the unique case of a 20-year-old female patient with pseudohypoparathyroidism, who sustained bilateral triceps avulsion fractures after a fall. She underwent suture anchor fixation, augmented with tension band suture as double row repair with excellent post-operative results. We describe the pathophysiology of this injury and the unique method of fixation, which can be an alternative effective method to repair these injuries.
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Affiliation(s)
- Ali-Asgar Najefi
- Ali-Asgar Najefi, Trauma & Orthopaedic
Department, Royal Free Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet EN5
3DJ, UK.
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19
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[Transosseous reconstruction of triceps tendon rupture : Surgical technique]. Unfallchirurg 2021; 124:1024-1031. [PMID: 34023923 PMCID: PMC8632856 DOI: 10.1007/s00113-021-01007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
Operationsziel Transossäre Rekonstruktion der Trizepssehne. Indikation Sämtliche Trizepssehnenrupturen, die eine spannungsfreie Rekonstruktion erlauben. Kontraindikation Retrahierte Trizepssehnenrupturen, die nach Mobilisation keine spannungsfreie Rekonstruktion erlauben. Operationstechnik Durch 2 sich kreuzende transossäre Kanäle erfolgt das Durchfädeln eines nichtresorbierbaren Fadens. Direkt im Footprint erfolgt zudem das Setzen eines Fadenankers. Durch den primären Faden erfolgt nach transossärem Shutteln am Footprint beginnend das Durchflechten der Sehne in Krackow-Nahttechnik und, erneut am Footprint angekommen, das erneute transossäre Shutteln sowie das körperferne Verknoten. Mit dem ersten Fadenpaar des Ankers erfolgen in ähnlicher Weise das Armieren der Sehne und anschließend das intratendinöse Verknoten. Durch ein Verknoten des zweiten Fadenpaares des Ankers auf den primären körperfernen Knoten kann der Anpressdruck auf das Avulsionsfragment erhöht werden. Alternativ kann mit den Fäden des Fadenankers eine Mason-Allen Naht-durchgeführt werden. Weiterbehandlung Die ersten 6 Wochen erfolgt die Nachbehandlung in einer „ROM brace“ mit einem stufenweisen Freigeben der Flexion. Nach 6 Wochen freie Flexion. Beginn mit Kräftigungsübungen nach 12 Wochen. Ergebnisse Autoren beschreiben gute Ergebnisse nach operativer Versorgung von Trizepssehnenrupturen. Im vorliegenden Fall wird 6 Monate postoperativ, ungeachtet von einem in der Literatur beschriebenen möglichen Extensionsdefizit, ein exzellentes Outcome mit freiem Bewegungsausmaß erreicht.
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20
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Surgical Repair Using Suture Bridge Technique for Triceps Tendon Avulsion. Case Rep Orthop 2021; 2021:5572126. [PMID: 33968456 PMCID: PMC8081627 DOI: 10.1155/2021/5572126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Triceps tendon avulsion is a rarely occurring tendinous injury. Various surgical procedures, such as repair using sutures through the transosseous tunnel or suture anchors, have been reported for treating triceps tendon avulsion. However, standard surgical treatment has not yet been established. Here, we present a case of triceps tendon avulsion treated using the suture bridge technique. A 58-year-old man who fell on his left elbow from standing height presented to our hospital. Plain radiography revealed an avulsion fracture of the left olecranon process, suggesting triceps tendon avulsion. We performed surgical repair of the avulsed bone fragments and ruptured triceps tendon. We inserted suture anchors into the ulna, proximal to the fracture site, and passed the sutures through the full thickness of the triceps. Subsequently, fracture fragments were reduced and fixed by pulling them together with the triceps. We inserted knotless anchors into the ulna distal to the fracture site and fixed the avulsed bone fragments and triceps tendon using the suture bridge technique. The patient recovered well in five months and reported no elbow pain or limited range of motion. This suture bridge technique is advantageous as it prevents iatrogenic fracture and knot irritation, and it would be indicated in cases with poor bone quality or thin skin soft tissue of the olecranon.
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21
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Agarwalla A, Gowd AK, Jan K, Liu JN, Garcia GH, Naami E, Wysocki RW, Fernandez JJ, Cohen MS, Verma NN. Return to work following distal triceps repair. J Shoulder Elbow Surg 2021; 30:906-912. [PMID: 32771606 DOI: 10.1016/j.jse.2020.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the rate and duration of return to work in patients undergoing distal triceps repair (DTR). METHODS Consecutive patients undergoing DTR from 2009 to 2017 at our institution were retrospectively reviewed at a minimum of 1 year postoperatively. Patients completed a standardized and validated work questionnaire; a visual analog scale for pain; the Mayo Elbow Performance Score; the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire; and a satisfaction survey. RESULTS Of 113 eligible patients who underwent DTR, 81 (71.7%) were contacted. Of these patients, 74 (91.4%) were employed within 3 years prior to surgery (mean age, 46.0 ± 10.7 years; mean follow-up, 5.9 ± 3.9 years). Sixty-nine patients (93.2%) returned to work by 2.2 ± 3.2 months postoperatively. Sixty-six patients (89.2%) were able to return to the same level of occupational intensity. Patients who held sedentary-, light-, medium-, and high-intensity occupations were able to return to work at a rate of 100.0%, 100.0%, 80.0%, and 76.9%, respectively, by 0.3 ± 0.5 months, 1.8 ± 1.5 months, 2.5 ± 3.6 months, and 4.8 ± 3.9 months, respectively, postoperatively. Of the workers' compensation patients, 15 (75%) returned to work by 6.5 ± 4.3 months postoperatively, whereas 100% of non-workers' compensation patients returned to work by 1.1 ± 1.6 months (P < .001). Seventy-one patients (95.9%) were at least somewhat satisfied, with 50 patients (67.6%) reporting excellent satisfaction. Seventy-two patients (97.3%) would undergo the operation again if presented the opportunity. A single patient (1.4%) required revision DTR. CONCLUSIONS Approximately 93% of patients who underwent DTR returned to work by 2.2 ± 3.2 months postoperatively. Patients with higher-intensity occupations had an equivalent rate of return to work but took longer to return to their preoperative level of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Kyleen Jan
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, CA, USA
| | | | - Edmund Naami
- School of Medicine, University of Illinois, Chicago, IL, USA
| | - Robert W Wysocki
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - John J Fernandez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Mark S Cohen
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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22
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Weber S, Zimmermann B, Bühler G, Stillhard PF. A case series of a rare tendon rupture. J Surg Case Rep 2021; 2021:rjab058. [PMID: 33815751 PMCID: PMC8007176 DOI: 10.1093/jscr/rjab058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 11/12/2022] Open
Abstract
The distal triceps tendon rupture is a rare finding. Only 1% of tendon ruptures are related to it. The triceps brachii muscle has three parts. All of them insert together at the posterior surface of olecranon. Mostly, the tendon ruptured at this level of insertion. The typically trauma mechanism is a fall on the hand with fully extended elbow or a direct trauma. There are also some cases described after weightlifting or secondary due to insufficiency after total joint replacement of the elbow. The diagnosis is based on clinical findings. Ultrasound or magnetic resonance imaging diagnostic is secondary but might help to differentiate between partial or complete rupture as well as to assess tendon retraction. The diagnosis should be treated operatively. Until today, there is no standard of art of surgery techniques. We describe three cases with traumatic triceps tendon rupture fixed by a transosseous refixation.
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Affiliation(s)
- Sabrina Weber
- Department of Orthopaedic Surgery, Kantonsspital Graubünden, 7000 Chur, Switzerland
| | - Bernd Zimmermann
- Department of Orthopaedic Surgery, Kantonsspital Graubünden, 7000 Chur, Switzerland
| | - Gian Bühler
- Department of Orthopaedic Surgery, Kantonsspital Graubünden, 7000 Chur, Switzerland
| | - Philipp F Stillhard
- Department of Orthopaedic Surgery, Kantonsspital Graubünden, 7000 Chur, Switzerland
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23
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Hall RR, Sarokhan AK, Leung NL. Clinical Outcomes of Low-Cost, Anchorless Repair of the Triceps Tendon Using a Proximal Knot Technique. Arthrosc Sports Med Rehabil 2021; 3:e535-e541. [PMID: 34027466 PMCID: PMC8129437 DOI: 10.1016/j.asmr.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/09/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To use validated outcome measures to evaluate the clinical results of surgical repair of distal triceps tendon ruptures using transosseous tunnels and high-strength sutures with proximally based knots. Methods A consecutive series of traumatic distal triceps tendon ruptures at a single institution was studied. All cases were surgically repaired by 1 surgeon using high-strength suture with a bone tunnel-based repair technique. Repair knots were oriented proximally instead of in the traditional distal position. All patients were evaluated at long-term follow-up with a physical examination performed by the orthopaedic surgeon and the following validated outcome measures: Disabilities of the Arm, Shoulder and Hand score; Mayo Elbow Performance Score; and visual analog scale score. Results Seven male patients with a mean age of 38 years (range, 19-50 years) and mean follow-up period of 4.1 ± 1.2 years underwent distal triceps tendon repair with bone tunnels and high-strength sutures with proximally positioned knots. Of the repairs, 4 involved the dominant arm. At final follow-up, the mean Disabilities of the Arm, Shoulder and Hand score was 1.3 ± 3.1; the mean Mayo Elbow Performance Score was 99.3 ± 1.9; and the mean visual analog scale score was 0. One additional patient who declined participation in the study had wound dehiscence and infection with an associated partial rerupture. Conclusions This case series of triceps tendon repairs using transosseous tunnels and proximally based knots showed favorable postoperative elbow function based on validated outcome measures. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Robert R. Hall
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
- Address correspondence to Robert R. Hall III, B.S., Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, U.S.A.
| | - Alison K. Sarokhan
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Nicky L. Leung
- Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts, U.S.A
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24
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Abstract
Triceps tendon injuries are an uncommon clinical entity poorly described in the literature. This review discusses the spectrum of pathology, effective diagnosis, nonsurgical treatment, surgical treatment, rehabilitation, and surgical complications of triceps tendon injuries. Management of triceps tendinopathies depends on the mechanism of injury and the patient's motor examination. Triceps tendinopathies and partial tendon tears with intact strength can be managed conservatively with rest, ice, immobilization, nonsteroidal anti-inflammatory drugs, and physical therapy. If conservative management fails for 6 months or there are strength deficits on examination, surgery should be considered. Based on the current evidence, there are no clear guidelines for "best" surgical approach. Although rare, the most significant surgical complication to be concerned about is rerupture. Rerupture rate is 4.62% among the articles we reviewed.
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Affiliation(s)
- Kyle Casadei
- Henry Ford Health System, Michigan, Lake Orion, MI
| | - John Kiel
- Emergency Medicine and Sports Medicine, University of Florida-Jacksonville College of Medicine, Jacksonville, FL
| | - Michael Freidl
- Orthopedic Surgery, University of Florida-Jacksonville College of Medicine, Jacksonville, FL
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25
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Anderson CN. All-Suture Anatomic Footprint Repair of the Distal Triceps Tendon. Arthrosc Tech 2020; 9:e2013-e2019. [PMID: 33381413 PMCID: PMC7768200 DOI: 10.1016/j.eats.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/11/2020] [Indexed: 02/03/2023] Open
Abstract
Distal triceps ruptures are an uncommon injury, and currently, there is a lack of consensus on the optimal surgical technique for repair. The traditional transosseous cruciate repair has been shown to be nonanatomic and to have a higher failure rate and be biomechanically inferior to suture anchor repairs. The use of anchors significantly increases procedure cost and theoretically increases the risk of complications related to drill and anchor placement. The technique described in this article allows anatomic restoration of the triceps tendon while avoiding the increased cost and risk that may be associated with suture anchor placement.
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Affiliation(s)
- Christian N. Anderson
- Address correspondence to Christian N. Anderson, M.D., Tennessee Orthopaedic Alliance, 4230 Harding Rd, Ste 1000, Nashville, TN 37203, U.S.A.
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26
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Sarokhan AK, Leung NL. Acute Triceps Tendon Repair: A Technique Utilizing 3 Curved Tunnels and Proximal Knots. Arthrosc Tech 2019; 8:e705-e712. [PMID: 31485396 PMCID: PMC6713898 DOI: 10.1016/j.eats.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/03/2019] [Indexed: 02/03/2023] Open
Abstract
Although triceps tendon tears are less common than other tendon tears, complete ruptures require surgical repair to restore the strength of the extensor mechanism of the elbow. There are several described techniques for repair using both transosseous tunnels and suture anchors. Current techniques often result in large suture knots over the dorsal ulna under thin subcutaneous tissue, which can be irritating for patients. Knotless techniques require costly suture anchors. In this technical note, we describe a novel transosseous 3-tunnel technique with proximal suture knots to lessen the potential for postoperative pain.
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Affiliation(s)
- Alison K. Sarokhan
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.,Address correspondence to: Alison K. Sarokhan, M.D., Department of Orthopaedic Surgery, Tufts Medical Center, 800 Washington Street, TMC Box #306, Boston, Massachusetts 02111, U.S.A.
| | - Nicky L. Leung
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.,Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts, U.S.A
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27
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Waterman BR, Dean RS, Veera S, Cole BJ, Romeo AA, Wysocki RW, Cohen MS, Fernandez JJ, Verma NN. Surgical Repair of Distal Triceps Tendon Injuries: Short-term to Midterm Clinical Outcomes and Risk Factors for Perioperative Complications. Orthop J Sports Med 2019; 7:2325967119839998. [PMID: 31069242 PMCID: PMC6492365 DOI: 10.1177/2325967119839998] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Few large-scale series have described functional outcomes after distal triceps tendon repair. Predictors for operative success and a comparative analysis of surgical techniques are limited in the reported literature. Purpose To evaluate short-term to midterm functional outcomes after distal triceps tendon repair in a broad patient population and to comparatively evaluate patient-reported outcomes in patients with and without pre-existing olecranon enthesopathy while also assessing for modifiable risk factors associated with adverse patient outcomes and/or revision surgery. Study Design Case series; Level of evidence, 4. Methods This study was a retrospective analysis of 69 consecutive patients who underwent surgical repair of distal triceps tendon injuries at a single institution. Demographic information, time from injury to surgery, mechanism of injury, extent of the tear, pre-existing enthesopathy, perioperative complications, and validated patient-reported outcome scores were included in the analysis. Patients with a minimum of 1-year follow-up were included. Results The most common mechanisms of injury were direct elbow trauma (44.9%), extension/lifting exercises (20.3%), overuse (17.4%), and hyperflexion or hyperextension (17.4%). Eighteen patients were identified with pre-existing symptomatic enthesopathy, and 51 tears were caused by an acute injury. A total of 36 complete and 33 partial tendon tears were identified. Bone tunnels were most commonly used (n = 30; 43.5%), while direct sutures (n = 23; 33.3%) and suture anchors (n = 13; 18.8%) were also used. Perioperative complications occurred in 21.7% of patients, but no patients experienced a rerupture at the time of final follow-up. No statistically significant relationship was found between patient age (P = .750), degree of the tear (P = .613), or surgical technique employed (P = .608) and the presence of perioperative complications. Conclusion Despite the heightened risk of perioperative complications after primary repair of distal triceps tendon injuries, the current series found favorable functional outcomes and no cases of reruptures at short-term to midterm follow-up. Furthermore, age, surgical technique, extent of the tear, and mechanism of injury were not associated with adverse patient outcomes in this investigation. Pre-existing triceps enthesopathy was shown to be associated with increased complication rates.
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Affiliation(s)
- Brian R Waterman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Robert S Dean
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Shreya Veera
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Robert W Wysocki
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Mark S Cohen
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - John J Fernandez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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28
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Dimock RA, Kontoghiorghe C, Consigliere P, Salamat S, Imam MA, Narvani AA. Distal Triceps Rupture Repair: The Triceps Pulley-Pullover Technique. Arthrosc Tech 2019; 8:e85-e91. [PMID: 30899656 PMCID: PMC6408749 DOI: 10.1016/j.eats.2018.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/14/2018] [Indexed: 02/03/2023] Open
Abstract
Distal triceps rupture is an uncommon but debilitating injury, and surgical fixation is almost invariably warranted. A number of techniques have been described in the literature in which combinations of transosseous tunnels and bone anchors have been used. We describe a modification to existing techniques-the triceps pulley-pullover technique with all-suture anchors. This technique minimizes bone loss, while maximizing the bone-tendon contact area and creating a double-row repair to optimize strength and healing.
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Affiliation(s)
- Richard A.C. Dimock
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom
| | | | - Paolo Consigliere
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom
| | - Shadi Salamat
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom
| | - Mohamed A. Imam
- Norfolk & Norwich University Hospitals, Norwich, United Kingdom
| | - A. Ali Narvani
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom
- Fortius Clinic, London, United Kingdom
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