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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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Shivdasani K, Scheidt M, Anderson J, Okafor L, Garbis N, Salazar D. Full-thickness triceps tears misdiagnosed as olecranon bursitis: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:319-323. [PMID: 38706666 PMCID: PMC11065744 DOI: 10.1016/j.xrrt.2024.02.002] [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: 05/07/2024]
Affiliation(s)
- Krishin Shivdasani
- Corresponding author: Krishin Shivdasani, BS, MPH, Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153, USA.
| | - Michael Scheidt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | | | - Lauren Okafor
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Nickolas Garbis
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Dane Salazar
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
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Ntourantonis D, Mousafeiris V, Lianou I. Nontraumatic Triceps Tendon Rupture in a Young Bodybuilder Athlete: A Case Report and Review of the Literature of a Known Injury in an Unknown Setting. J Orthop Case Rep 2023; 13:70-76. [PMID: 37521377 PMCID: PMC10379251 DOI: 10.13107/jocr.2023.v13.i07.3758] [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: 04/02/2023] [Revised: 05/16/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Triceps' tendon rupture is thought to be a relatively rare injury, and its exact incidence is unknown. As a result of the rareness of this injury, very few cases of weightlifters or bodybuilders taking androgenic anabolic steroids have been published in the literature to date. In this article, we report a very rare case of non-traumatic triceps tendon rupture in a professional bodybuilder under androgenic anabolic steroids. Case Report A 32-year-old male patient was admitted to our emergency department, reporting that while trying to maneuver his motorbike to avoid collision with another vehicle, he felt sudden pain at the posterior elbow and heard a popping sound. Active extension of the elbow was found to be reduced, raising suspicion of triceps tendon rupture. Ultrasound and magnetic resonance imaging revealed rupture of the triceps, confirming the clinical diagnosis. Intraoperatively, an almost complete rupture of the triceps was noted at its insertion into the olecranon. After the recognition and preparation of the triceps' footprint, two 3.5 mm titanium bone sutured anchors were placed at the anatomical insertion of the tendon, and the tendon was repaired using a modified double-row technique. Follow-up at 6 months and 1 year postoperatively revealed perfect Mayo Elbow Performance and Oxford Elbow Scores with no residual pain or range of motion deficits; triceps strength had returned to pre-injury levels. Conclusion Triceps tendon rupture is thought to be a relatively rare injury and among the rarest tendon injuries. It usually occurs in patients with systematic diseases, such as renal disease, or on medication, such as androgenic anabolic steroid use. As a result of its rareness, very few cases of weightlifters or bodybuilders taking steroids have been reported in the literature. To our knowledge, this is the first case of non-traumatic triceps tendon rupture in a bodybuilder under oral androgenic anabolic steroids.
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Affiliation(s)
| | | | - Ioanna Lianou
- Department of Orthopaedics and Trauma, General Hospital of Patras, Patras, Greece
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Trizepssehnenrupturen. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-022-00572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Lytle J, Meyers A, Ballard E, Fallahi AK, Nelson R. Global elbow instability: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:120-124. [PMID: 37588066 PMCID: PMC10426550 DOI: 10.1016/j.xrrt.2022.08.005] [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]
Affiliation(s)
- Jacob Lytle
- Orthopedic Surgery Department, Ascension Genesys Hospital, Grand Blanc, MI, USA
- Michigan State University, Statewide Campus System, East Lansing, MI, USA
| | - Amy Meyers
- Orthopedic Surgery Department, Ascension Genesys Hospital, Grand Blanc, MI, USA
- Michigan State University, Statewide Campus System, East Lansing, MI, USA
| | - Eric Ballard
- Orthopedic Surgery Department, Ascension Genesys Hospital, Grand Blanc, MI, USA
- Michigan State University, Statewide Campus System, East Lansing, MI, USA
| | | | - Ryan Nelson
- Greater Michigan Orthopedics, Grand Blanc, MI, USA
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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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9
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Postoperative MR Imaging of the Elbow. Magn Reson Imaging Clin N Am 2022; 30:629-643. [DOI: 10.1016/j.mric.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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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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11
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Kirchhoff K, Beirer M, Völk C, Buchholz A, Biberthaler P, Kirchhoff C. [Lesions of the triceps tendon : Diagnostics, management, treatment]. Unfallchirurg 2021; 125:73-82. [PMID: 34910226 DOI: 10.1007/s00113-021-01103-6] [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: 10/18/2021] [Indexed: 11/30/2022]
Abstract
The triceps brachii muscle is the main extender of the elbow joint. Triceps tendon rupture or tearing presents a rare injury pattern in general. Distal tendon ruptures occur most commonly in the area of the insertion of the olecranon. Fractures of the radial head are reported as the most common concomitant injury. In many cases, pre-existing degenerative damage predisposes for tendon injury. These include local steroid injections, anabolic steroid abuse, renal insufficiency requiring dialysis, hyperparathyroidism, lupus erythematosus and Marfan's syndrome. However, the most frequent trauma mechanism is a direct fall onto the extended forearm or a blow to the elbow. Beside clinical examination and sonography, magnetic resonance imaging is the diagnostic gold standard. The treatment of triceps tendon injuries includes conservative as well as operative approaches, whereby the indications for surgical treatment must be generously considered depending on the patient's age, functional demands of the patient, involvement of the dominant extremity as well as on the extent of the tendon rupture.
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Affiliation(s)
- K Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Beirer
- Klinik für Unfallchirurgie und Orthopädie, Schwarzwald-Baar Klinikum, Klinikstr. 11, 78052, Villingen-Schwenningen, Deutschland
| | - C Völk
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A Buchholz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - P Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - C Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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12
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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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13
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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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14
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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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15
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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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16
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Homen D, Domingo-Johnson EL, Helm JM, Schalow M, Zumwalt M. Triceps Tendon Rupture - A Novel Repair of an Uncommon Injury. J Orthop Case Rep 2020; 10:35-39. [PMID: 32953652 PMCID: PMC7476698 DOI: 10.13107/jocr.2020.v10.i02.1686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Triceps tendon rupture is a rare injury accounting for <1% of all tendon injuries with varying repair techniques described. We present this novel repair to supplement available literature and help optimize the clinical outcomes for affected patients. We report this technique because it is unique in that we augmented our surgical fixation with a subtle variation in the described technique by repairing the deep portion of the triceps tendon as a separate step, maximizing the recreation of the anatomic footprint of the triceps. Case Report The patient is a 70-year-old Caucasian male presenting with pain, swelling, and ecchymosis around the elbow after the episode of injury. He also complained of a painful popping sensation whenever he ranged the elbow and an inability to extend, with pain and weakness any time he attempted elbow extension. Radiographs reviewed at his initial visit revealed a small osseous fragment approximately 5 cm proximal to the olecranon tip. Subsequent MR imaging confirmed our suspicion, showing a complete tear of the triceps tendon with hematoma at its insertion site and tendon retraction approximately 3 cm proximally. With the diagnosis of triceps tendon rupture conformed, we took the patient for primary tendon repair using suture with bone bridge and suture anchor, using elements from described techniques. Our technique was unique in that we performed repair of the deep and superficial triceps attachments as separate steps, in an endeavor to improve the anatomic reconstruction of the footprint and biomechanical strength. Conclusions We combined findings from our review of the available literature with novel surgical techniques and suture design to maximize the patient outcome and minimize complications. The patient went on to have a very satisfactory functional recovery. We hope that this case report will complement the evidence-based care of these patients by orthopedic surgeons and lead to the best results possible.
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Affiliation(s)
- Dylan Homen
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center (TTUHSC), 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
| | - E L Domingo-Johnson
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center (TTUHSC), 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
| | - J Matthew Helm
- Department of Medicine, Texas Tech University Health Sciences Center School of Medicine, 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
| | - Melinda Schalow
- Department of Orthopaedic Surgery, Medical Office Bldg. 4102 24th St. Suite 407, Lubbock, Texas 79410, United States
| | - Mimi Zumwalt
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center (TTUHSC), 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
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Freislederer F, Papillo D, Glanzmann M, Scheibel M. Distale Bizepssehnen- und Trizepssehnenrupturen. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 158:663-682. [DOI: 10.1055/a-0999-8250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ZusammenfassungRupturen der distalen Bizeps- und Trizepssehne sind selten, treten jedoch gehäuft bei männlichen, sportlichen und körperlich schwer arbeitenden Patienten auf. Dieser Übersichtsartikel beschreibt Ätiologie und Pathogenese sowie Diagnostik, Behandlungsmöglichkeiten, das zu erwartende Outcome dieser Verletzungen und gibt Einblicke in das eigene Vorgehen.
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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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19
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Gaviria M, Ren B, Brown SM, McCluskey LC, Savoie FH, Mulcahey MK. Triceps Tendon Ruptures: Risk Factors, Treatment, and Rehabilitation. JBJS Rev 2020; 8:e0172. [PMID: 32539261 DOI: 10.2106/jbjs.rvw.19.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Triceps tendon ruptures (TTRs) are rare and often occur as a result of falling on an outstretched hand, forceful eccentric contraction, direct trauma to the elbow, or lifting against resistance. TTRs are most commonly seen in middle-aged men, football players, and weightlifters. Radiography, ultrasonography, and magnetic resonance imaging may be utilized for diagnosis and to guide treatment. Acute partial TTRs may have good outcomes with nonoperative management. Surgery should be considered if nonoperative treatment is unsuccessful or if substantial musculotendinous retraction is present. Surgical repair is strongly recommended for complete TTRs.
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Affiliation(s)
- Manuela Gaviria
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Beth Ren
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Symone M Brown
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Leland C McCluskey
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Felix H Savoie
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
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20
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Ding BTK, Decruz J, Kunnasegaran R. Time-sensitive ambulatory orthopaedic soft-tissue surgery paradigms during the COVID-19 pandemic. INTERNATIONAL ORTHOPAEDICS 2020; 44:1531-1538. [PMID: 32409911 PMCID: PMC7225011 DOI: 10.1007/s00264-020-04606-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 12/17/2022]
Abstract
Purpose Timing of surgery for orthopaedic injuries continues to evolve, as an improved understanding of biology, healing, and technological advances continues to challenge historical norms. With the growing COVID-19 pandemic stretching limited healthcare resources, postponing surgery becomes an inevitable and unenviable task for most orthopaedic surgeons, and a shift in outpatient paradigms is required to mitigate poor outcomes in patients. Methods A scoping review of five databases on surgical timing and orthopaedic soft-tissue injuries was performed. All randomized controlled trials, longitudinal cohort studies, retrospective case series, systematic reviews, meta-analyses, and expert opinions were included for review, with 65 studies meeting the inclusion criteria. Results Better outcomes appear to be associated with early surgery for subluxations (< 1 week), recurrent dislocations (> 2 episodes), ligamentous and tendinous injuries (< 2 weeks), and bony avulsion injuries (< 3 weeks). Spinal conditions with neurological compromise should be operated on within 24 hours and spinal instability within 72 hours to reduce the risk of complications and poor outcomes. Conclusion Most soft-tissue orthopaedic injuries can be managed with outpatient ambulatory surgery in a semi-elective setting. As the paradigm for outpatient surgery shifts due to technological advances and the COVID-19 pandemic, it is critical for surgeons to time their surgery appropriately to maintain the high standards of orthopaedic practice.
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Affiliation(s)
- Benjamin Tze Keong Ding
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, S308433, Singapore.
| | - Joshua Decruz
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, S308433, Singapore
| | - Remesh Kunnasegaran
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, S308433, Singapore
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21
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Vannabouathong C, Ayeni OR, Bhandari M. A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118809050. [PMID: 30450008 PMCID: PMC6236480 DOI: 10.1177/1179544118809050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/16/2018] [Indexed: 11/15/2022]
Abstract
Avulsion fractures compromise function and movement at the affected joint. If
left untreated, it can lead to deformity, nonunion, malunion, pain, and
disability. The purpose of this review was to identify and describe the
epidemiology and available treatment options for common avulsion fractures of
the upper and lower extremities. Current evidence suggests that optimal
treatment is dependent on the severity of the fracture. Conservative efforts
generally include casting or splinting with a period of immobilization. Surgery
is typically indicated for more severe cases or if nonoperative treatments fail;
patient demographics or preferences and surgeon experience may also play a role
in decision making. Some avulsion fractures can be surgically managed with any
one of various techniques, each with their own pros and cons, and often there is
no clear consensus on choosing one technique over another; however, there is
some research suggesting that screw fixation, when possible, may offer the best
stability and compression at the fracture site and earlier mobilization and
return to function. Physicians should be mindful of the potential complications
associated with each intervention.
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Affiliation(s)
| | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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22
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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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23
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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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