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Yoon JP, Lee HB, Jeon YJ, Kim DH, Jeong SM, Jeong JM. Reconstruction of Bilateral Chronic Triceps Brachii Tendon Disruption Using a Suture-Mediated Anatomic Footprint Repair in a Dog. Animals (Basel) 2024; 14:1687. [PMID: 38891734 PMCID: PMC11171138 DOI: 10.3390/ani14111687] [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: 05/03/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
A 2-year-old, intact female Pomeranian presented with bilateral forelimb lameness, characterized by the olecranon making contact with the ground. The patient experienced two separate incidents of falling, occurring four and three weeks before admission, respectively. Following each episode, non-weight-bearing lameness was initially observed in the left forelimb, followed by the development of crouch gait. Based on the physical examination, radiographic, and ultrasonographic findings, bilateral triceps brachii tendon disruption was diagnosed. Intraoperatively, excessive granulation tissue at the distal end of the tendon was excised. The footprint region of each triceps brachii tendon was decorticated with a high-speed burr until bleeding was observed. The triceps brachii tendon was reattached to completely cover its footprint on the olecranon using the Krackow suture technique. This method involves anchoring the suture through bone tunnels in the ulna. Trans-articular external skeletal fixation was applied to both forelimbs to immobile and stabilize the elbow joints for nine weeks. Subsequently, the dog gradually increased its walking activities while on a leash over a six-week period. At the three-year follow-up, the patient exhibited improved forelimb function and maintained a normal gait without signs of lameness. Suture-mediated anatomic footprint repair proved useful in this single case and may be an effective surgical alternative for the management of chronic triceps brachii tendon disruption in dogs.
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Affiliation(s)
| | | | | | | | | | - Jae-Min Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99, Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (J.-P.Y.); (H.-B.L.); (Y.-J.J.); (D.-H.K.); (S.-M.J.)
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Chorba R, Hu C, Feldtmann J. Triceps Tendon Avulsion in a Soldier: A Case Report. Int J Sports Phys Ther 2024; 19:618-624. [PMID: 38707857 PMCID: PMC11065787 DOI: 10.26603/001c.116276] [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] [Received: 12/08/2023] [Accepted: 03/20/2024] [Indexed: 05/07/2024] Open
Abstract
Background Clinical assessment of triceps brachii tendon tears is challenging, and conventional imaging methods have limitations. Timely surgical referral is important in high-grade tears to maximize patient outcomes, and musculoskeletal ultrasound (MSK US) can be used at the time of clinical examination to identify such injuries requiring advanced imaging and orthopedic referral. Hypothesis/Purpose The purpose of this case report is to describe how MSK US was used to facilitate advanced imaging and timely orthopedic referral for a patient presenting to a physical therapist with a high-grade triceps tendon avulsion. Study Design Case Report. Case Description A 35-year-old male soldier presented to a direct access sports physical therapist with acute-on-chronic right elbow pain. Physical examination and MSK US were used to identify a high-grade partial triceps brachii tendon tear. The MSK US findings informed the physical therapist's decision-making process to refer the subject for timely advanced imaging studies as well as referral to an orthopedic physician. Outcomes A high-grade partial triceps tendon avulsion was confirmed on magnetic resonance imaging (MRI). The subject was then seen by an orthopedic surgeon and underwent surgical repair of the tendon within the recommended three-week timeframe for optimal outcomes. The subject completed a post-operative rehabilitation program and returned to full physical and occupational activities. Conclusion MSK US can assist in the diagnosis of challenging triceps tendon injuries, facilitating timely advanced imaging and orthopedic referrals for high-grade injuries to optimize patient outcomes. Level of Evidence 5.
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Welborn B, White CC, Bruce JR. Augmentation of triceps tendon repair with a bio-inductive collagen scaffold. BMJ Case Rep 2023; 16:e255469. [PMID: 37793840 PMCID: PMC10551870 DOI: 10.1136/bcr-2023-255469] [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] [Indexed: 10/06/2023] Open
Abstract
Two active, adult male patients, one with prior triceps rupture and direct repair, presented with traumatic rupture of the distal triceps tendon. MRI confirmed not only complete rupture with retraction in both, but also signal changes within the tendon, raising concern for healing potential and re-rupture. Surgical repair was performed using heavy, non-absorbable suture and suture anchors in the standard fashion, followed by augmentation with a bovine, bio-inductive collagen scaffold in order to increase tendon thickness and aid with healing capability. This technique is well described for rotator cuff repair augmentation but is a novel technique to the literature in the setting of triceps tendons repair. Both patients returned to full, preinjury activity without complication with sustained results at 3 and 3.5 years postoperatively.
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Affiliation(s)
- Benjamin Welborn
- Department of Orthopaedic Surgery, The University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee, USA
| | - Charles Cody White
- Department of Orthopaedic Surgery, The University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee, USA
| | - Jeremy R Bruce
- Department of Orthopaedic Surgery, The University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee, USA
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Pohl NB, Brush PL, Toci GR, Heinle JT, Thomas A, Hornstein J, Aita D, Beredjiklian P, Katt B, Fletcher D. Clinical Outcomes Following Open Olecranon Bursa Excision for Septic and Aseptic Olecranon Bursitis: An Observational Study. Cureus 2023; 15:e43696. [PMID: 37724223 PMCID: PMC10505354 DOI: 10.7759/cureus.43696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Background and objective Olecranon bursitis (aseptic or septic) is caused by inflammation in the bursal tissue. While it is typically managed with conservative measures, refractory cases may indicate surgical intervention. There is currently limited research about outcomes following bursal excision for both septic and aseptic etiologies. In light of this, the purpose of this study was to determine if patients experienced improvement following surgical olecranon bursa excision and to compare outcomes between septic and aseptic forms. Materials and methods A retrospective review was performed involving patients who underwent olecranon bursa excision from 2014 to 2021. Demographic data, patient characteristics, surgical data, and outcome-related data were collected from the medical records. Patients were classified into subgroups based on the type of olecranon bursitis (septic or aseptic). Preoperative and one-year postoperative 12-item short-form survey (SF-12) results and range of motion (ROM) outcomes were evaluated for the entire cohort as well as the subgroups. Results We included 61 patients in our study and found significant improvement in the Physical Component Scale 12 (PCS-12) score for all patients (42.0 vs. 45.5, p=0.010) following surgery. However, based on subgroup analysis, the aseptic group improved in PCS-12 following surgery (41.5 vs. 46.8, p<0.001), but the septic group did not (43.6 vs. 40.5, p=0.277). No improvements were found in the Mental Component Scale 12 (MCS-12) scores following surgery in either group. Eighteen of the 61 patients experienced postoperative complications (29.5%), but only 6.5% required a second surgical procedure. Specifically, 14 of the 18 complications occurred in the aseptic group while two septic and two aseptic patients required additional surgeries. Elbow ROM did not change significantly after surgery but more patients were found to have full ROM postoperatively (83.0% to 91.8%, p=0.228). Conclusion Our findings suggest that patients with refractory olecranon bursitis, particularly if aseptic, tend to gain significant physical health benefits from open bursectomy.
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Affiliation(s)
- Nicholas B Pohl
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Parker L Brush
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Gregory R Toci
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Jeremy T Heinle
- Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Anna Thomas
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Joshua Hornstein
- Division of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Daren Aita
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Brian Katt
- Division of Hand Surgery, Hackensack Meridian Ocean Medical Center, Brick Township, USA
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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Bartlett LE, Klein BJ, Daley A, Goodwillie A, Cohn RM. Functional Considerations in Bilateral, Simultaneous Tendon Injuries of the Upper Extremity: A Narrative Review of Current Literature. JBJS Rev 2023; 11:01874474-202306000-00008. [PMID: 37307343 DOI: 10.2106/jbjs.rvw.23.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
» Bilateral, simultaneous same-tendon injuries of the upper extremity are rarely encountered, yet their unique complexity poses a substantial challenge for treating orthopaedic surgeons.» In general, extremities with more tendon retraction should be repaired acutely while contralateral injuries can be treated in a staged or simultaneous manner depending on injury morphology, location, and anticipated functional impairment.» Combinations of accelerated and conventional rehabilitation protocols can be used for individual extremities to minimize the length of functional impairment.
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Affiliation(s)
- Lucas E Bartlett
- Department of Orthopedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntinton, New York
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Daniels SP, Fritz J. Acute and Chronic Elbow Disorders. Magn Reson Imaging Clin N Am 2023; 31:269-284. [PMID: 37019550 DOI: 10.1016/j.mric.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Elbow pain is very common and can be due to many pathologic conditions. After radiographs are obtained, advanced imaging is often necessary. Both ultrasonography and MR imaging can be used to evaluate the many important soft-tissue structures of the elbow, with each modality having advantages and disadvantages in certain clinical scenarios. Imaging findings between the two modalities often correlate. It is important for musculoskeletal radiologists to understand normal elbow anatomy and how best to use ultrasonography and MR imaging to evaluate elbow pain. In this way, radiologists can provide expert guidance to referring clinicians and best guide patient management.
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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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Pilih KA, Kozic M. Partial triceps tendon avulsion delayed reconstruction using Achilles tendon allograft, a case report. Trauma Case Rep 2022; 42:100701. [PMID: 36247880 PMCID: PMC9561914 DOI: 10.1016/j.tcr.2022.100701] [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: 10/02/2022] [Indexed: 11/09/2022] Open
Abstract
A case report of a 32-year-old bodybuilder with an incomplete triceps tendon avulsion on his right dominant upper extremity is presented. At initial presentation, an avulsion injury was suspected. Ultrasound diagnostics pointed toward partial distal triceps tendon rupture, and since the patient had retained active elbow extension, a trial of conservative treatment was initiated. The patient failed to regain forceful elbow extension. MRI revealed an avulsion fracture of the olecranon with large partial triceps tendon rupture with muscle retraction. A triceps tendon tenolysis and fixation with transosseous olecranon sutures was conducted in a secondary trauma center. However, we failed to recognize the true tendon in the extensive scar tissue formation, and the patient did not regain appropriate elbow extension strength. He was administered to a university medical center. An extensive triceps tenolysis was performed along with clear identification of retracted bony avulsion fragment and re-fixation of true triceps tendon on the olecranon using Achilles tendon allograft. During the postoperative period and physical rehabilitation therapy, the patient gradually developed normal elbow extension strength and was able to return to bodybuilding without limitations. Goniometric measurements and isokinetic testing were performed one year after the second surgery, showing only a minor reduction of right elbow extension strength compared to the uninjured elbow. Elbow function measured by the functional score questionnaire was comparable to the uninjured upper extremity. During an initial operative procedure, a vast scar tissue formation was observed. Tendon tenolysis was performed with clear identification of the bony avulsion. Achilles tendon allograft without a calcaneal bone fragment was used to bridge. Control MRI was performed, showing reconstructed triceps tendon continuity. The patient feels he can live his life unaffected by the injury.
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Affiliation(s)
- Klemen Aleš Pilih
- Department of Traumatology and Orthopedics, General Hospital Slovenj Gradec, Gosposvetska cesta 1, 2380 Slovenj Gradec, Slovenia,Corresponding author at: General Hospital Slovenj Gradec, Gosposvetska cesta 1, 2380 Slovenj Gradec, Slovenia.
| | - Mitja Kozic
- Department of Traumatology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
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Jacob J, O'Connor P, Pass B. Muscle Injury Around the Shoulder. Semin Musculoskelet Radiol 2022; 26:535-545. [DOI: 10.1055/s-0042-1756687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractAcute shoulder tendon and intra-articular injuries are common and their imaging well described. However, a subset of patients present with more unusual acute shoulder muscle injury. Of these, pectoralis major muscle injuries are encountered the most often and are increasingly prevalent due to a focus on personal fitness, particularly bench-press exercises. Other muscle injuries around the shoulder are rare. This article reviews the anatomy, mechanism of injury, and the imaging findings in relation to injuries of these muscles around the shoulder. We focus on pectoralis major injury but also review proximal triceps, latissimus dorsi, teres major, and deltoid muscle injuries, providing imaging examples.
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Affiliation(s)
- J. Jacob
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - P. O'Connor
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - B. Pass
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
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10
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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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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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12
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Abstract
Distal triceps ruptures are uncommon, usually caused by a fall on an outstretched hand or a direct blow. Factors linked to injury include eccentric loading of a contracting triceps, anabolic steroid use, weightlifting, and traumatic laceration. Risk factors include local steroid injection, hyperparathyroidism, and olecranon bursitis. Initial diagnosis can be complicated by pain and swelling, and a palpable defect is not always present. Plain radiographs can be helpful. MRI confirms the diagnosis and directs treatment. Incomplete tears can be treated nonsurgically; complete tears are best managed surgically. Good to excellent restoration of function has been shown with surgical repair.
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Hanlon DP, Mavrophilipos V. The Emergent Evaluation and Treatment of Elbow and Forearm Injuries. Emerg Med Clin North Am 2019; 38:81-102. [PMID: 31757256 DOI: 10.1016/j.emc.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article provides an updated review of the emergent evalution and treatment of elbow and forearm injuries in the emergency department. Clinically necessary imaging is discussed. Common and uncommon injuries of the elbow and forearm are reviewed with an emphasis on early recognition, efficient management, and avoidance of complications. The astute emergency physician will rely on a focused history and precise examination, applied anatomic knowledge, and strong radiographic interpretative skills to avoid missed injuries and complications.
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Affiliation(s)
- Dennis P Hanlon
- Department of Emergency Medicine, Allegheny General Hospital, 320 E. North Avenue, Pittsburgh, PA 15212, USA.
| | - Vasilios Mavrophilipos
- Department of Emergency Medicine, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
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Molenaars RJ, Schoolmeesters BJA, Viveen J, The B, Eygendaal D. There is a role for allografts in reconstructive surgery of the elbow and forearm. Knee Surg Sports Traumatol Arthrosc 2019; 27:1840-1846. [PMID: 30341449 DOI: 10.1007/s00167-018-5221-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/15/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Allografts play an important role in tendon, ligament, and bone reconstruction surgery, particularly when suitable available autologous tissue is limited. Enthusiasm for the use of allografts in reconstructive orthopedic surgery has increased over the past decade, with an increase in allograft use in a variety of procedures. The purpose of this review is to provide an overview of the various applications and indications for the use of allografts in reconstructive surgical procedures of the elbow and forearm. METHODS MEDLINE/PubMed was searched from 1990 through October 2018 for studies on tendon and bony allografts in elbow and forearm reconstructive surgery. RESULTS The Achilles tendon allograft is the most frequently used tendinous allograft, predominantly used in distal biceps and triceps reconstruction. Although reconstruction of the ulnar collateral ligament of the elbow is generally performed using autografts, it has been shown that semitendinosus and gracilis allografts may be equally effective. Extensor hallucis longus allografts are recommended for reconstruction of the lateral collateral ligaments in patients with posterolateral rotatory instability, and there may be a role for osteochondral allograft transplantation in capitellar osteochondral defects. In addition, the use of allografts in reconstruction of the interosseous membrane and various bone pathologies (fractures, bone tumors, forearm nonunions) has been described in current literature. CONCLUSION There is a large variety of pathology and procedures involving the use of various types of allografts in orthopedic reconstructive surgery of the elbow and forearm.
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Affiliation(s)
- R J Molenaars
- Sports Medicine Center, Harvard Medical School at Massachusetts General Hospital, 175 Cambridge St, 4th Floor, Boston, MA, 02114, USA. .,Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - J Viveen
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - B The
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - D Eygendaal
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
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Abstract
The acutely injured elbow can present as a diagnostic challenge, encompassing a spectrum of conditions that involve the various osseous and soft tissue structures of this complex joint. Imaging plays a vital role in the management of these patients by providing an accurate interpretation of the underlying trauma sustained, which can have important implications on the preservation of joint function and stability. This article examines the mechanisms, patterns, classifications, and imaging findings of acute elbow injuries, providing key concepts for the radiologist in the interpretation of these injuries.
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Affiliation(s)
- Teck Yew Chin
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Republic of Singapore.
| | - Hong Chou
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Republic of Singapore
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Republic of Singapore
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Simultaneous Ipsilateral Quadriceps and Triceps Tendon Rupture in a Patient with End-Stage Renal Failure. Case Rep Orthop 2018; 2018:7602096. [PMID: 30155330 PMCID: PMC6098857 DOI: 10.1155/2018/7602096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Quadriceps tendon ruptures (QTR) frequently occur in patients with end-stage renal failure, while triceps brachii tendon ruptures (TTR) are less common. This is the first properly documented report of a simultaneous ipsilateral traumatic rupture of both of these tendons. Case Report A 50-year-old patient, on hemodialysis for end-stage renal failure, fell on his right side. He presented with sudden right knee and elbow pain, with functional impairment of both joints. X-rays showed avulsion-like osseous lesions on the olecranon and patella with a low-riding patella. Ultrasound confirmed complete quadriceps and triceps avulsion ruptures. Both lesions were treated surgically. Fixation was performed with anchors using the Krackow suture technique for both tendons. Postoperative clinical and radiological results were satisfactory, and follow-up was uneventful. The patient regained his preinjury functional level with a complete range of motion of both his knee and elbow. Discussion Isolated QTR and TTR are frequent lesions in chronic renal failure patients treated with hemodialysis. Simultaneous ipsilateral rupture of both tendons however is extremely rare and should therefore not be overlooked. Surgical treatment is recommended for complete ruptures.
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Martins WR, Blasczyk JC, Soares S, de Paula WD, Bottaro M, Gentil P. A novel approach for rehabilitation of a triceps tendon rupture: A case report. Phys Ther Sport 2018; 32:194-199. [DOI: 10.1016/j.ptsp.2018.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/28/2022]
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Giannicola G, Bullitta G, Rotini R, Murena L, Blonna D, Iapicca M, Restuccia G, Merolla G, Fontana M, Greco A, Scacchi M, Cinotti G. Results of primary repair of distal triceps tendon ruptures in a general population: a multicentre study. Bone Joint J 2018; 100-B:610-616. [PMID: 29701103 DOI: 10.1302/0301-620x.100b5.bjj-2017-1057.r2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims The aim of the study was to analyze the results of primary tendon reinsertion in acute and chronic distal triceps tendon ruptures (DTTRs) in the general population. Patients and Methods A total of 28 patients were operated on for primary DTTR reinsertions, including 21 male patients and seven female patients with a mean age of 45 years (14 to 76). Of these patients, 23 sustained an acute DTTR and five had a chronic injury. One patient had a non-simultaneous bilateral DTTR. Seven patients had DTTR-associated ipsilateral fracture or dislocation. Comorbidities were present in four patients. Surgical treatment included transosseous and suture-anchors reinsertion in 22 and seven DTTRs, respectively. The clinical evaluation was performed using Mayo Elbow Performance Score (MEPS), the modified American Shoulder and Elbow Surgeons Score (m-ASES), the Quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH), and the Medical Research Council (MRC) Scale. Results A total of 27 patients (28 DTTRs) were available for review at a mean of 47.5 months (12 to 204). The mean MEPS, QuickDASH, and m-ASES scores were 94 (60 to 100), 10 (0 to 52), and 94 (58 to 100), respectively. Satisfactory results were observed in 26 cases (93%). Muscle strength was 5/5 and 4/5 in 18 and ten DTTRs, respectively. One patient with chronic renal failure experienced a traumatic rerupture of distal triceps. One patient (1 DTTR) experienced mild elbow stiffness. Conclusion Primary repair of acute and chronic DTTRs in a general population yields satisfactory results in the majority of patients with a low rerupture rate. Cite this article: Bone Joint J 2018;100-B:610-16.
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Affiliation(s)
- G Giannicola
- Department of Anatomical, Histological,Forensic Medicine and Orthopedics Sciences,Sapienza University of Rome -PoliclinicoUmberto I, Rome, Italy
| | - G Bullitta
- Department of Anatomical, Histological,Forensic Medicine and Orthopedics Sciences,Sapienza University of Rome - PoliclinicoUmberto I
| | - R Rotini
- Shoulder and Elbow Surgery Unit, RizzoliOrthopedic Institute, Bologna, Bologna, Italy
| | - L Murena
- Clinical University Department of Medical,Surgical and Health Sciences, Orthopaedicsand Traumatology Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste,Università degli Studi di Trieste, Trieste, Italy
| | - D Blonna
- Orthopedics and Traumatology Department,Mauriziano-Umberto I Hospital, University ofTurin Medical School, Turin, Italy
| | - M Iapicca
- Department of Orthopaedic Surgery, AziendaOspedaliera Papa Giovanni XXIII, Bergamo, Bergamo, Italy
| | - G Restuccia
- S.O.D. Orthopaedics and Traumatology, AOUPAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - G Merolla
- Unit of Shoulder and Elbow Surgery, D. CervesiHospital, Cattolica-AUSL della RomagnaAmbito Territoriale di Rimini, Cattolica, Italy
| | - M Fontana
- Department of Orthopaedics andTraumatology, Ospedale degli Infermi, Faenza, Italy
| | - A Greco
- Department of Orthopaedics andTraumatology, Ospedale San Salvatore, L' Aquila, Italy
| | - M Scacchi
- Department of Anatomical, Histological andForensic Medicine, and Orthopaedic Sciences,Sapienza University of Rome - PoliclinicoUmberto I, Rome, Italy
| | - G Cinotti
- Department of Anatomical, Histological andForensic Medicine, and Orthopaedic Sciences,Sapienza University of Rome - PoliclinicoUmberto I, Rome, Italy
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19
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Mirzayan R, Acevedo DC, Sodl JF, Yian EH, Navarro RA, Anakwenze O, Singh A. Operative Management of Acute Triceps Tendon Ruptures: Review of 184 Cases. Am J Sports Med 2018; 46:1451-1458. [PMID: 29578750 DOI: 10.1177/0363546518757426] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Distal triceps tendon ruptures are rare. The authors present a series of 184 surgically treated, acute, traumatic triceps tendon avulsions and compare the complications between those treated with anchors (A) versus transosseous (TO) suture repair. HYPOTHESIS No difference exists in the retear rate between TO and A repairs. Study Designed: Cohort study; Level of evidence, 3. METHODS All patients who underwent an open primary repair of a traumatic triceps tendon avulsion within 90 days of injury, between 2007 and 2015, were retrospectively reviewed. Surgeries were performed within a multisurgeon (75 surgeons), multicenter (14 centers), community-based integrated health care system. Patient demographic information, type of repair, complications, and time from surgery to release from medical care were recorded. RESULTS 184 triceps tears in 181 patients met the inclusion criteria. The mean age was 49 years (range, 15-83 years). There were 169 males. The most common mechanisms of injury were fall (56.5%) and weight lifting (19%). Mean time from injury to surgery was 19 days (range, 1-90 days); in 74.5% of cases, surgery was performed in 3 weeks or less. There were 105 TO and 73 A repairs. No significant difference was found between the two groups in the mean age ( P = .18), sex ( P = .51), completeness of tears ( P = .74), tourniquet time ( P = .455), and prevalence of smokers ( P = .64). Significant differences were noted between TO and A repairs in terms of reruptures (6.7% vs 0%, respectively; P = .0244), overall reoperation rate (9.5% vs 1.4%; P = .026), and release from medical care (4.3 vs 3.4 months; P = .0014), but no difference was seen in infection rate (3.8% vs 0%; P = .092). No difference was noted in release from medical care in patients who underwent surgery 3 weeks or less after injury compared with those undergoing surgery more than 3 weeks after injury (3.90 vs 4.09 months, respectively; P = .911). CONCLUSION Primary repair of triceps ruptures with TO fixation has a significantly higher rerupture rate, higher reoperation rate, and longer release from medical care than does repair with A fixation. Implementation of suture anchors in triceps repairs offers a lower complication rate and earlier release from medical care.
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Affiliation(s)
- Raffy Mirzayan
- Kaiser Permanente Southern California, Baldwin Park, California, USA
| | - Daniel C Acevedo
- Kaiser Permanente Southern California, Panorama City, California, USA
| | - Jeffrey F Sodl
- Kaiser Permanente Southern California, Orange County, California, USA
| | - Edward H Yian
- Kaiser Permanente Southern California, Orange County, California, USA
| | - Ronald A Navarro
- Kaiser Permanente Southern California, South Bay, California, USA
| | | | - Anshuman Singh
- Kaiser Permanente Southern California, San Diego, California, USA
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20
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Edelman D, Ilyas AM. Triceps Tendon Anatomic Repair Utilizing the "Suture Bridge" Technique. J Hand Microsurg 2018; 10:166-171. [PMID: 30483027 DOI: 10.1055/s-0038-1636729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/20/2018] [Indexed: 01/17/2023] Open
Abstract
Triceps tendon ruptures are uncommon injuries, but they typically require surgical repair. Multiple primary repair techniques are available, including transosseous, suture anchor, and anatomic repairs. The technique described here, the "suture bridge" repair, provides an anatomic repair of the distal triceps tendon to its footprint. It has the potential advantages of increased load to failure, better footprint coverage, higher load resistance, and allows for early motion.
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Affiliation(s)
- David Edelman
- Sidney Kimmel Medical College of the Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Asif M Ilyas
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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21
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Earley NF, Ellse G, Wallace AM, Parsons KJ, Voss K, Pugliese LC, Moores AP, Whitelock R, Stork C, Langley-Hobbs SJ, Radke H. Complications and outcomes associated with 13 cases of triceps tendon disruption in dogs and cats (2003-2014). Vet Rec 2017; 182:108. [PMID: 29097604 DOI: 10.1136/vr.104280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 08/24/2017] [Accepted: 10/04/2017] [Indexed: 11/03/2022]
Abstract
This study reports data from a larger number of cases of triceps tendon disruption. Records from 10 veterinary referral hospitals between 2003 and 2014 were searched for canine and feline cases diagnosed with triceps tendon disruption, based on orthopaedic examination confirmed during surgery. Long-term follow-up and owner satisfaction were assessed using a questionnaire. There were 13 cases of triceps tendon disruption diagnosed across seven hospitals (nine dogs, four cats). Trauma, history or presence of a wound, surgery in the region of tendon attachment or corticosteroid treatment preceded triceps tendon disruption. Radiographic signs or histopathology suggestive of a chronic tendinopathy was common. All cases underwent surgical repair involving a tendon suture pattern, 12 of which were secured through bone tunnels. Immobilisation was used in all cases in the form of transarticular external skeletal fixation (TAESF) (8/9 dogs) or spica splint (four cats, two dogs; in one dog a TAESF was applied after complications associated with the spica splint). Complications occurred in 11 cases (17 total complications), frequently associated with the immobilisation method. One case had traumatic tendon rerupture two years following surgery. A wound at presentation was associated with the development of multiple complications. Nine cases had long-term follow-up; five achieved normal function, four achieved acceptable function. Despite the complications, overall return to subjective normal or acceptable function, as assessed by the owners, was achieved in the majority of cases.
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Affiliation(s)
- Naomi Frances Earley
- Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK.,Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Gemma Ellse
- Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK
| | - Adrian M Wallace
- Bundoora Veterinary Hospital and Clinic, Small Animal Veterinary Referral Hospital, Melbourne, AU
| | - Kevin J Parsons
- Langford Veterinary Services, University of Bristol, Bristol, UK
| | - Katja Voss
- University Veterinary Teaching Hospital, University of Sydney, Sydney, AU
| | | | - Andy P Moores
- Anderson Moores Veterinary Specialists, Small Animal Veterinary Referral Hospital, Hursley, Hampshire, UK
| | - Richard Whitelock
- Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK.,Davies Veterinary Specialists, Small Animal Veterinary Referral Hospital, Higham Gobion, Hertfordshire, UK
| | - Christoph Stork
- Orthovet, Veterinary Orthopaedic Specialist Referral Service, Kings Hill, Kent, UK
| | - Sorrel J Langley-Hobbs
- Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK.,Langford Veterinary Services, University of Bristol, Bristol, UK
| | - Heidi Radke
- Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK
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22
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Gupta RK, Soni A, Malhotra A, Masih GD. Triceps tendon reconstruction using autologous semitendinosis graft in professional kabaddi player-A rare case report. J Clin Orthop Trauma 2017; 8:S38-S40. [PMID: 28878538 PMCID: PMC5574866 DOI: 10.1016/j.jcot.2017.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 11/19/2022] Open
Abstract
Triceps tendon rupture is a rare injury occurs due to sudden forceful contraction of triceps against flexed elbow. Though there are case reports describing various treatment options for this injury, including primary repair as well as reconstruction using different technique, no standardised technique has been defined. We present, for the first time, a case of five month old neglected triceps tendon rupture in a professional kabaddi player. Ruptured tendon was reconstructed using free autologous semitendinous graft with good functional outcome.
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23
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Dorweiler MA, Van Dyke RO, Siska RC, Boin MA, DiPaola MJ. A Comparative Biomechanical Analysis of 2 Double-Row, Distal Triceps Tendon Repairs. Orthop J Sports Med 2017; 5:2325967117708308. [PMID: 28607942 PMCID: PMC5453408 DOI: 10.1177/2325967117708308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Triceps tendon ruptures are rare orthopaedic injuries that almost always require surgical repair. This study tests the biomechanical properties of an original anchorless double-row triceps repair against a previously reported knotless double-row repair. HYPOTHESIS The anchorless double-row triceps repair technique will yield similar biomechanical properties when compared with the knotless double-row repair technique. STUDY DESIGN Controlled laboratory study. METHODS Eighteen cadaver arms were randomized into 2 groups. One group received the anchorless repair and the other received the knotless anchor repair. A materials testing system (MTS) machine was used to cycle the repaired arms from 0° to 90° with a 2.5-pound weight for 1500 cycles at 0.25 Hz. Real-time displacement of the tendon was measured during cycling using a probe. Load to failure was performed after completion of cyclic loading. RESULTS The mean displacement with the anchorless technique was 0.77 mm (SD, 0.25 mm) at 0° (full elbow extension) and 0.76 mm (SD, 0.38 mm) at 90° (elbow flexion). The mean displacement with the anchored technique was 0.83 mm (SD, 0.57 mm) at 0° and 1.01 mm (SD, 0.62 mm) at 90°. There was no statistically significant difference for tendon displacement at 0º (P = .75) or 90º (P = .31). The mean load to failure with the anchorless technique was 618.9 N (SD, 185.6 N), while it was 560.5 N (SD, 154.1 N) with the anchored technique, again with no statistically significant difference (P = .28). CONCLUSION Our anchorless double-row triceps repair technique yields comparable biomechanical properties to previously described double-row triceps tendon repair techniques, with the added benefit of avoiding the cost of suture anchors. CLINICAL RELEVANCE This anchorless double-row triceps tendon repair can be considered as an acceptable alternative to a knotless anchor repair for triceps tendon ruptures.
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Affiliation(s)
- Matthew A Dorweiler
- Department of Orthopedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Dayton, Ohio, USA
| | - Rufus O Van Dyke
- Department of Orthopedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Dayton, Ohio, USA
| | - Robert C Siska
- Department of Orthopedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Dayton, Ohio, USA
| | - Michael A Boin
- Department of Orthopedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Dayton, Ohio, USA
| | - Mathew J DiPaola
- Department of Orthopedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Dayton, Ohio, USA
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24
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Abstract
Distal triceps ruptures are rare injuries due to the special anatomical features of the muscle and tendon–bone junction. This injury typically occurs at the tendon–bone junction due to an eccentric contraction of the muscle. The treatment is controversial, especially in partial ruptures; surgical repair is indicated for complete ruptures of the distal triceps tendon. Several repair techniques have been described for acute complete ruptures. Chronic ruptures often require reconstruction rather than direct repair.
Cite this article: Demirhan M, Ersen A. Distal triceps ruptures. EFORT Open Rev 2016;1:255-259. DOI: 10.1302/2058-5241.1.000038.
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25
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Mancini F, Bernardi G, DE Luna V, Tudisco C. Surgical repair of isolated triceps tendon rupture using a suture anchor technique: a case report. JOINTS 2017; 4:250-252. [PMID: 28217662 DOI: 10.11138/jts/2016.4.4.250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rupture or avulsion of the distal triceps tendon is one of the least common tendon injuries. The most common clinical presentation of the injury is avulsion from the olecranon. The diagnosis of acute triceps tendon rupture may be missed and this can result in prolonged disability. We report the case of a 42-year-old man with isolated triceps rupture treated by an open surgical repair technique involving the use of bone suture anchors.
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Affiliation(s)
- Federico Mancini
- Department of Orthopaedics and Traumatology, Policlinico Tor Vergata, Rome, Italy
| | - Gabriele Bernardi
- Department of Orthopaedics and Traumatology, Policlinico Tor Vergata, Rome, Italy
| | - Vincenzo DE Luna
- Department of Orthopaedics and Traumatology, Policlinico Tor Vergata, Rome, Italy
| | - Cosimo Tudisco
- Department of Orthopaedics and Traumatology, Policlinico Tor Vergata, Rome, Italy
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26
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Outcomes and complications of triceps tendon repair following acute rupture in American military personnel. Injury 2016; 47:2247-2251. [PMID: 27507547 DOI: 10.1016/j.injury.2016.07.061] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Triceps tendon ruptures are uncommon injuries primarily occurring in young, active males or elderly individuals with various systemic diseases. Relatively little is known about the epidemiology of this injury, or the results of surgical management in high-demand populations. The purpose of this study was to define the incidence and outcomes of surgical treatment in active duty American military personnel. PATIENTS AND METHODS The Military Data Repository (MDR) was queried for all active duty military personnel undergoing surgical repair or reconstruction of a triceps tendon rupture between January 2012 and December 2014. The electronic health records of all patients with at least 12 months clinical follow-up were searched for demographic information, injury details, preoperative imaging findings, post-operative complications, and ability to return to duty following surgical repair. Incidence was calculated based on total active duty population in the MDR over the study period. Risk factors for postoperative complication and inability to return to duty following surgical repair were assessed using univariate analyses. RESULTS A total of 54 acute triceps tendon ruptures were identified in the search, of which 48 had at least 12 months follow-up and complete post-operative records. The incidence of acute triceps tendon rupture was 1.1 per 100,000 person-years. Twelve patients experienced post-operative complications, six of which were traumatic re-ruptures within four months of the index surgery. No patient had a post-operative infection or atraumatic repair failure. 94% of patients were able to return to active military service following surgical repair. Enlisted rank was a significant risk factor for a post-operative complication, but no factor predicted inability to return to active duty service. CONCLUSIONS Surgical repair of acute triceps tendon ruptures reliably restores strength and function even in high-demand individuals. In our population, traumatic rerupture was the most common complication.
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27
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Aunon-Martin I, Prada-Canizares A, Jimenez-Diaz V, Vidal-Bujanda C, Leon-Baltasar JL. Treatment of a Complex Distal Triceps Tendon Rupture With a New Technique: A Case Report. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e32221. [PMID: 27148500 PMCID: PMC4853493 DOI: 10.5812/atr.32221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
Introduction: The distal triceps tendon rupture is an uncommon injury. The acute treatment is well-defined, but when a delayed diagnosis is made or when a tendon retraction is present the alternatives or reconstruction are limited and sometimes complex. Case Presentation: In this case, we report on a 28-year-old man who presented with a chronic disruption of the distal triceps tendon with a gap of approximately 15 cm. The patient was diagnosed in another center with an inveterate breakage of the distal triceps tendon and was initially treated with an Achilles allograft that was complicated by a wound infection and required more than ten surgeries. Nearly 22 months after the initial trauma, and 12 months after the first surgery, we performed a reconstruction with an Achilles tendon allograft using the new technique of distal attachment. At the 12-month follow-up the patient presented a joint balance from -5º to 110º and presented with no pain. Conclusions: The use of an Achilles tendon allograft provides excellent results in complex distal triceps tendon ruptures. We report the use of a new technique to anchor a distal Achilles allograft.
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Affiliation(s)
- Ismael Aunon-Martin
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
- Corresponding author: Ismael Aunon-Martin, Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain. Tel: +35-913908227, E-mail:
| | - Alfonso Prada-Canizares
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
| | - Veronica Jimenez-Diaz
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
| | - Carlos Vidal-Bujanda
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
| | - Jose Luis Leon-Baltasar
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
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28
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Abstract
Acute triceps ruptures are an uncommon entity, occurring mainly in athletes, weight lifters (especially those taking anabolic steroids), and following elbow trauma. Accurate diagnosis is made clinically, although MRI may aid in confirmation and surgical planning. Acute ruptures are classified on an anatomic basis based on tear location and the degree of tendon involvement. Most complete tears are treated surgically in medically fit patients. Partial-thickness tears are managed according to the tear severity, functional demands, and response to conservative treatment. We favor an anatomic footprint repair of the triceps to provide optimal tendon to bone healing and, ultimately, functional outcome.
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Affiliation(s)
- Jay D Keener
- Department of Orthopaedic Surgery, Washington University, CB# 8233, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| | - Paul M Sethi
- The ONS Sports and Shoulder Service, 6 Greenwich Office Park, Greenwich, CT 06831, USA
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29
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Simultaneous Bilateral Rupture of the Triceps Tendon in a Renal Transplant Patient. Case Rep Orthop 2015; 2015:903690. [PMID: 26366314 PMCID: PMC4558418 DOI: 10.1155/2015/903690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/12/2015] [Indexed: 11/30/2022] Open
Abstract
The unilateral rupture of the triceps brachii tendon is a rare lesion representing 1% of all tendon injuries. The most common causes are the result of a contraction against resistance (especially weightlifters) and direct trauma. It has also been associated with systemic diseases such as diabetes mellitus, chronic renal failure, secondary hyperparathyroidism, and use of systemic corticosteroids. Simultaneous bilateral rupture of the triceps tendons is less frequent and has been described in association with chronic metabolic disorders, especially in those patients on hemodialysis. This paper presents a case of bilateral triceps tendon rupture of a 36-year-old woman with renal transplantation secondary to chronic renal failure. Early surgical repair was performed using a bone tunnel technique with a nonabsorbable suture. Clinically active extension with 135 degrees of range of motion was achieved.
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30
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Abstract
Complete triceps tendon rupture is relatively rare, but more commonly seen in the athletic population. Loss of extension strength is the functional deficit for the elbow after rupture of the triceps tendon. Although partial tears may be treated conservatively, complete tears of the triceps tendon must be repaired to provide active extension at the elbow. Our preferred surgical technique for repair of the acute triceps tendon rupture is presented, as well as strategies for reconstruction of the triceps tendon with an Achilles tendon allograft.
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Affiliation(s)
- James B Bennett
- Department of Orthopedic Surgery, and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX.
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31
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Hausman MR, Lang P. Examination of the elbow: current concepts. J Hand Surg Am 2014; 39:2534-41. [PMID: 25459959 DOI: 10.1016/j.jhsa.2014.04.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 03/31/2014] [Accepted: 04/06/2014] [Indexed: 02/02/2023]
Abstract
The elbow's complex anatomy and synergism of bony and ligamentous stabilizers make physical examination challenging. Adequate elbow assessment is essential for accurate diagnosis and initiating proper treatment. Isolated elbow injuries are rare; fractures should be interpreted as proxies for associated, often unappreciated, soft tissue injuries. A careful elbow examination informs the need for and interpretation of radiological studies, including fluoroscopy, magnetic resonance imaging, and computed tomography scanning.
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Affiliation(s)
- Michael R Hausman
- Department of Orthopedic Surgery, Mount Sinai Medical Center, New York, NY.
| | - Penelope Lang
- Department of Orthopedic Surgery, Mount Sinai Medical Center, New York, NY
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